STD 101 Unlocking Good Health with Prevention and

STD 101 Unlocking Good Health with Prevention and Control Miami-Dade STD Program Florida Department of Health

“Early knowledge of STD infection is a critical component in preventing & controlling the spread of STDs, including HIV. ”

Who Are We?

STD Program objectives: ¢ Intervene in the spread of HIV and other sexually transmitted diseases ¢ Reduce the complications brought on by sexually transmitted diseases ¢ Protect the community from sexually transmitted disease related outbreaks

STD Clinic offers: ¢ Four convenient sites ¢ Routine voluntary HIV test with STD exam ¢ Multilingual & culturally competent trained staff ¢ Private Setting ¢ Client Confidentiality ¢ Community & Case Specific Screenings ¢ Educational Presentations

STD Screening & Care “Clients who are HIV-infected or at increased risk for HIV are at risk for other STDs and should receive or be referred for STD screening and treatment. ”

Types of STD Clinical Services ¢ Comprehensive Exam & Screening for common STDs l l l l ¢ Chlamydia Gonorrhea Syphilis Herpes BV Trichomoniasis Genital Warts l l Blood Orasure Rapid Test ¢ ¢ HIV Testing l ¢ ¢ NE W Treatment available for common STDs Hepatitis A & B & C Testing Hepatitis A vaccination for eligible clients Hepatitis B vaccination available Pap Smear Testing Start-up Birth Control for STD Clients Pregnancy Testing for STD Clients

Disease Intervention & Prevention Services ¢ ¢ General & Specific Patient Education & Counseling HIV Counseling & Testing in Field Setting l l ¢ ¢ Risk & Harm Reduction Counseling HIV Post Test Counseling l l l ¢ ¢ ¢ Confidential Anonymous Negative Positive Indeterminate Disease Intervention Interviews Partner Counseling & Referral Services (PCRS) Community Awareness & Sexual Health Promotion Referrals Other STD Testing in Field Setting

How We Work?

STD Prevention & Control DIS clie locat e inte nt for s & r e rvie RX , e fers w, & P valu CR atio n, S or oct D s to e o m G Exa r o f STD Gets At-A-Glance Test Residents & Visitors ed s et Do Ge es t T No re t at ed Send t ea r T Lab G D b La DCH / & M tor to c Do orts rep Report to STD Su r Ve veill a rifi Tre es nce atm en t/P TC

What’s A STD?

Sexually Transmitted Disease (STD)? A sexually transmitted disease is a broad term that refers to as many as 20 different infections, all of them transmitted by sex. STDs are serious, sometimes painful and can cause a lot of damage in your body. Some STDs infect your reproductive and sexual organs. Others (HIV, hepatitis B, and syphilis) cause general body infections.

How are STDs spread? ¢ Through the exchange of body fluids such as semen, vaginal fluid, and blood with someone who is infected. ¢ Through vaginal, anal and oral sex. ¢ STDs can be given by mothers to their babies ¢ You can get some STDs, such as herpes, by kissing and caressing or close contact with infected areas—not just intercourse.

Asymptomatic Vs Symptomatic disease Asymptomatic – Sometimes a person can have an STD with no signs or symptoms. ¢ Symptomatic – Other times, a person will have symptoms that go away on their own. ¢ Either way, the person will still have the STD until he/she gets treated. A few STDs can not be cured. But most can be cured with treatment.

How common are STDs? STDs are increasingly common in the United States today. That’s distressing news, because STDs are also easy to prevent.

STD FACT SHEET According to CDC, each year ¢ An estimated 19 million new infections occur, almost half of them among young people ages 15 to 24 ¢ Direct medical costs associated with STDs in the United States are estimated at up to $14. 1 billion annually ¢ An estimated 2. 8 million new cases of chlamydia occur in the United States ¢ Gonorrhea is the second most commonly reported infectious disease in the U. S. Like chlamydia, however, gonorrhea is substantially under-diagnosed and under-reported, and approximately twice as many new infections are estimated to occur each year as are reported.

Types of Organisms responsible for STDs Bacteria ¢ Viruses ¢ Fungi ¢ Protozoa ¢ Metazoa ¢

Bacteria (including mycoplasmas and chlamydiae) Types of Bacteria that affects humans ¢ ¢ ¢ Spirilla-syphilis, yaws Cocci-gonorrhea, meningitis Bacilli-typhoid fever, tetanus Mycoplasmas-nongonococcal urethritis (NGU), pneumonia Chlamydia trachomatis-chlamydial urethritis, mucopurulent cervicitis (MPC)

Viruses A few of the significant viral STDs are ¢ ¢ hepatitis B genital herpes condylomata acuminata (genital warts) acquired immunodeficiency syndrome (AIDS)

Fungi causes ¢ ¢ Candidiasis Other vaginal yeast infections Lung diseases Ring worm

Protozoa are responsible for ¢ ¢ Trichomoniasis Malaria

Metazoa ¢ ¢ Metazoa causes many diseases and infestations Scabies Guinea worm infection Pediculosis pubis

Common STDs ¢ ¢ ¢ ¢ ¢ Bacterial Vaginosis (BV) Chlamydia Gonorrhea Genital Warts Herpes (HSV types I and II) Hepatitis B (Hep B) Human Immunodeficiency Virus (HIV) Lice & Scabies Syphilis Trichomoniasis (Trich)

Chlamydia v Chlamydia is a sexually transmitted disease that is caused by the bacterium Chlamydia trachomatis. Signs and Symptoms v Pain and burning when urinating, discharge. 75% of women and 50% of men have no signs or symptoms. Diagnosis v Lab exam of fluid from the infected area Treatable? v Yes Therapy v Antibiotic pills that kill bacteria Result if Left Untreated v Pelvic infections such as Pelvic Inflammatory Disease (PID).

Chlamydia ¢ Chlamydia trachomatis in a Thin Prep PAP Test is a i yd ong m hla n am DC c se mo n, C ual for u ca com me ann ing men e B st wo ds en wo s mo ung men scre ive ell a isk t yo om dia ac s w ith r y a c re lam ually 26, n w w or ch sex age ome s ne rs all der er w h a rtne un old suc x pa for tors le se fac ltip mu

Chlamydia ¢ Chlamydia Trachomatis in a Thin Prep PAP Test Chlamydia urethritis, penile ¢

Gonorrhea v Gonorrhea is a sexually transmitted disease that is caused by the bacterium Neisseria gonorrhoeae. Signs and Symptoms v Pain or burning when urinating, yellow discharge Diagnosis v Lab exam of fluid from the infected area Treatable? v Yes Therapy v Antibiotic pills that kill bacteria Results if Left Untreated v Pelvic Infections, PID, and Sterility

Gonorrhea Positive Gram Stain from Urethral Discharge Studies suggest that the presence of gonorrhea infection makes an individual three to five times more likely to acquire HIV, if exposed Gonoccocal Urethritis Gonoccocal Cervicitis

Gonorrhea ¢ Bartholin’s abscess Gonococcal ophthalmia

Gonorrhea ¢ Disseminated gonorrhea – skin lesion

Genital Warts Genital warts is a sexually transmitted disease that is caused by the virus Human Papilloma. Signs and Symptoms v Bumpy warts on/near genitals Diagnosis v Visual Treatable? v Yes (but can’t be cured) Therapy v Burning or liquid removal of warts Result if Left Untreated v May lead to some cancers v

Genital Warts ¢ Condyloma acuminata, vaginal wall

Genital Warts Condyloma Acuminata Anal Meatus

Genital Warts Condyloma Acuminata Vulva Meatus

Herpes v Herpes is a sexually transmitted disease caused by the herpes simplex virus (HSV). Signs and Symptoms v HSV-type 1 (oral herpes) commonly causes fever blisters on the mouth or face v HSV-type 2 (genital herpes) typically affects the genital area causing red bumps/blisters. However, both viral types can cause either genital or oral infections. Diagnosis v Lab exam of fluid from the sore Treatable? v Yes (but can’t be cured) Therapy v Pills and ointment Results if Left Untreated v Prolonged and more severe symptoms

Herpes Primary Same Patient, 4 Days Later

Herpes Primary Recurring

Herpes Vulva Cervicitis

Lice and Scabies v Lice (Crabs) is a sexually transmitted diseases caused by the metazoa Pediculosis Pubis. You get crabs by having sex, sharing clothes, bed sheets, or towels with someone who is infected. Scabies is a contagious skin disease caused by the metazoa Sarcoptes scabiei, a very small mite. Signs and Symptoms v Severe itching, rashes Diagnosis v Visual Treatable? v Yes Therapy v Over-the-counter or prescription lotion Results if Left Untreated v Continuing symptoms

Lice Female Crab Louse Lice in the pubic Area

Scabies Mite Eczema Scabies

Syphilis ¢ Syphilis has been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those caused by other diseases.

Syphilis v Syphilis is a sexually transmitted disease caused by the bacterium Treponema Pallidum. Signs and Symptoms v Chancre sore, rash, genital ulcers Diagnosis v Lab exam of tissue, fluids/blood test Treatable? v Yes Therapy v Penicillin shots to kill bacteria or antibiotic pills Results if Left Untreated v Blindness, Heart disease, Brain damage

Syphilis Stages: ¢ ¢ Primary Secondary Latent Treponema Pallidum

Primary Stage The most infectious stage of the disease.

Primary Syphilis Chancres Vaginal Penile

Primary Syphilis Vaginal Anal Chin

Secondary Stage Lesions of the mouth, throat, and cervix (mucous patches) frequently occur during this stage.

Secondary Syphilis Papulo-pustular rash Condyloma Lata

Secondary Syphilis Nickel and Dime Lesion Alopecia Palmer Rash

Latent Syphilis ¢ The stage in which no clinical signs or symptoms are present to suggest infection and serologic tests for syphilis are reactive. An early latent stage of syphilis can appear between the primary and secondary stages; between secondary relapses; and after the secondary stage, continuing to the latent stage, late syphilis, or cure. Late Syphilis ¢ Untreated late syphilis may present a wide range of signs and symptoms, varying from none which are apparent to those which indicate severe damage to one or more body systems. Late syphilis is classified as neurosyphilis, cardiovascular syphilis, and late benign syphilis.

Congenital syphilis Through the 18 th week of gestation the Langhan’s cell layer of the early placenta may help in restricting the treponema from crossing the placenta to infect the fetus. Thus, pregnancy while the mother is in the primary or secondary stages of infection frequently terminate in a stillbirth, whereas pregnancy occurring during the later stages of syphilis may result in a clinical spectrum from a fulminating fatal congenital syphilis

Congenital Syphilis IS Preventable

Congenital Syphilis ¢ Primary chancre of syphilis that appeared at the age of 4 wks

Congenital Syphilis Perforation of Palate Mucous Patches

Congenital Syphilis Hypertropic Skin Hemorraoic Snuffles

Syphilis ¢ Congenital syphilis – Hutchinson’s teeth

The link between syphilis and HIV ¢ While the health problems caused by the syphilis bacterium for adults and newborns are serious in their own right, it is now known that the genital sores caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually. ¢ There is a 2 - to 5 - fold increased risk of acquiring HIV infection when syphilis is present. Areas of the U. A. that have the highest number rates of syphilis also have the fastest – growing HIV infection rates in women of childbearing age.

Why We Care?

Sexual Health Prevention Strategies: ¢ Cancer Prevention ¢ HIV Prevention through STD Intervention ¢ Healthy Moms and Healthy Babies through Reproductive Health ¢ Eliminating Health Disparities

Unlocking Good Health Disease Prevention Messages ¢ Practice sexual abstinence, or limit sexual contact to one uninfected partner. ¢ Limit the number is sexual partners, and do not go back and forth between partners ¢ Use latex condoms correctly every time you have sex. ¢ Condoms do not provide complete protection from all STDs. Sores and lesions of other STDs on infected men and women may be present in areas not covered by the condom, resulting in transmission of infection to another person.

Unlocking Good Health Disease Prevention Messages ¢ Any genital symptoms such as 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. ¢ If you are told you have syphilis, gonorrhea, or any other STD and receive treatment, you should notify all of your recent sex partners so that they can see a health care provider and be treated. This will reduce the risk that your partner(s) will develop serious complications from the disease and will reduce your own risk of becoming reinfected.

Unlocking Good Health Disease Control Messages!!! ¢ If you think you might have an STD, get checked out. Don’t just hope the STD will go away. It won’t! ¢ You must get treatment for the STD, even if it is a hard thing for you to do. This is the only way you will get well. ¢ Most STDs can be treated with antibiotics. Do exactly what you doctor tells you. Be sure to use all of your medicine. If you do not use all of your medicine, the STD will not go away. ¢ Medicine you buy off the streets will not get you well. In fact, it may only hide your symptoms. You will still have the STD.

Unlocking Good Health Disease Control Messages!!! ¢ You must tell your sexual partner(s). If they aren’t treated, they can spread the STD. They might even give it to you again! ¢ The health department can arrange confidential partner counseling and referral services for you if you don’t feel comfortable telling your partner(s). ¢ If you have any questions about STDs, services or clinic hours, please contact one of the four local STD clinics

Where Are We?

Miami-Dade County Health Department Sexually Transmitted Disease Clinics Downtown STD Clinic 1350 NW 14 th St, Bldg. #4 Miami, Fl 33125 Mon-Fri 7: 30 am-3: 00 pm (305) 324 -2422 www. dadehealth. org English, Spanish, Creole Walk-in 12 years old and above Central Miami-Dade County West Perrine STD Clinic 18255 Homestead Avenue Perrine, Fl 33157 Mon-Thurs 8: 00 am-11: 00 am And 1: 00 pm-3: 00 pm (305) 256 -6315 www. dadehealth. org English, Spanish Walk-in 12 years old and above South Miami-Dade County Little Haiti Health Center 300 N. E. 80 th Terrace Miami, Fl 33137 Mon, Wed, & Fri 8 am-3: 00 pm (305) 795 -2100 www. dadehealth. org English, Creole, Spanish Walk-in 12 years old and above North Miami-Dade County Miami Beach STD Clinic 615 Collins Ave. Miami Beach, FL 33139 Mon , Wed & Fri 8: 00 am-11: 00 am 1: 00 pm-4: 00 pm (305) 535 -5540 www. dadehealth. org English, Spanish, Creole Walk-in 12 years old and above East Miami-Dade County N EW

“April is STD Awareness Month” “STD Awareness” STD Awareness : www. std-awareness. com HPV Awareness : www. hpv-awareness. com

THANK YOU! Need more information about STD Facts or reporting STDs to the county health department? Contact the Miami-Dade STD Program @ (305) 325 -3242