Sexually Transmitted Infections and HIV Class 2015


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  • Autoinoculation is the spread of an infection from one site to another
  • Women more likely then men d/t environment in vagina – microscopic tears
    Any child with an STD should be considered a victim of sexual abuse.
    McKinney: adolescents at greater risk d/t:
    Frequent unprotected intercourse – lack knowledge of methods of preventing
    Biologically more susceptible to infection?
    Face multiple obstacles to access to health care
    Use of drugs & ETOH increases risk for unsafe & unprotected sex.
    Advocate: AAP stance “educating adolescents about sex does not increase sexual activity.”
  • STIs can be transmitted by any sexual activity between opposite-sex or same-sex partners
    Having 1 STI does not confer immunity against that one or any others
    Sexual partners need to be assessed for treatment
  • Youths and Geriatric patients may not be suspected/believed to be sexually active/promiscuous so health care provider may not screen them.
    Lower soc/economic peoples have less education concerning risk to exposures to diseases/access to medical care/Ins/money for perscriptions/other risky behaviors etoh/drugs lower good judgement ability and inhibitions
  • From Black et al, pg. 973
    High-risk sexual activity:
    Use of prostitutes
    Mult. Or casual partners, esp. w/IV drug abuse
    Unprotected sex
    Poverty: affects all socio-economic groups, cultures, ethnicities, & age groups, but poverty often prevents access to healthcare.
    “Half of all new HIV infections in the US occur among young people between the ages of 13 and 24” (AAP, 2001)
    Male homosexuals, sexually active heterosexuals, younger adolescents who are sexually active, IV drug users (McKinney et al pl 1034)
  • Sterility
    Neurologic damage
    Ophthalmic infection
    Gonorrhea (newborn innoculation, self-innoculation
  • Assess: risky behaviors leading to unwanted/planned pregnancy? Aware of STI’s? Consequences of pregnancy/single parent/care giver burden/finances/family supports?
    Abortion: neither “side” wants it used as a contraception
    You do not believe in abortion: can you be forced to care for someone who has just had one?
  • Mucosa with columnar epithelium is susceptible to G.
    Present in genitalia, rectum, and oropharynx
  • Characterized by redness and edema of cervix with discharge
    Prophylactic instillations of erythromycin (.5%) or silver nitrate to newborn’s eyes are usually implemented
  • Men
    Presumed to be infected if urethral discharge follows a sexual contact with an infected partner.
    Gram-stained discharge from penis provides certain diagnosis
    Culture of discharge from men whose smears are negative but with symptoms
    Smears and discharge do not establish diagnosis
    Female GU tract harbors organisms resembling N. gonorrhea
    Must have culture to confirm diagnosis
    Other tests:
    Nucleic acid amplification test like culture
    Testing for other STDs
  • Others
    Cefixime (Suprax)
    Levofloxacin (Levaquin)
    Ciprofloxacin (Cipro)
    Patients with coexisting syphilis are likely to be cured by same drugs
  • Gummas
    Destructive skin, bone, soft tissue nodular lesions
    Cardiovascular system
    Aneurysms, heart valve insufficiency, and heart failure
    General paresis, speech disturbances, tabes dorsalis
  • Gummas
    Destructive skin, bone, soft tissue nodular lesions
  • Scarring of aortic valve results in insufficiency and eventually failure
    Neurosyphilis causes degeneration of brain with mental deterioration. Neurologic deficits possible.
    Tabes dorsalis cause nerve involvement
  • Serological testing:
    Nonspecific antitreponemal tests – VDRL, RPR
    Specific treponemal tests – FTAaAbs, T. pallidum
  • Recurring or persistent symptoms after drug therapy are re-treated
  • Monitor neurosyphilis with periodic serologic testing, clinical evaluation, and repeat CSF exams for 3 years
  • Still underreported because infected persons are asymptomatic
  • THESE are the most common tests done:
    Nucleic acid amplification test (NAAT)
    Direct fluorescent antibody (DFA)
    Enzyme immunoassay (EIA)
    The cervical discharge tend to be be less purulent and painful in chlamydia than in gonorrhrea.
  • Chlamydial infections can be easily treated once diagnosed.
  • See Table 32-1, p. 868
  • Virus enters peripheral or autonomic nerve endings
    Ascends to sensory or autonomic nerve ganglion where it is dormant
  • Genetal herpes infections tend to be benign but some complications may be present
    Lower motor damage can lead to :
    Atonic bladder
    Autoinoculation to extragenital sites
    Lips, breasts, and fingers
    High risk of transmission in pregnancy with episode near delivery
    Active lesion is indication for cesarean section
    Herpes simplex virus keratitis - HSV infection of the eye
    Resolves within 1 to 2 weeks
    Can progress to ulcers
  • p 869
  • A member of the herpes virus family, it is mainly aquired as an infection in childhood and carried for life in a latent form.  The infection typically remains quiet until the T-lymphocyte-mediated immunity is compromised.  CMV is transmitted through blood to blood and intimate contacts and organ transplants and is found in saliva, breast milk, urine and semen.
  • Trichomoniasis can usually be cured with the prescription drug, metronidazole, given by mouth in a single dose. The symptoms of trichomoniasis in infected men may disappear within a few weeks without treatment. However, an infected man, even a man who has never had symptoms or whose symptoms have stopped, can continue to infect or re-infect a female partner until he has been treated. Therefore, both partners should be treated at the same time to eliminate the parasite. Persons being treated for trichomoniasis should avoid sex until they and their sex partners complete treatment and have no symptoms. Metronidazole can be used by pregnant women.
    Having trichomoniasis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.
    The genital inflammation caused by trichomoniasis can increase a woman's susceptibility to HIV infection if she is exposed to the virus. Having trichomoniasis may increase the chance that an HIV-infected woman passes HIV to her sex partner(s).
    The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
    Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of trichomoniasis.
    Any genital symptom such as discharge or burning during urination or an unusual sore or rash should be a signal to stop having sex and to consult a health care provider immediately. A person diagnosed with trichomoniasis (or any other STD) should receive treatment and should notify all recent sex partners so that they can see a health care provider and be treated. This reduces the risk that the sex partners will develop complications from trichomoniasis and reduces the risk that the person with trichomoniasis will become re-infected. Sex should be stopped until the person with trichomoniasis and all of his or her recent partners complete treatment for trichomoniasis and have no symptoms.
    p 869
  • Risk for infection RT lack of knowledge re mode of disease transmission, inadequate personal and genital hygiene,
    Anxiety RT impact of disease outcome and lack of knowledge of disease
    Ineffective health maintenance RT lack of knowledge re disease process, appropriate follow up measures
  • HCW have an obligation to maintain confidentiality unless there is a risk to the health or life of a third party.
  • Sexually Transmitted Infections and HIV Class 2015

    1. 1. SEXUALLY TRANSMITTED DISEASES Nelia B. Perez RN, MSN Class 2015
    2. 2. Sexually Transmitted Diseases • Infectious diseases most commonly transmitted through sexual contact • Can also be transmitted by • Blood • Blood products • Autoinoculation
    3. 3. National Health Picture on STDs • As of January 2013, the Department of Health (DOH) AIDS Registry in the Philippines reported 10,514 people living with HIV/AIDS. • Most Common in the Philippines - Chlamydia - Gonorrhea - Genital Herpes - HIV / AIDS - Syphillis - Ectoparasitic Infections
    4. 4. General Overview • Highest incidence: adolescents & young adults • Sexual abuse • Primary Prevention • Advocate for adolescent education re: sex and sexually transmitted disease. (AAP, 2001) • Abstinence • Condoms 4
    5. 5. Healthy People 2020 • Goal: Promote healthy sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases and their complications. 5
    6. 6. Factors contributing to spread • • • • Asymptomatic nature of STDs Gender disparities Age disparities Lag time between infection and complications • Social, economic and behavioral factors 6
    7. 7. Risk Factors • • • • • • • • IV drug use Other substance abuse High-risk sexual activity Younger age at beginning of sexual activity Inner city residence Poverty/lower socioeconomic status Poor nutrition Poor hygiene 7
    8. 8. • Sterility Consequences • Neurologic damage • Ophthalmic infection – other congenital problems for newborn • Cancer • Death 8
    9. 9. Unwanted Pregnancy • Negative pregnancy test: a teachable moment • Abortion • Medical • Surgical • Post op care 9
    10. 10. Gonorrhea Etiology and Pathophysiology • 2nd most frequently reported STD in US • Caused by Neisseria gonorrheae • Gram-negative bacteria • Direct physical contact with infected host • Killed by drying, heating, or washing with antiseptic • Incubation: 3-8 days
    11. 11. Gonorrhea Etiology and Pathophysiology • Elicits inflammatory process that can lead to fibrous tissue and adhesions • Can lead to : • Tubal pregnancy • Chronic pelvic pain • Infertility in women
    12. 12. Gonorrhea Clinical Manifestations • Men • Initial site of infection is urethra • Symptoms • Develop 2 to 5 days after infection • Dysuria • Profuse, purulent urethral discharge • Unusual to be asymptomatic
    13. 13. Gonococcal Urethritis Fig. 53-1
    14. 14. Gonorrhea Clinical Manifestations • Women • Mostly asymptomatic or have minor symptoms • Vaginal discharge • Dysuria • Frequency of urination
    15. 15. Gonorrhea Clinical Manifestations • Women (cont’d) • After incubation • Redness and swelling occur at site of contact • Greenish, yellow purulent exudate often develops • May develop abscess • Transmission more efficient from men to women
    16. 16. Endocervical Gonorrhea Fig. 53-2
    17. 17. Gonorrhea Clinical Manifestations • • Anorectal gonorrhea • Usually from anal intercourse • Soreness, itching, and anal discharge Orogenital • Gonoccocal pharyngitis can develop
    18. 18. Gonorrhea Complications • Men • Include prostatitis, urethral strictures, and sterility • Often seek treatment early so less likely to develop complications
    19. 19. Gonorrhea Complications • Women • Include pelvic inflammatory disease (PID), Bartholin’s abscess, ectopic pregnancy, and infertility • Usually asymptomatic so seldom seek treatment until complication are present
    20. 20. Gonorrhea Diagnostic Studies • History and physical examination • Laboratory tests • Gram-stained smear to identify organism • Culture of discharge • Nucleic acid amplification test • Testing for other STDs
    21. 21. Gonorrhea Treatment & Nursing Care • Drug therapy • Treatment generally instituted without culture results • Treatment in early stage is curative • Most common • IM dose of ceftriaxone (Rocephin)
    22. 22. Gonorrhea Treatment & Nursing Care cont’d • All sexual contacts of patients must be evaluated and treated • Patient should be counseled to abstain from sexual intercourse and alcohol during treatment • Reexamine if symptoms persist after treatment
    23. 23. Syphilis
    24. 24. Syphilis Etiology and Pathophysiology • Caused by Treponema pallidum • Spirochete bacterium • Enters the body through breaks in skin or mucous membranes • Destroyed by drying, heating or washing • May also spread via contact with lesions and sharing of needles
    25. 25. Syphilis Etiology and Pathophysiology • Incubation 10 to 90 days • Spread in utero after 10th week of pregnancy • Infected mother has a greater risk of a stillbirth or having a baby who dies shortly after birth
    26. 26. Syphilis Etiology and Pathophysiology • Association with HIV • Syphilitic lesions on the genitals enhance HIV transmission • Evaluation includes testing for HIV with patient’s consent
    27. 27. Syphilis Clinical Manifestations • Variety of signs/symptoms that can mimic other disease • Primary stage • Chancres appear • Painless indurated lesions • Occur 10 to 90 days after inoculation • Lasting 3 to 6 weeks
    28. 28. Primary Syphilitic Chancre Fig. 53-4
    29. 29. Syphilis Clinical Manifestations • Secondary stage • Systemic • • • • • • Begins a few weeks after chancres Blood-borne bacteria spread to all major organ systems Flu-like symptoms Bilateral symmetric rash Mucous patches Condylomata lata
    30. 30. Secondary Syphilis Fig. 53-5
    31. 31. Syphilis Clinical Manifestations • Latent or hidden stage • Immune system is suppressing infection • No signs/symptoms at this time • Diagnosed by positive specific treponema antibody test for syphilis with normal cerebrospinal fluid
    32. 32. Syphilis Clinical Manifestations • Tertiary or late stage • Manifestations rare • Significant morbidity/mortality rates • Gummas • Cardiovascular system • Neurosyphilis
    33. 33. Syphilis Complications • Occur mostly in late syphilis • Irreparable damage to bone, liver, or skin from gummas • Pain from pressure on structures such as intercostal nerves by aneurysms
    34. 34. Syphilis Complications • • • • • Scarring of aortic valve Neurosyphilis Tabes dorsalis Sudden attacks of pain Loss of vision and sense of position
    35. 35. Syphilis Diagnostic Studies • History including sexual history • PE • Examine lesions • Note signs/symptoms • Dark-field microscopy • Serologic testing • Testing for other STDs
    36. 36. Syphilis Treatment & Nursing Care • Drug therapy • Benzathine penicillin G (Bicillin) • Aqueous procaine penicillin G
    37. 37. Syphilis Treatment & Nursing Care cont’d • • • • Monitor neurosyphilis Confidential counseling and HIV testing Case finding Surveillance
    38. 38. Chlamydial Infections Etiology and Pathophysiology • #1 reported STD in US • Caused by Chlamydia trachomatis • Gram-negative bacteria • Transmitted during vaginal, anal, or oral sex • Incubation period: 1 to 3 weeks
    39. 39. Chlamydial Infections Etiology and Pathophysiology • Risk factors • • • • • Women and adolescents New or multiple sexual partners History of STDs and cervical ectopy Coexisting STDs Inconsistent/incorrect use of condoms
    40. 40. Chlamydial Infections Clinical Manifestations • “Silent disease” • Symptoms may be absent or minor • Infection often not diagnosed until complications appear
    41. 41. Chlamydial Infections Clinical Manifestations • Men • Urethritis • Dysuria • Urethral discharge • Proctitis • Rectal discharge • Pain during defecation
    42. 42. Chlamydial Infections Clinical Manifestations • Men (cont’d) • Epididymitis • Unilateral scrotal pain • Swelling • Tenderness • Fever • Possible infertility and reactive arthritis
    43. 43. Chlamydial Infection Fig. 53-6
    44. 44. Chlamydial Infections Clinical Manifestations • Women • Cervicitis • Mucopurulent discharge • Hypertrophic ectopy • Urethritis • Dysuria • Frequent urination • Pyuria
    45. 45. Chlamydial Infections Clinical Manifestations • Women (cont’d) • Bartholinitis • Purulent exudate • Perihepatitis • Fever, nausea, vomiting, right upper quadrant pain
    46. 46. Chlamydial Infections Clinical Manifestations • Women (cont’d) • PID • Abdominal pain, nausea, vomiting, fever, malaise, abnormal vaginal bleeding, menstrual abnormalities • Can lead to chronic pain and infertility
    47. 47. Chlamydial Infections Diagnostic Studies • Laboratory tests • Nucleic acid amplification test (NAAT) • Direct fluorescent antibody (DFA) • Enzyme immunoassay (EIA) • Testing for other STDs • Culture for chlamydia
    48. 48. Chlamydial Infections Treatment & Nursing Care • Drug therapy • Doxycycline (Vibramycin) • 100 mg BID for 7 days • Azithromycin (Zithromax) • 1 g in single dose • Alternatives include erythromycin, ofloxacin (Floxin), or levofloxacin (Levaquin)
    49. 49. Chlamydial Infections Treatment & Nursing Care cont’d • Abstinence from sexual intercourse for 7 days after treatment • Follow-up care for persistent symptoms • Treatment of partners • Encourage use of condoms
    50. 50. Chlamydia • Prevention: limit the number of sexual partner & use condoms & spermicides What are the Nursing Implications?
    51. 51. Genital Herpes • Not a reportable disease in most states • True incidence difficult to determine • Caused by herpes simplex virus (HSV)
    52. 52. Genital Herpes Etiology and Pathophysiology • Enters through mucous membranes or breaks in the skin during contact with infected persons • HSV reproduces inside cell and spreads to surrounding cells
    53. 53. Genital Herpes Etiology and Pathophysiology • Two different strains • HSV-1 • Causes infection above the waist • HSV-2 • Frequently infects genital tract and perineum • Either strain can cause disease on mouth or genitals
    54. 54. Genital Herpes Clinical Manifestations • Primary (initial) episode • Burning or tingling at site • Small vesicular lesion appear on penis, scrotum, vulva, perineum, perianal areas, vagina, or cervix
    55. 55. Genital Herpes Clinical Manifestations • Primary (initial) episode (cont’d) • Primary lesions present for 17 to 20 days • New lesions sometimes continue to develop for 6 weeks • Lesions heal spontaneously
    56. 56. Genital Herpes Clinical Manifestations • Recurrent genital herpes • Occurs in 50% to 80% in following year • Triggers • Stress • Fatigue • Sunburn • Menses
    57. 57. Genital Herpes Clinical Manifestations • Recurrent genital herpes (cont’d) • Prodromal symptoms of tingling, burning, itching at lesion site • Lesions heal within 8 to 12 days • With time, lesions will occur less frequently
    58. 58. Genital Herpes Complications • Aseptic meningitis • Lower neuron damage • Autoinoculation to extragenital sites • High risk of transmission in pregnancy with episode near delivery • Herpes simplex virus keratitis
    59. 59. Autoinoculation of Herpes Simplex Virus Fig. 53-8
    60. 60. Genital Herpes Diagnostic Studies • History and physical examination • Viral isolation by tissue culture • Antibody assay for specific HSV viral type
    61. 61. Genital Herpes Treatment & Nursing Care • Drug therapy • Inhibit viral replication • Suppress frequent recurrences • Acyclovir (Zovirax) • Valacyclovir (Valtrex) • Famciclovir (Famvir) • Not a cure but shorten duration, healing time and reduce outbreaks
    62. 62. Genital Herpes Treatment & Nursing Care cont’d • Symptomatic care • • • • • • • Genital hygiene Loose-fitting cotton underwear Lesions clean and dry Sitz baths Barrier methods during sexual activity Drying agents Pain: dilute urine with water, local anesthetic
    63. 63. Genital Herpes • Treatment: use Betadine on lesions to dry & prevent secondary infections, however, Acyclovir (Zovirax) eases symptoms & lessens reoccurrence but is not a cure • If Untreated: in fetus/newborns there is a risk of spontaneous abortion; neonatal herpes; mental retardation, death • Prevention: limit number of sexual partners and using condoms & spermicidal foam may reduce transmission Nursing Implications?
    64. 64. Genital Warts • Most common STD in the US • Often asymtomatic so patient maybe unaware of infection • Caused by human papillomavirus (HPV) • Usually types 6 and 11 • Highly contagious • Frequently seen in young, sexually active adults
    65. 65. Genital Warts Etiology and Pathophysiology • Minor trauma causes abrasions for HPV to enter and proliferate into warts • Epithelial cells infected undergo transformation and proliferation to form a warty growth • Incubation period 3 to 4 months
    66. 66. Genital Warts Clinical Manifestations • Discrete single or multiple growths • White to gray and pink-fleshed colored • May form large cauliflower-like masses
    67. 67. Genital Warts Clinical Manifestations • Warts in men: penis, scrotum, around anus, in urethra • Warts in women: vulva, vagina, cervix • Can have itching with anogenital warts & bleeding on defecation with anal warts
    68. 68. Genital Warts Diagnostic Studies • Serologic and cytologic tests • HPV DNA test to determine if women with abnormal Pap test results need follow-up • Identify women who are infected with high-risk HPV strains
    69. 69. Genital Warts Diagnostic Studies • Primary goal: Removal of symptomatic warts • Removal may or may not decrease infectivity • Difficult to treat • Often require multiple office visits and variety of treatment modalities
    70. 70. Genital Warts Treatment & Nursing Care • Chemical • Trichloroacetic acid (TCA) • Bichloroacetic acid (BCA) • Podophyllin resin • For small external genital warts • Patient managed • Podofilox (Condylox.Condylox gel0 • Imiquimod (Aldara) • Immune response modifier
    71. 71. Genital Warts Treatment & Nursing cont’d • If warts do not regress with previously mentioned therapies • Cryotherapy with liquid nitrogen • Electrocautery • Laser therapy • Use of α-interferon • Surgical excision
    72. 72. Genital Warts Treatment & Nursing Care cont’d • Recurrences and reinfection possible • Careful long-term follow-up advised • Vaccine to prevent cervical cancer, precancerous genital lesion, and genital warts due to HPV
    73. 73. CMV - Cytomegalovirus • Found is saliva, urine, semen, and vaginal secretions • symptoms include pharyngitis, malaise, fever and lymphadenopathy, heterophil antibody negative, blood smears may show atypical lymphocytes • may be fatal to those patients with AIDS
    74. 74. CMV • Treatment: most resolve spontaneoulsy • therapy is often required for immunosuppressed patients • Ganciclovir
    75. 75. Trichomoniasis • Symptoms: • Most men with trichomoniasis do not have signs or symptoms; • some men may temporarily have an irritation inside the penis, mild discharge, or slight burning after urination or ejaculation.
    76. 76. Trichomoniasis • Symptoms • frothy, yellow-green vaginal discharge with a strong odor • discomfort during intercourse and urination, • irritation and itching of the female genital area. • lower abdominal pain • Incubation: 4 to 10 days
    77. 77. Trichomoniasis • Organism: Trichomoniasis is caused by the singlecelled protozoan parasite, Trichomonas vaginalis.
    78. 78. Trichomoniasis • Infectivity: The vagina is the most common site of infection in women, and the urethra (urine canal) is the most common site of infection in men. • The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva (the genital area outside the vagina) contact with an infected partner. • Women can acquire the disease from infected men or women, but men usually contract it only from infected women.
    79. 79. Trichomoniasis • Treatment: Trichomoniasis can usually be cured with the prescription drug, metronidazole, given by mouth in a single dose. • If Untreated: increases a woman's susceptibility to HIV infection if she is exposed to the virus. • Pregnant women with trichomoniasis may have babies who are born early or with low birth weight (less than five pounds). • Prevention: limit number of sexual partners and using condoms & spermicidal foam may reduce transmission Nursing Implications?
    80. 80. Nursing Care : STD Nursing Diagnoses • Risk for infection RT ? • Anxiety RT ? • Ineffective health maintenance RT ?
    81. 81. Ethical/Legal Implications • In your opinion, what is the best way to balance the needs of an individual patient with STD with those of the general public?
    83. 83. Means of transmission • Of the 10,514 HIV positive cases reported from 1984 to 2013, 92% (9,637) were infected through sexual contact, 4% (420) through needle sharing among injecting drug users, 1% (59) through mother-to-child transmission, <1% (20) through blood transfusion and needle prick injury <1% (3). No data is available for 4% (375) of the cases.
    84. 84. • Cumulative data shows 33% (3,147) were infected through heterosexual contact, 41% (3,956) through homosexual contact, and 26% (2,534) through bisexual contact. • From 2007 there has been a shift in the predominant trend of sexual transmission from heterosexual contact (20%) to males having sex with other males (80%)
    85. 85. • Overseas workers from the Philippines (e.g., seafarers, domestic helpers, etc.) account for about 20 percent of all HIV/AIDS cases in the country.
    86. 86. HIV (Human Immunodeficiency Virus) AIDS (Acquired Immunity Deficiency Syndrome) • HIV is NOT the same as having AIDS, it is only the virus that causes AIDS. • Currently there is NO cure but drug therapies "show great promise in managing HIV infection". • "HIV infected people are healthy and do not realize they have been infected. HIV primarily infects certain white blood cells that manage the operation of the immune system.
    87. 87. HIV (Human Immunodeficiency Virus) AIDS (Acquired Immunity Deficiency Syndrome) • Eventually, the virus can disable the immune system, leaving the person with HIV infection vulnerable to a number of life-threatening illnesses. • People who have HIV infection may not have symptoms for many years, especially if they receive good medical care and effective therapies" (American College Health Association [ACHA] , 2001).
    88. 88. HIV (Human Immunodeficiency Virus) AIDS (Acquired Immunity Deficiency Syndrome) • "When symptoms do develop, they are usually similar at first to those of common minor illnesses, such as the "flu", except that they last longer and are more severe. • Persistent tiredness, unexplained fevers, recurring night sweats, prolonged enlargement of the lymph nodes, and weight loss are all common.
    89. 89. HIV (Human Immunodeficiency Virus) AIDS (Acquired Immunity Deficiency Syndrome) • People with HIV infection can transmit the virus to others - even if they have no symptoms and even if they do not know they have been infected. • HIV can be transmitted (1) by sexual contact (anal, vaginal, & oral); (2) by direct exposure to infected blood; and (3) from an HIVinfected woman to her fetus during pregnancy or childbirth, or to her infant during breastfeeding" (ACHA, 2001).
    90. 90. HIV (Human Immunodeficiency Virus) AIDS (Acquired Immunity Deficiency Syndrome) • Prevention: • "make careful choices about sexual activity, • communicate assertively with your sexual partner and negotiate for safer sexual practices, • remove alcohol and drugs from sexual activity," and • "use latex condoms for intercourse" (ACHA, 2001).