STDs and HIV

STDS and HIV South Shore High School Health Fair Dr. Chinwe Chukwurah Anupama Gowda, Aqeel Muhammad, Vikram Durairat Jackson Park Hospital 7531 S. Stony Island Ave. Chicago, IL 60649

MISCONCEPTIONS You can’t get pregnant if it’s your first time. Jumping up and down immediately after intercourse will prevent contraception. Douching with Coca-Cola or 7-up will kill whatever sperm the process doesn’t wash away. It’s impossible to get pregnant if you have sex during your period. After intercourse, a hot bath or heating pad on the stomach prevents conception. As long as neither party takes off their underpants, no babies will result. Taking 20 Aspirin right after will halt conception from taking place. Provided you do it standing up or with the girl on top, the sperm will never reach the egg. As long as he pulls out before he ejaculates, no sperm will be loosed inside the girl. Sneezing after sex prevents pregnancy . Oh yes you can. The bottom line: if the girl is ovulating at the time of her first experience with intercourse, and / or her first ovulation is at the same time as her first intercourse, she can be buying diapers and being a MOM. The average ejaculate contains 300 million sperm and each of them is doing their best to swim towards the uterus…and they are intent on fulfilling their purpose. The only thing that will happen by using these “chemicals” is a yeast infection. There are NO safe days. It takes a large amount of heat to “zap” a small amount of sperm. If this was true, condoms would be made of cotton. Simply put.. the sperm have a job to do.. There is no “magic bullet” in preventing pregnancy. Gravity does not have a say.. force is with the sperm. Again, there are millions of sperm..

STDs are common among young people

DID YOU KNOW?... About 333 million new cases of curable sexually transmitted diseases (STDs) occur each year among young adults around the world. One in five people in the United States has an STD. One in four new STD infections occurs in teenagers. (THAT’S 3 MILLION TEENS PER YEAR) One in four people will have an STD at some point during his or her life. One in 10 teenagers knows someone who is HIV-positive. Fifty-six percent of teenagers 12 to 17 years of age think STDs are a big problem for people their age.

WHAT IS A STD? STD is a sexually-transmitted disease. It includes: Bacterial— Gonorrhea , Syphilis , and Chlamydia Viral— HIV , HPV (can cause genital warts), Herpes, and Hepatitis B

SYMPTOMS Some have it…. and some don’t… therefore you could be infected and NOT know it… then infect another. Can occur within days to months,… and can even show up years after the initial exposure May include: (1) Bumps or blisters near the mouth or genitals; (2) Burning or pain during urination or a bowel movement; (3) Flu-like symptoms, including fever, chills, and aches, as well as swelling in the groin area.

STDs are preventable If you engage in vaginal, anal, or ORAL sex, you can get a STD. ABSTINENCE is the BEST policy Condoms can prevent STDs IF used consistently and correctly BUT are not 100% protection.

HUMAN PAPILLOMAVIRUS (HPV) INFECTION

Genital/Venereal Warts Papillomavirus (HPV)

HPV WHAT? Group of viruses that include more than 100 different strains or types, and more than 30 are sexually transmitted. They infect the genital area of men and women including the skin of the penis, vulva (area outside of the vagina), or anus, and the linings of the vagina, cervix, or rectum. Most who become infected will not have symptoms and will clear the infection on their own.

How common? 1. Approximately 20 million people are currently infected 2. At least 50% of sexually active men and women will acquire the infection at some point of their lives 3. By age 50, at least 80% of women will have acquired genital HPV infection 4. About 6.2 million Americans will get a new genital infection each year

HPV and CERVICAL CANCER All types can cause mild PAP test abnormalities which may or may not lead to serious consequences. Approximately 10 of the 30 identified types can lead to cervical cancer. It is those women who have persistent infection with the “high-risk” types that have the main risk factor for cervical cancer.

HPV and CERVICAL CANCER A PAP TEST is the BEST indicator, along with medical follow-up, to detect pre-cancerous and cancerous cells on the cervix. AND is responsible for greatly reducing deaths from cervical cancer. HPV DNA testing —specific test for those with mild Pap test abnormalities or >30 years of age, can help health care providers decide if further tests or treatment are necessary. NO HPV tests are available for men. Most women who develop invasive cervical cancer have NOT had regular cervical cancer screening.

HPV SIGNS and SYMPTOMS Most do NOT know that they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Some may get visible genital warts or have pre-cancerous changes in the cervix, vulva, anus, or penis.

GENITAL WARTS soft, moist, pink, or flesh-colored swellings, usually in the genital area. Can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. Appear on the vulva, in or around vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all. Diagnosed by visual inspection Removed by medications that patient applies or performed by a health care provider..some choose to bypass treatment to see if the warts will disappear on their own. No treatment regimen is better than another or ideal for all cases.

PREVENTION BEST and SUREST way is to refrain from any genital contact with another individual. For those who choose to be sexually active, A long-term, mutually monogamous relationship with an un-infected partner OR Reducing the number of sexual partners AND Choosing a partner less likely to be infected Use condoms

PREVENTION Inactivated (not live) vaccine which protects against 4 major types of HPV—2 types that cause 70% of cervical cancer and 2 types that cause 90% of genital warts. Long-lasting along with regular pap smears. Routinely recommended for girls aged between 11-12 years , WHY? It’s important for the girls to get the vaccine BEFORE their first sexual contact—when they have not been exposed to HPV. Young girls as young as 9 years may receive the vaccine. If the young lady has been exposed then will not prevent the disease from that type. CATCH-UP VACCINATION—ladies between the ages of 13-26 years. Not recommended for ladies older than 26 years or for males. 3-Dose series: 1 st dose: NOW 2 nd dose: 2 months after 1 st dose 3 rd dose: 6 months after 1 st dose Who should not receive it?— anyone who has had a life-threatening allergic reaction to yeast, to any other component of HPV vaccine. Inform your doctor if you have any severe allergies. And those who are pregnant or with moderate or severe illnesses. The vaccine can cause: pain, redness, or swelling at the injection site, fever (mild or moderate), itching at the injection site.

Genital Herpes Blisters on or around the genitals or rectum. The blisters break, leaving painful ulcers (sores)

GENITAL HERPES WHAT? Caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most are caused by HSV-2. May have no or only minimal signs or symptoms—one or more blisters on or around the genitals or rectum—the blisters break, leaving tender ulcers (sores) that may take 2-4 weeks to heal the first time. Another outbreak can appear weeks or months after the first outbreak.. It can stay in the body indefinitely, and usually the number of outbreaks tends to decrease over a period of years.

Genital Herpes Affects about 50 million Americans . HSV-1 most often involves body above the waist. It causes cold sores or fever blisters. (50% of first-episode cases of genital herpes are caused by HSV-1-recurrences and subclinical shedding are much less frequent ) HSV-2 occurs most often below the waist, and causes genital herpes. Either virus will grow on the opposite spot, if carried by oral sex. Asymptomatic patients without obvious lesions can be highly infectious. Recurrences happen for many reasons, including being sick, friction from tight clothing or intercourse, emotional stress, and heat.

Differentiates between HSV-1 and HSV-2 It becomes positive in at least half of people at 3 weeks, and in 98% of people by 6 weeks.

GENITAL HERPES TREATMENT Acyclovir is the common drug prescribed for 5-10 days dependent on IF it’s for FIRST time, Episodic, or Chronic Suppression treatment. Two other drugs that could be prescribed IF Acyclovir not available include: Famciclovir and Valacyclovir. Topical therapy is NOT recommended because it has very minimal clinical benefit. Foscarnet is another drug prescribed IF there is drug resistance.

Management of Sex Partners Symptomatic sex partners should be evaluated and treated in the same manner as patients who have genital lesions. Asymptomatic sex partners of patients who have genital herpes should be questioned concerning histories of genital lesions and offered type-specific serologic testing for HSV infection.

Genital Herpes HIV Infection May have prolonged or severe episodes with extensive genital or perianal disease Episodic or suppressive antiviral therapy often beneficial For severe cases, acyclovir 5-10 mg/kg IV q 8 hours may be necessary

Genital Herpes Treatment in Pregnancy The risk for neonatal transmission is high (30%–50%) among women who acquire genital herpes in late pregnancy/near the time of delivery and is low (<1%) during the first trimester. In genital HSV during late pregnancy; acyclovir therapy vs routine cesarean section vs both. Acyclovir may be used with first episode or severe recurrent disease (Limited experience prenatal exposure to valacyclovir or famciclovir) Women without h/o genital herpes (or seronegative) should avoid intercourse during the third trimester with partners known/suspected of having genital herpes. Women without known orolabial herpes should avoid receptive oral sex during the third trimester with partners known or suspected to have orolabial herpes.

HUMAN IMMUNODEFIENCY VIRUS (HIV)

HIV Human Immunodeficiency Virus—the virus that causes AIDS. It attacks the immune system, destroying the T cells or CD4 cells. Why is this important? —The immune system helps us in fighting various infections, and the T cells are one of the main components that help our bodies in that fight. LIFE CYCLE

AIDS Acquired Immunodeficiency Syndrome Final stage of HIV infection—takes years for a person, even without treatment, to reach this stage. It means that the virus has weaken the immune system such that the body is having a difficult time in fighting infections

Changing Faces of HIV/AIDS No Longer A Disease of Gay Men And Drug Abusers

HIV TRANSMISSION Fragile virus—can NOT live for very long outside the body.. can NOT be transmitted through day-to-day activities… --Shaking hands --hugging --casual kiss --from a toilet seat --drinking fountain --doorknob --dishes --drinking glasses --food --pets --from musquitoes

It is found primarily in the blood, semen, or vaginal fluid of an infected person. Transmitted in 3 main ways: --Having sex (anal, vaginal, or oral) --Sharing needles and syringes --Being exposed (fetus or infant) to HIV before or during birth or through breast feeding. Transmitted through blood infected with HIV but since 1985, all donated blood in the United States has been tested for HIV… therefore the risk for HIV infection is extremely low. HIV TRANSMISSION

RISK FACTORS FOR HIV TRANSMISSION Injected drugs or steroids, during which equipment (needles, syringes, cotton, water) and blood were shared with others. Had unprotected vaginal, anal , or oral sex (sex without the use of condoms) with men who have sex with men, multiple partners, or anonymous partners. Exchanged sex for drugs or money Been given a diagnosis of, or been treated for, hepatitis, tuberculosis (TB), or a sexually transmitted disease (STD) such as syphillis. Received a blood transfusion or clotting factor during 1978-1985 Had unprotected sex with someone who has any of the risk factors listed above.

HIV Timeline UNTREATED NATURAL HISTORY

SYMPTOMS OF HIV The only way to know is to be tested. WHY? A person infected with HIV does not have symptoms for many years. A person can look and feel healthy but can still be infected. One quarter of the HIV-infected persons in the United States do not know that they are infected.

HIV TESTING There are many different kinds of HIV tests..including rapid tests and home test kits. When looking for a test, make sure that it is approved by the United States government. Where? —health departments, doctors’ office, hospitals, and sites specifically set up to provide HIV testing…. the clinic offers HIV testing, and it will be kept confidential .

PREVENTION OF TRANSMISSION OF HIV First and foremost,.. ABSTAIN from sex but if you must be sexually active,…(oral, vaginal, or anal)…and / or plan to have more than one partner… Use latex condoms and lubricant every time Get tested for HIV Talk about HIV and other STDs with each partner before you have sex Learn about each partner’s past behavior (sex and drug use)..consider the risks to your health before you have sex Ask your partners if they have been tested, and insist that they do… no test, no sex!! If you think that you may have been exposed to another STD (gonorrhea, syphilis, or Chlamydia), get treatment… these diseases INCREASE your risk of getting HIV. Get vaccinated against Hepatitis B virus!!

Get tested whenever you have a regular medical check-up, even IF you think that you are low risk. Do NOT inject / take illicit drugs (drugs not prescribed by your physician)…HIV can be transmitted through “dirty” needles and syringes. Plus drugs will cloud your mind which may result in riskier sex. Do NOT have sex when you are taking drugs or drinking alcohol… why? ...being high can make you more likely to take risks. PREVENTION OF TRANSMISSION OF HIV

If you do inject drugs, do the following…. Use only clean needles, syringes, and other works Never share needles, syringes, and other works Be careful not to expose yourself to another person’s blood Get tested for HIV test at least once a year Consider counseling and treatment for your drug use Get vaccinated against hepatitis A and B viruses. PREVENTION OF TRANSMISSION OF HIV

PREVENTION OF HIV A BSTINENCE B E FAITHFUL C ONDOMS

Chlamydia The most prevalent STD in the United States. ~Four million cases annually, most occurring in men and women under the age of 25 . About 1 in 6 sexually active teens are infected with chlamydia . The greater the number of sex partners, the greater the risk of infection. Can be transmitted during vaginal, anal , or oral sex. Teenage girls and young women are at high risk, why? —their cervix (opening to the uterus) is not fully matured. Direct and indirect costs of chlamydia (mainly costs for complications) total $24 billion a year. ~Half of people with chlamydia likely have gonorrhea too. Caused by a bacterium called Chlamydia trachomatis.

CHLAMYDIA TRANSMISSION AND SYMPTOMS Transmitted by heterosexual or male homosexual contact. However, infected secretions from the genitals to the hands and eventually to the eyes can cause trachoma . Known as the “silent” disease because 75% of infected women and 50% of infected men with Chlamydia are asymptomatic . If symptoms do occur, usually appear within 1-3 weeks after exposure. In women , symptoms include increased vaginal discharge, burning during urination, irritation of the area around the vagina, bleeding after sexual intercourse, lower abdominal pain, and abnormal vaginal bleeding. In men , clear, white, or yellow discharge (drip) from the urethra, burning and pain during urination, and tingling or itching sensations. Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum--causing rectal pain, discharge, or bleeding. Can be also found in the throats of men and women having oral sex with an infected partner.

COMPLICATIONS OF CHLAMYDIA IF untreated , can progress to serious reproductive and other health problems with short-term and long-term consequences…can often be “silent.” MEN Rare Infection spreads to the epididymis (tube that carries the sperm from the testis) Causes pain, fever, sterility. Can cause arthritis that is accompanied by skin lesions and inflamamation of the eye and urethra (Reiter’s syndrome). WOMEN Infection can spread to the uterus or fallopian tubes causing PID (Pelvic Inflammatory Disease), causing damage to: fallopian tubes, uterus, and surrounding tissues. Damage leads to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy. Are more likely (five times more) to become infected with HIV.

CHLAMYDIA Simple laboratory tests either from urine or collecting a specimen from the penis or cervix can easily diagnose this infection. Can be easily treated and cured with antibiotics BUT all sexual partners should be evaluated, tested, and treated. Should abstain from sexual intercourse of any kind until they and their sex partners have completed treatment, otherwise re-infection is possible. Women whose sex partners have not been treated are at high risk for re-infection …multiple infections increases a woman’s risk of serious reproductive health complications including infertility. Retesting needs to be done on women, especially adolescents, 3-4 months after treatment, especially if the woman does not know if her sex partner received treatment.

PREVENTION--CHLAMYDIA ABSTAIN or BE in a long-term mutually monogamous relationship with a partner who has been tested and known to be uninfected. Otherwise,… --Use correctly and consistently a latex male condom -- Screening is recommended annually for sexually active females 25 years and younger , and for all pregnant women -- Any genital symptoms (discharge or burning during urination or unusual sore or rash) should be a signal to stop having sex and to consult a health care provider immediately. --Inform ALL sex partners to be tested and treated. -- NO SEX UNTIL TREATMENT IS COMPLETE .

GONORRHEA WHAT? Bacterium that grows and multiplies easily in the warm, moist areas of the reproductive tract including the cervix, uterus, and fallopian tubes in women; and the urethra in women and men. Can also grow in the mouth, throat, eyes, and anus. TRANSMITTED by? Through contact with the penis, vagina, mouth, or anus. Ejaculation does NOT have to occur.. Can be spread from mother to baby during delivery. And a person who had it and been treated.. can be re-infected IF they have sexual contact with a person infected with gonorrhea.

Caused by a bacterium Neisseria gonorrhoeae Gonorrhea Males usually experience pain while urinating, and they may have a yellow-green discharge from the penis Females may experience a vaginal discharge and/or have pelvic or abdominal pain

GONORRHEA SIGNS AND SYMPTOMS Men —usually will have NO symptoms BUT if they do: --can be from 5 to 30 days to appear -- Include : burning sensation when urinating, or a white, yellow, or green discharge from penis. --can get painful or swollen penis. WOMEN —usually mild but also with NO symptoms -- BUT if they do, usually are non-specific and can be mistaken for a vaginal or bladder infection. -- Initially, painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. --Are at risk of developing serious complications regardless of the presence or severity of symptoms. Symptoms of rectal infection in both men and women—discharge, anal itching, soreness, bleeding, or painful bowel movements. OR it could cause NO symptoms. Infections in the throat may cause a sore throat BUT usually causes NO symptoms. Swollen testicles or epididymitis

COMPLICATIONS--GONORRHEA IF left untreated , women can develop PID and usually do not have symptoms… When symptoms are present, can be very severe and includes abdominal pain and fever. PID can lead to internal abscesses, and long-lasting, chronic pelvic pain; can damage the fallopian tubes to cause infertility or increase the risk of ectopic pregnancy.

COMPLICATIONS--GONORRHEA For men, epididymitis can occur.. Can spread to the blood or to the joints, could be life- threatening. Those infected with gonorrhea can easily acquire HIV, and HIV-infected people with gonorrhea more likely to transmit HIV to someone else

GONORRHEA DIAGNOSIS and TREATMENT Simple laboratory tests available for diagnosis --sample taken from infected area (cervix, urethra, rectum, or throat) --sent to lab for analysis Urine sample can be taken IF the gonorrhea is present in the cervix or urethra GRAM’S STAIN —sample from the urethra or cervix seen under the microscope, usually better for men than women. There are several antibiotics available for treatment to successfully cure gonorrhea BUT… Drug-resistant strains are increasing and successful treatment is becoming difficult IF one has gonorrhea, usually they have chlamydia…antibiotics for both are given together. Persons should be tested for other STDs.

GONORRHEA CHILDREN and INFANTS Gonorrhea can also be spread from mother to baby during delivery. During childbirth, gonococci infect the eyes,throat, respiratory tract and gastrointestinal tract of the baby.

TRICHOMONIASIS Caused by a parasite called Trichomonas vaginalis Likes to “hang-out” in the vagina (women) and the urethra (men) Treated with metronidazole (prescription drug), and should be given to both partners at the same time so that they won’t re-infect each other. Can be given to pregnant women.

Trichomoniasis Some men may temporarily have an irritation inside the penis, mild discharge, or slight burning after urination or ejaculation. Women have frothy, yellow-green vaginal discharge with a strong odor, discomfort during intercourse and urination, as well as irritation and itching of the female genital area .

Syphilis Caused by the bacterium Treponema pallidum Three stages: Primary, Secondary, and Tertiary Likes to “hang-out” around the genitals, anus, and in / around the mouth. Transmitted through direct contact with a syphilis sore, occurring during vaginal, anal, or oral sex Pregnant women can pass to their fetuses unless treated before the 16 th week of pregnancy. Children born with syphilis may or may not have symptoms…IF they do have symptoms, it can be severe enough to cause brain damage and death. Treatment is with Pencillin by injection or a substitute if allergic to penicillin NO sex until the sores have completely healed.

Primary Syphilis-‘Hard’Chancre The primary ‘chancre’- a hard, highly infectious, painless sore. The lesion appears 2-4 weeks after exposure, sometimes with mild fever and swollen glands… proceeds to…

Women Who Have Sex with Women (WSW) Risk varies by the specific STD and sexual practice (e.g., oral-genital sex, vaginal or anal sex using hands, fingers, or penetrative sex items, and oral-anal sex High prevalence of BV Transmission of HPV can occur with skin-to-skin or skin-to-mucosa contact, which can occur during sex between women (13%–30%) HSV-2 genital transmission less frequent but higher risk for HSV-1 due to orogenital sex Transmission of syphilis between female sex partners, probably through oral sex, has been reported WSW who also have sex with men (53%–99%) are at risk for Chlamydia . Reports of metronidazole-resistant trichomoniasis and genotype-concordant HIV

PREVENTION A BSTINENCE B E FAITHFUL C ONDOMS

Center for Substance Abuse Treatment National Hotline: (800) 662-HELP Centers for Disease Control and Prevention Voice Information System (STD, HIV, and TB information): (800) 232-3228 Toll-free, 24 hours a day, 7 days a week National AIDS Hotline: (800) 342-AIDS (English) (800) 344-7432 (Spanish) (800) 243-7889 (TTY) Toll-free, 24 hours a day, 7 days a week TTY—10:00 a.m. to 10:00 p.m. Eastern Time, Monday through Friday National Herpes Hotline: (919) 361-8488 National HPV and Cervical Cancer Prevention Hotline: (919) 361-4848 National Institute on Drug Abuse Hotline (provides information about drug and substance abuse and referrals to treatment centers nationwide): (800) 662-4357 (English and Spanish) Toll-free, 24 hours National Planned Parenthood Hotline (provides information about area clinics providing STD diagnosis and treatment): (800) 230-7526 National STD Hotline: (800) 227-8922 English—24 hours per day, 7 days a week Spanish—8:00 a.m. to 2:00 a.m. Eastern Time, 7 days a week TTY—10:00 a.m. to 10:00 p.m. Eastern Time, Monday through Friday TEEN Line (provides peer-to-peer counseling for teens): (800) 443-8336 Toll-free, 24 hours

Word of Wisdom “ The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.” Dr. Martin Luther King, Jr.

STDs and HIV

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