STDS Chapter 8

1. HAPPY VALENTINE’S DAY Love … Very Carefully!!!

3. STDs or STIs • Bacterial or viral diseases that are sexually transmitted through genital/oral/anal contact but also other conduits • Bacterial STIs: • can be cured if caught early • Viral: • can NOT be cured

4. STDs or STIs • Difference between most common reportable STI and most common STI • not all STIs are required to be reported • Many if not most (depending on disease and gender) are ASYMPTOMATIC • So: can transmit unknowingly

5. STDs or STIs • Most Common: • HPV human papilloma virus (warts) • HPV: • over 100 different strains • cauliflower-like warts in vulva, vagina, penis, pubic area and anus but can be asymptomatic • leads to cervical cancer • can cause penile and anal cancer • 100 MUN female students a year have precancerous changes due to HPV • birth control pill interaction • hormones in contraceptive promotes changes in cervical cells that make it more vulnerable (squamous cells)

6. STDs or STIs • HPV (Cont’d): • smoking interaction: • nicotine metabolites increase cervical cancer risk • early sex (13-15) is a risk factor • multiple partners, also a risk factor • effect of alcohol and drugs: • weaken immune system, impair judgment of risk • condoms not effective in protecting against HPV: • warts can be in areas other than penis, e.g. pubic area, anus • no cure • 20-33% people have it – some studies report almost 100% incidence but strong immune system can fight it off

7. STDs or STIs HPV (Cont’d): • A new vaccine for HPV prevention is available since July ’06 • the vaccine prevents four strains of HPV, which happen to be the ones that most commonly (70%) cause cervical cancer. The recommendation is to vaccinate girls between ages 9 and 14, before they become sexually active. Girls chosen due to cervical cancer risk • New study (Feb. ’08): HPV causes oral cancer in men via oral sex, rivaling oral cancers due to tobacco and alcohol. Vaccine currently being tested in men

8. STDs or STIs • Chlamydia: • most common reportable STI in Canada • decrease since 90’s but still very high • more in women, but less reporting from men • age 15-24 women highest rate • 75% women asymptomatic until it spreads to uterus • damage to: • cervix • uterus • fallopian tubes • peritoneum • liver

9. STDs or STIs • Chlamydia (Cont’d): • causes: • PID • tubal blockage • ectopic pregnancies • infertility • prematurity and low birth weight

10. STDs or STIs • Chlamydia (Cont’d): • males: • 50% asymptomatic • 50% have urethral discharge • burning urination • epididymitis • infertility • Reiter’s syndrome (conjunctivitis and arthritis) • if having anal sex: • proctitis and proctocolitis

11. STDs or STIs • Genital Herpes: • children of mothers with GH Type II have higher rates of schizophrenia (preliminary study) or other psychoses. Correlational data. • Caused by herpes simplex virus, Type I (cold sores) and Type II – both cause the STI • Most are asymptomatic: • if symptomatic: small, painful blisters on genitals • also, fever, painful urination, headaches

12. STDs or STIs • Genital Herpes (Cont’d): • These symptoms last 3 weeks, then virus goes dormant, but still contagious. Symptoms may recur randomly • Pregnant women can transfer to fetus, can lead to fatal brain infection • No cure, some antiviral drugs lessen severity of symptoms and shorten the outbreak but always contagious • Long term: can lead to meningitis, narrowed urethra, increased HIV infection, genital scarring • No cure

13. STDs or STIs • Hepatitis: • Viral disease of the liver. • Types A, B, C, D, E. • Type B most common STI. • Next is Type C.

14. STDs or STIs • Hepatitis (Cont’d): • Hep B: • Through blood, saliva, semen, vaginal secretion, other body fluids, IV drugs, piercing, tatoos. • Symptoms: • Enlarged liver, fever, fatigue, jaundice, vomiting. But some asymptomatic. No cure, can lead to liver degeneration and death. • Liver cirrhosis, cancer: • Second leading cause of cancer world-wide (after smoking). • But – there is a vaccine: prevention. • 200 times more common than HIV.

15. STDs or STIs • Hepatitis (Cont’d): • Hep C: • Can also lead to liver cirrhosis and cancer of the liver. Found in users of IV drugs, nasal coke, tattoos and piercings. Also contaminated water.

16. STDs or STIs • HIV: • Human Immunodeficiency Virus • HIV/AIDS: • By December ’03 almost 20,000 in Canada reported cases. • 67% had died. • AIDS: • Acquired Immune Deficiency Syndrome • Estimate (2003): 56,000 Canadians live with HIV. One third not aware. • Worldwide: 40 million have HIV (estimate)

17. STDs or STIs • AIDS (Cont’d): • Transmission: • body fluids (not saliva) • sex (penis/vagina or penis/anus) • contaminated blood • hypodermic needles • during pregnancy and childbirth • Condoms 87% effective for HIV • No cure but effective treatments make it a chronic illness • Recent studies: health problems of HIV/AIDS patients in middle/old age

18. STDs or STIs • TRICHOMONIASIS: • Caused by neither bacterium nor virus. • Trichomonas vaginalis: • single cell protozoan, a parasite that attaches to vaginal cells. • transmitted mostly through sex, but the organism can survive for some time on toilet seats and other surfaces. • more common in women, very widespread (8,000,000 in North America, 170 million worldwide).

19. STDs or STIs • TRICHOMONIASIS (Cont’d): • Men are asymptomatic, 50% women have symptoms: • vaginal itch • smelly (fishy), frothy vaginal discharge • Can cause: • PID • increased female vulnerability to HIV • people with HIV transmit it more easily if they have trichomoniasis • in pregnancy, premature birth and/or low birth weight • Treatment: • Flagyl (metronidazole)

20. LYMPHOGRANULOMA (LPV) • So far mostly men/men • Same type as chlamydia • Much more invasive • Through oral, vaginal, anal sex • Treatable with antibiotics • Symptoms (3-30 days): vaginal painless sore in initial phase • Low grade fever • Fatigue • Muscle and joint aches

21. STDs or STIs Safe Sex vs. safER sex • Two monogamous people who have tested negative for STIs or have never had any sexual contact before. • Issue of trust.