SEXUALLY TRANSMITTED DISEASES Lynne D Feldman MD MPH

SEXUALLY TRANSMITTED DISEASES Lynne D. Feldman, MD, MPH – District Health Director Elsie Napier, RN, FNP – District Program Manager Brenda Mims, RN – Infectious Disease Coordinator

South Health District, 8 -1 STD Presentation to Valdosta State University / Student Health Brenda Mims, RN – Infectious Disease Coodinator

DCH Mission ACCES S Access to affordable, quality health care in our communitie s RESPONSIB LE Responsible health planning and use of health care resources HEALTH Y Healthy behaviors and improved health outcomes

DCH Initiatives FY 2009 and FY 2010 FY 2009 FY 2010 Medicaid Transformation Health Care Consumerism Financial & Program Integrity Health Improvement Solutions for the Uninsured Workforce Development Customer Service Peach. Care for Kids. TM Program Stability Emergency Preparedness Customer Service

Disclosure Statements • To obtain nursing contact hours for this session, you must be present for the entire hour and complete an evaluation. • Neither the planners of this session nor I have any financial relationship with pharmaceutical companies, biomedical device manufacturers, or corporations whose products and services are related to the vaccines we discuss. • There is no commercial support being received for this event. • The mention of specific brands of vaccines in this presentation is for the purpose of providing education and does not constitute endorsement. • The GA Immunization Program utilizes ACIP recommendations as the basis for this presentation and for our guidelines, policies, and recommendations. • For certain vaccines this may represent a slight departure from or off-label use of the vaccine package insert guidelines.

Goal • To promote Sexually Transmitted Disease awareness, prevention and education.

Objectives • After the completion of this presentation participants should be able to: 1. 2. 3. 4. 5. 6. 7. Define Sexually Transmitted Diseases (STDs); Describe how STDs are transmitted; Name at least three of the most commonly diagnosed STDs; Identify signs and symptoms of STDs; Understand the effects of STDs on pregnancy; Describe recommended CDC treatments for STDs; Understand the STD reporting and follow-up process.

Sexually Transmitted Diseases (STDs) • Definition – An infection passed during sex by means of sexual contact, including vaginal intercourse, oral sex, and anal sex. • Until the 1990’s these illnesses/diseases were commonly known as venereal diseases. Veneris – the Latin name for Venus, who is considered the Roman goddess of love. • Can have no symptoms • Infect the following areas: – Mouth – Rectum – Sex organs ( vagina, vulva, penis, testes)

Can You Name these STD?

STDs • • CHLAMYDIA GONORRHEA Genital Warts HEPATITIS A, B. & C Bacterial Vaginosis Scabies Epididymitis Nongonococcal Urethritis • Pediculosis Pubis • • • GENITAL HERPES/HPV HIV/AIDS SYPHILIS Trichomoniasis “Trich” Genital & Perianal Warts Lymphogranuloma Venereum • Vulvovaginal Candidiasis • Pelvic Inflammatory Disease

Chlamydia • What is Chlamydia? – Sexually transmitted infection – A common STD caused by the bacterium Chlamydia Trachomatis – Can be transmitted through vaginal, anal or oral sex as well as to a child from the mother during birth – Can cause sterility • Mode of transmission – Spread during vaginal, anal or oral sex with someone who has Chlamydia • Symptoms – May present as non-gonococcal urethritis (NGU) syndrome in males or mucopurulent cervicitis syndrome in females – Known as the “silent” disease – Abnormal vaginal bleeding (between menstrual periods) – Burning sensation during urination – Back pain and/or pain during intercourse • Treatment – Antibiotic (Usually Azithromycin or Doxyclycline) – Partner should also be treated to prevent re-infection • Prevention – Abstinence – Condoms – Monogomy

Chlamydia

Chlamydia

Treatment For Chlamydia • Chlamydia can be treated with the following medications: – Azithromycin – Doxyclycline – Amoxicillin – Erythromycin

Gonorrhea • • • What is Gonorrhea? – Sexually transmitted disease caused by Neisseria Gonorrhoeae – Can also grow in the mouth, throat, eyes, and anus Mode Of Transmission – Spread during vaginal, anal or oral sex with someone who has Gonorrhea Symptoms – Many men may have no symptoms • Some symptoms may take up to 30 days to appear – Burning sensation during urination – White, yellow or green discharge from the penis or vagina – Painful or swollen testicles – Vaginal bleeding between periods – Painful bowel movements – Many with Gonorrhea also have other STDs Treatment – Antibiotics – Drug resistant strains are increasing Prevention – Abstinence – Condoms – Monogomy

Gonorrhea

Treatment For Gonorrhea • Gonorrhea can be treated with the following medications: – Ceftriaxone (Rocephin) – Cefixime – Azithromycin – Doxycycline – Erythromycin

Genital Warts • What is Genital Warts – Small, sexually transmitted growths that is caused by Human Papillona Virus – Flesh-colored (look like miniature cauliflower florets) – Can be visible in the vagina, urethra, cervix, vulva, penis, anus • Mode of Transmission – Spread during vaginal, anal or oral sex, and sometimes by genital touching, with someone who has genital warts • Symptoms – The virus lives in the skin or mucous membranes – Can cause no symptoms • Treatment – Can be removed – No Cure (will have the virus for the rest of your life) • Prevention – Condoms – Monogamy

Genital Warts

Treatment For Genital Warts • Genital Warts can be treated but not cured: – Podofilox – Imiquimod – Trichloroacetic Acid – Podophyllin – Gardasil (HPV Vaccine)

Hepatitis • What is Hepatitis? – A disease that damages the liver – Caused by a virus – Hepatitis A, B, C are most common • Hepatitis A – Passed in human feces, food and water – Symptoms: Jaundice, Fatigue, Abdominal Pain, Diarrhea, Nausea • Hepatitis B – Passed through blood, saliva, semen, or vaginal fluids (anal or oral sex), from mother to baby during birth, sharing needles to inject drugs or for any other reason – Symptoms: Persistent flu-like feelings, tiredness, jaundice, dark urine, light-colored bowel movements • Hepatitis C – Passed through blood, from mother to baby during birth, during sex (not common) • Hepatitis B & C can become chronic – Can cause cirrhosis (scarring) of the liver – Liver cancer • Prevention – Hepatitis A & B vaccine available – Hepatitis C – No Vaccine but medication available to prevent further liver damage

Hepatitis • Picture of a healthy liver • Effects of hepatitis on the liver

Treatment For Hepatitis A, B & C • Hepatitis A – No treatment – There is a vaccine to prevent Hepatitis A – Goes away by itself in 2 -6 months • Hepatitis B – Yes / Treatment isn’t always successful – There is a vaccine that should be started at birth – all ages 0 -18 should be vaccinated • Hepatitis C – Treatment with antivirals (interferon – most common) to manage and slow disease progression – There is no vaccine for Hepatitis C

Perinatal Hepatitis B

Perinatal Hepatitis B Prevention Program • Program Goals – Ensure all pregnant women are screened for HBs. Ag at their initial prenatal screening panel as standard of care – Be sure Public Health conducts case investigations on all positive HBs. Ag pregnant women – Confirm 90% of all infants born to HBs. Ag positive women receive HBIG and the first dose of Hep B vaccine within 12 hours of birth – Ensure that 90% of all infants born to HBs. Ag positive women receive the second dose of vaccine at 1 -2 months of age – Ensure that 80% of all infants born in Georgia to HBs. Ag positive women are tested at 9 months to 18 months of age for HBs. Ag and Hepatitis B surface antibodies (Anti-HBs)

Genital Herpes • • What is herpes? – A viral infection characterized by recurring vesicular and ulcerative lesions on the genitals or adjacent areas that heal spontaneously without scarring. – Some severe cases of first episode infection last an average of 12 days and aseptic meningitis or generalized symptoms due to viremia may occur. Mode of transmission – Spread through vaginal, anal and oral sex – sometimes by genital touching with someone who has herpes Symptoms – Oral Herpes • Cold sores or “fever blisters” – Genital Herpes • Most have no symptoms • Most common symptoms – cluster of blistery sores – usually on the vagina, vulva, cervix, penis, buttocks or anus • May last several weeks – may return in weeks, months or years • Fever, blisters, burning feelings if urine flows over sores, itching, open sores Prevention – Abstinence – Do not have sexual contact during outbreaks – Use condoms between outbreaks

Oral & Genital Herpes

Treatment For Genital Herpes • There is no cure for Genital Herpes • Treatment may include: – – – Acyclovir Famciclovir Valacyclovir Valtrex Acetominophen or Ibuprofen (Oral Analgesic)

Syphilis • What is Syphilis? – – – An STD caused by the bacterium Treponema Pallidum Called the “great intimidator” because many of the signs and symptoms are indistinguishable from those of other diseases Stages of Syphilis • • • Mode of Transmission – • Spread during vaginal, anal or oral sex, and sometimes by genital touching, with someone who has Syphilis Symptoms – – • Primary Secondary Late Congenital Primary: Appearance of a sore (chancre) at the spot where syphilis entered the body – could be one or more Secondary: Skin rash and mucous membrane lesions, fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue Late: Difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementia Congenital: rash, thinning of the skin Prevention – – – Abstinence Condoms Monogamy

Primary Syphilis

Secondary Syphilis

Late Syphilis

Congenital Syphilis

Treatment of Syphilis • Syphilis can be treated; however, a person will usually have a “titer” after treatment – Titer, def. the concentration of antibodies present in the highest dilution of a serum sample at which visible clumps with an appropriate antigen are formed. The concentration of antibodies present in the highest dilution of a serum sample at which visible clumps with an appropriate antigen are formed. • Benzathine Penicillin G • Doxyclycline (Cannot be used on lactating clients)

Can You Tell Who Has HIV?

HIV • Human Immunodeficiency Virus • The virus that causes AIDS • Damages the body’s immune system which protects the body from diseases • Can have for many years without signs or symptoms

HIV Modes of Transmission • During vaginal, oral or anal sex • Blood-to-blood contact – (blood with HIV in it comes into contact with blood or mucous membranes of another person) • Sharing needles • Needles used for tattoos and piercing or to inject vitamins or steroids • Healthcare workers caring for HIV can get HIV from needle-stick injuries • Mother to baby during pregnancy, childbirth, or breast feeding

HIV • HIV is not passed by: – Donating blood – Hugging, dry kissing, or sharing food – Telephones, toilet seats, or eating utensils – Tears, saliva, sweat or urine – Mosquitoes or other insects – Coughing, sneezing, or spitting

HIV • Incubation Period: – Some people develop symptoms shortly after being infected – Sometimes it takes more than 10 years for symptoms to appear.

Stages of HIV “Stage 1” • Primary HIV Infection – Last for a few weeks – Have flu-like symptoms – Body begins seroconversion • Body responds to the virus by producing HIV antibodies • Can last 3 weeks to 6 months

Stages of HIV “Stage 2” • Asymptomatic Stage – Having no obvious signs of symptoms • Immune system still strong enough to prevent symptoms – Last for an average of 10 years – People continue to look and feel healthy • The virus can still be passed to other people – Unprotected sex, needle sharing – HIV virus continues to weaken the immune system

Stages of HIV “Stage 2” Continue • Symptoms: – Moderate unexplained weight loss – Recurrent respiratory infections – Fungal nail infections – Herpes zoster

Stages of HIV “Stage 3” • Symptomatic HIV Infection – The virus has become more active in the body and the immune system is weakened. – Symptoms: • • Skin Rashes Fatigue Night Sweats Slight weight loss Mouth ulcers Thrush (yeast infection) Fungal skin and nail infections

Stages of HIV “Stage 3” Continue – Symptoms • • • Unexplained sever weight loss Chronic diarrhea Persistent fever Oral candidiasis Oral hairy leukoplakia Bacterial infections – Pneumonia

• Stages of HIV “Stage 4” AIDS – CD 4 count is less than 200 – Or has a history of an AIDS defining illness • Opportunistic Infections – Infections that the immune system would normally prevent. » Examples: – Pneumocystis Carinii Pneumonia (PCP) » A fungal infection of the lungs – Tuberculosis (TB) » A bacterial infection often found in the lungs but can spread to other parts of the body – Kaposi’s Sarcoma (KS) » A rare cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat or in other organs – Cytomegalovirus (CMV) » A common virus that infects most people at some time during their lives but rarely causes obvious illness. It is a member of the herpes virus family » Can cause blindness – Toxoplasmosis » A disease caused by a single-celled parasite called Toxoplasma gondii

Pneumocystis Carnaii Pneumonia • There is increased white (opacity) in the lower lungs on both sides, characteristic of Pneumocystis pneumonia

Tuberculosis

Kaposi’s Sarcoma

CMV Normal Retinas With CMV

Toxoplasmosis

How Does A Person Find Out Whether Or Not They Are HIV+? • Taking the HIV Antibody test – Giving A Blood Sample • Blood is drawn and sent to the lab for processing • Results back in about two weeks – Taking the Ora. Sure Test • A swab is taken from the cheek (an additive on the swab pulls blood from the capillaries inside the cheek) • Results back in 2 -3 days – Taking the Ora. Quick test • A needlestick test • Results usually back in about 30 minutes • If a positive is revealed a confirmatory test is performed

HIV Testing • Test for HIV antibodies – Immune system makes these to fight HIV – Does not tell if you have AIDS • If you have antibodies – Test results are positive – Have HIV • If you don’t have HIV antibodies – Test results negative – You don’t have HIV

HIV Testing Continued • The Window Period – Usually takes up to 3 months after infection for the body to make HIV antibodies – In rare cases, it can take up to 6 months

STDs & Pregnancy

Additional Resources

Q Q U U E E S S T T I I O O N N S S

Contact Information Brenda Mims, RN, BSN Infectious Disease Coordinator South Health District, Unit 8 -1 (229) 245 -8711; Ext. 237 bcmims@dhr. state. ga. us