1 Sexually transmitted infectionsHSERV 100 May 14, 2012

2 Wed May 30th The Last Straw- board game Will divide into teams

3 Which is it? STDs: Sexually Transmitted DiseasesSTIs: Sexually Transmitted Infections

4 Why are STDs a disease category?

5 How do you get STDs? Sexual contact IV drug use (HIV, hepatitis) AnalVaginal Oral IV drug use (HIV, hepatitis)

6 Who gets STDs? It’s not who you are, it’s what you do!Certain behaviors = greater or lesser risk More partners = more risk No condoms = more risk

7 Young people & women are at increased risk15-24 year-olds represent 25% of the ever sexually active population, but acquire nearly half of all new STDs 2/3 of STDs occur among women

8 STD rates among young people are increasingChlamydia 15-19 year-olds:  7.7% 20-24 year-olds:  6.6% Gonorrhea 15-19 year-olds:  2.1% 20-24 year-olds:  0.7% Syphilis Increased annually since 2004 Source: Center for Disease Control and Prevention

9 Types of STDs Bacterial Viral Other Chlamydia GonorrheaPelvic inflammatory disease (PID) Syphilis Bacterial vaginosis Viral HIV HPV Herpes Hepatitis B, C Other Trichomoniasis - protozoa Candidiasis Public lice Scabies

10 Chlamydia Most commonly reported bacterial STI Symptoms1-3 weeks after exposure “silent” disease Burning sensation with urination Discharge clear Leads to PID, scarring, epididymitis Treatable with antibiotics

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13 Gonorrhea Second most commonly reported bacterial STI SymptomsIf symptoms, 1-14 days after exposure Burning sensation with urination Discharge white, yellow, or green Leads to PID, epididymitis, infection blood and joints Treatable with antibiotics – BUT…

14 ‘ Gonococcal Isolate Surveillance Project (GISP)National sentinel surveillance system established in 1986 25-30 sentinel sites around U.S. Monitor resistance patterns of gonorrhea

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17 Gonorrhea treatment Increasing resistance Ceftriaxone injectionAND zithromax or doxycycline

18 Syphilis 3 stages Mother-to-child-transmission Treated with penicillinPrimary Secondary Tertiary Mother-to-child-transmission Treated with penicillin

19 Males WA 5.5 per 100,000 (U.S. rate 7.6 per 100,000Females WA 0.2 per 100,000 (U.S. rate 1.2 per 100,000

20 Herpes HSV 1 and 2 Causes ulcers/sores at infection siteVirus becomes latent; infection recurs periodically Can be spread even without visible lesion Mother-to-child-transmission No cure but antivirals can reduce symptoms and reduce risk of transmission

21 Prevalence HSV 2 NHANES (U.S. civilian, non-institutionalized population) 7,293 persons age tested 16.2% seropositive 88% not aware of infection Increased risk with age (1.4% 14-19; 26.1% 40-49) Increased risk women (20.9% women; 11.5% men)

22 Human Papillomavirus Over 100 typesCauses genital warts, cervical cancer Usually transient & asymptomatic Screening with Pap test Vaccine now recommended for men and women (gardisil = HPV 6, 11, 16, 18)

23 Types of HPV among females age 14-59 in NHANES, 2003-2004

24 High risk HPV – sentinel surveillance27% in STI clinics; 26% in family planning clinics; 15% in primary care By age group: 14-19: 35% 20-29: 29% 30-39: 13% 40-49: 11% 50-65: 6.3% cities involved: baltimore, boston, new orleans, denver, seattle, LA

26 The #1 most common symptomNOTHING

28 How to prevent STDs

29 Get tested!

30 HIV/AIDS: The Basics TransmissionAnal, oral, vaginal sex Mother-to-child IV drug use Contact with infected blood Infection with another STD can increase your chances of contracting HIV Attacks helper T cells (CD4)

31 Brief history of HIV in U.S.First discovered in 1981 Peaked in mid-1980s Medications became available in 1996 ~1 in 4 living with HIV do not know they are infected!

32 AIDS only affects people in Africa, right?Baltimore – 2.5% D.C. – 3% Blacks – 2.1% Angola – 2.1% Nigeria – 3.1% Ghana – 1.9%

33 Exposure 4-11 days acute HIV viral set point4-6 weeks later 96% reduction in transmission in heterosexual couples with early treatment Antiretroviral medications – May 2011

34 Increased risk of STI with:Concurrent partners Other sexually transmitted infections

35 Why are STDs a disease category?Disease load Type of sexual behavior Other STIs Other STIs

36 Frontline: The Age of AIDS good video for history of HIV- fyi only