Current Overview of Sexually Transmitted Diseases (STDs)

1. Current Overview of Sexually Transmitted Diseases (STDs) Nicole Perry Concordia University Nebraska

2. What is the difference between a STI and a STD? • STI: Sexually transmitted infection • STD: Sexually transmitted disease

3. Common STDs • Bacterial diseases • Chlamydia (CT) • Gonorrhea (GC) • Syphilis • Viral diseases • Human Papillomavirus (HPV) • Genital herpes (HSV-2 or HSV-1) • Hepatitis B

4. Common STDsEstimated U.S. Annual Incidences • Human Papillomavirus: 5.5 million • Trichomoniasis: 5 million • Chlamydia: 3 million • Genital herpes: 1 million • Gonorrhea: 650,000 • Hepatitis B: 120,000 • Syphilis: 70,000

5. Chlamydia Infection • Most common reportable disease in the U.S. • Estimated 3million cases annually • Incidence is highest among sexually active adolescents and young adults • Most infections are asymptomatic • Leading cause of preventable infertility in women • Direct and indirect costs estimated at $1.7 billion annually

6. Chlamydia — Rates by state: U.S. and outlying areas, 2002

7. Chlamydia Age- and sex-specific rates: U.S., 2002

8. Chlamydia Infection

9. Signs and symptoms Chlamydia may be difficult for you to detect because early-stage infections often cause few or no signs and symptoms. When they do occur, they usually start one to three weeks after you've been exposed to chlamydia. Even when signs and symptoms do occur, they're often mild and passing, making them easy to overlook. Signs and symptoms may include: • Painful urination • Lower abdominal pain • Vaginal discharge in women • Discharge from the penis in men • Pain during sexual intercourse in women • Testicular pain in men

10. Chlamydia: KEY POINTS • Most common bacterial (curable) STD in the U.S. • Most cases in women and men give no symptoms • Leading cause of PID and infertility in women • All sexually active women 25 y.o.a. and younger should be tested at least annually

11. Gonorrhea Infection • Caused by Neisseria gonorrhoeae • Overall rates falling, but incidence in certain groups remains high • Most common in young adults and adolescents • CT co-infection of GC cases remains at about 40% • Resistance to medication is an spreading problem

12. Gonorrhea Rates by stateU.S. and outlying areas, 2002

13. GonorrheaAge- and sex-specific rates: U.S.

14. Gonorrhea InfectionsClinical Manifestations

15. Signs and symptoms The first gonorrhea symptoms generally appear within two to 10 days after exposure. However, some people may be infected for months before signs or symptoms occur. Signs and symptoms of gonorrhea may include: • Thick, cloudy or bloody discharge from the penis or vagina • Pain or burning sensation when urinating • Abnormal menstrual bleeding • Painful, swollen testicles • Painful bowel movements • Anal itching

16. Gonorrhea: KEY POINTS • Second most common bacterial (curable) STD in the U.S. • Concentrations of infection in MSM in urban areas • Resistance to medications is a spreading problem

17. Syphilis • Incidence had been steadily declining in the U.S. since 1990 • 28 U.S. counties account for 50% of the reported cases • In 2005, the CDC initiated a nation-wide Syphilis Elimination Effort, targeting these areas • Recently, local outbreaks centered in urban areas among MSM

18. Primary and Secondary SyphilisRates by state: U.S. and outlying areas, 2002 Note: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 2.5 per 100,000 population. The Healthy People 2010 objective is 0.2 case per 100,000 population.

19. Primary and Secondary SyphilisAge- and sex-specific rates: U.S., 2002

20. Regional Syphilis Hotspots • Higher endemic levels in rural South and Phoenix, AZ • Outbreaks among MSM in many urban areas • SF, LA, Denver, NY, Chicago, District of Columbia, Miami

21. Signs and symptoms Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms don't always occur in the same order. You may be infected with syphilis and not notice any symptoms for years. Primary syphilisThe first sign of syphilis is a small sore, called a chancre (SHANG-kur). The sore appears at the spot where the bacteria entered your body. While most people infected with syphilis develop only one chancre, some people develop several of them. The chancre usually develops about three weeks after exposure. Many people who have syphilis don't notice the chancre because it's usually painless and it may be hidden within the vagina or rectum. The chancre will heal on its own within six weeks.

22. Signs and symptoms cont... • Secondary syphilisWithin a few weeks of the original chancre healing, you may experience a rash that begins on your trunk but eventually covers your entire body — even the palms of your hands and the soles of your feet. This rash is usually not itchy and may be accompanied by wart-like sores in the mouth or genital area. Some people also experience muscle aches, fever, sore throat and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year. • Latent syphilisIf you aren't treated for syphilis, the disease moves from the secondary to the latent (hidden) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary (third) stage.

23. Signs and symptoms Cont… • Tertiary or late syphilisAbout 15 to 30 percent of people infected with syphilis who don't get treatment will develop complications known as tertiary, or late, syphilis. In the late stages, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection. • Congenital syphilisBabies born to women who have syphilis can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet. Later symptoms may include deafness, teeth deformities and saddle nose — where the bridge of the nose collapses.

24. Primary Syphilis Photos: Dr. Joseph Engelman, San Francisco City Clinic

25. Rash of Secondary Syphilis

26. Syphilis: KEY POINTS • Serious systemic infection • Many different stages of Syphilis all with different symptoms

27. Genital Herpes • Caused by Herpes Simplex Viruses • HSV 1: orolabial herpes • Cold Sores • HSV 2: genital herpes • Both symptomatic & asymptomatic infections are common • Can cause serious complications

28. Signs and symptoms • Most people do not get or recognize symptoms • Any of the following symptoms of a genital HSV infection can occur in a man or a woman: • Cracked, raw, or red areas around your genitals without pain, itching, or tingling • Itching or tingling around your genitals or your anal region • Small blisters that break open and cause painful sores. These may be on or around your genitals (penis or vagina) or on your buttocks, thighs, or rectal area. More rarely, blisters may occur inside the urethra -- the tube urine passes through on its way out of your body. • Pain from urine passing over the sores -- this is especially a problem in women.

29. Genital Herpes: KEY POINTS • About 1/5 of adult Americans have HSV 2 • Most do not recognize or get symptoms • New type-specific blood tests can accurately diagnose HSV 2 infection even when no symptoms are present • Treatment to control symptoms and lessen the chance of transmission are available

30. Genital Human Papillomavirus (HPV) • Two disease processes caused by different viral types • Precancer and cancer of the genital tissues (abnormal Paps and anal carcinoma) • Skin growths in the anogenital area (genital warts)

31. Signs and symmptoms • The HPV virus lives in mucous membranes, such as those in the genital area, or on the skin. If genital warts show up, it's an indication of HPV infection. Genital warts take on many different appearances. They can be raised, flat, pink, or flesh-colored. They can even be shaped like cauliflower. Sometimes there is a single wart; other times multiple warts appear. They can be small or large. They can be on the anus, cervix, scrotum, groin, thigh, or penis. • Genital warts can show up weeks or even months after sexual contact with a person infected with an HPV virus. That person may not know he or she is infected and is responsible for HPV transmission.

32. What happens once people get infected with HPV? • For most people, nothing will happen • The body’s immune system usually eliminates HPV infection • After HPV is found on the cervix, it becomes undetectable within 2 years in at least 90% of women • Some people who get “low-risk” types will develop: • Visible genital warts • Low-grade Pap smear abnormalities that usually go away on their own

33. Typical Genital Warts DOIAWebsite, 2000

34. HPV: KEY POINTS • Extremely common virus • Some types cause genital warts • Other types cause cervical and anal cancer • HPV tests can help in managing female patients with abnormal Paps

35. Hepatitis B • Hepatitis B is an infectious hepatitis caused by the hepatitis B virus (HBV). This infection has two possible phases; 1) acute and 2) chronic. • Acute hepatitis B refers to newly acquired infections. Affected individuals notice symptoms approximately 1 to 4 months after exposure to the virus. In most people with acute hepatitis, symptoms resolve over weeks to months and they are cured of the infection. However, a small number of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis. • Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely.

36. Signs and symptoms • Half of all people infected with the hepatitis B virus have no symptoms. • Symptoms develop within 30-180 days of exposure to the virus. The symptoms are often compared to flu. Most people think they have flu and never think about having HBV infection. • Appetite loss • Feeling tired (fatigue) • Nausea and vomiting • Itching all over the body • Pain over the liver (on the right side of the abdomen, under the lower rib cage) • Jaundice - A condition in which the skin and the whites of the eyes turn yellow in color • Urine becomes dark in color (like cola or tea). • Stools are pale in color (grayish or clay colored).