Week-3-STD.pdf

SEXUALLY TRANSMITTED DISEASES INTRODUCTION STD Sexually transmitted infections (STI’s) and their complications belong to the top five disease categories for which adults seek health care in developing countries, according to WHO. INTRODUCTION STD STI’s are a major global cause...

SEXUALLY TRANSMITTED DISEASES INTRODUCTION STD Sexually transmitted infections (STI’s) and their complications belong to the top five disease categories for which adults seek health care in developing countries, according to WHO. INTRODUCTION STD STI’s are a major global cause of acute illness, infertility, long term disability and death, with severe medical and psychological consequences for millions of men, women, and children. INTRODUCTION STD Unlike HIV, many STI’s can be treated and cured relatively easily and cheaply if diagnosed early enough. Most common treatable STI’s: o Chlamydia o Gonorrhea o Trichomonas o Syphilis – causes the most concern INTRODUCTION STD The proven most important method to prevent transmission of STI’s in risky sexual encounters is the consistent and correct use of condom. KEY FACTS STD 448 million new infections of curable sexually transmitted (syphilis, gonorrhoea, chlamydia and trichomoniasis) infections occur yearly (adults aged 15-49). Some sexually transmitted infections exist without symptoms. KEY FACTS STD In pregnant women with untreated early syphilis, 25% of pregnancies result in stillbirth and 14% in neonatal death. Sexually transmitted infections are the main preventable cause of infertility, particularly in women. KEY FACTS WHO recommends a syndromic approach to diagnosis and management of sexually transmitted infections. Infections and transmission STD Spread primarily through person-to-person sexual contact. There are more than 30 different sexually transmissible bacteria, viruses and parasites. Infections and transmission STD Several, in particular HIV and syphilis, can also be transmitted from mother to child during pregnancy and childbirth, and through blood products and tissue transfer. STIs without symptoms STD Up to 70% of women and a significant proportion of men with gonococcal and/or chlamydial infections experience no symptoms at all. Both symptomatic and asymptomatic infections can lead to the development of serious complications. STIs adversely affect the health of women Untreated STIs can have critical implications for reproductive, maternal and newborn health. STIs are the main preventable cause of infertility, particularly in women. STIs adversely affect the health of women 10 - 40% of women with untreated chlamydial infection develop symptomatic pelvic inflammatory disease (PID). Post-infection tubal damage is responsible for 30 - 40% of cases of female infertility. STIs adversely affect the health of women Women who have had pelvic inflammatory disease are 6 - 10 times more likely to develop an ectopic (tubal) pregnancy than those who have not, and 40 - 50% of ectopic pregnancies can be attributed to previous pelvic inflammatory disease. STIs adversely affect the health of women Infection with certain types of the human papillomavirus (HPV) can lead to the development of genital cancers, particularly cervical cancer in women. STIs and adverse outcomes of pregnancy Untreated STIs are associated with congenital and perinatal infections in neonates. In pregnant women with untreated early syphilis, 25% of pregnancies result in stillbirth and 14% in neonatal death – an overall perinatal mortality of about 40%. STIs and adverse outcomes of pregnancy Up to 35% of pregnancies among women with untreated gonococcal infection result in spontaneous abortions and premature deliveries, and up to 10% in perinatal deaths. STIs and adverse outcomes of pregnancy In the absence of prophylaxis, 30 - 50% of infants born to mothers with untreated gonorrhoea and up to 30% of infants born to mothers with untreated chlamydial infection will develop a serious eye infection (ophthalmia neonatorum), which can lead to blindness if not treated early. STIs and adverse outcomes of pregnancy Worldwide, 1000 - 4000 newborn babies become blind every year because of this condition. STIs and HIV STD The presence of untreated STIs increase the risk of both acquisition and transmission of HIV. STI syndromes STD urethral discharge genital ulcers inguinal swellings scrotal swelling vaginal discharge lower abdominal pain neonatal eye infections (conjunctivitis of the newborn). Prevention STD The most effective means to avoid becoming infected with or transmitting a STI is: o to abstain from sexual intercourse. o to have sexual intercourse only within a long- term, mutually monogamous relationship with an uninfected partner. Prevention Male latex condoms, when used consistently and correctly, are highly effective in reducing the transmission of HIV and other sexually transmitted infections. COMMON STIs STD 1. Gonorrhea 7. Genital Herpes 2. Syphilis 8. Genital Warts 3. Chlamydia 9. HPV 4. Trichomoniasis 5. Hepatitis B 6. HIV/AIDS  I. GONORRHEA (clap and drip) MICROSCOPY Your Logo What is gonorrhea? I. GONORRHEA Gonorrhea is a sexually transmitted disease (STD) caused by infection with the Neisseria gonorrhoeae bacterium. It infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. What is gonorrhea? I. GONORRHEA N. gonorrhoeae can also infect the mucous membranes of the mouth, throat, eyes, and anus. Incubation period o 2 – 10 days, possibly 3 days or more How common is gonorrhea? I. GONORRHEA Gonorrhea is a very common infectious disease. An estimated 200 million new cases of gonorrhea occur annually. (Globally) CDC estimates that, annually, more than 700,000 people in the United States get new gonorrheal infections. How do people get gonorrhea? I. GONORRHEA Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. How do people get gonorrhea? I. GONORRHEA Gonorrhea can also be spread perinatally from mother to baby during childbirth. People who have had gonorrhea and received treatment may be reinfected if they have sexual contact with a person infected with gonorrhea. Who is at risk for gonorrhea? I. GONORRHEA Any sexually active person can be infected with gonorrhea. What are the signs and symptoms? I. GONORRHEA Many men with gonorrhea are asymptomatic. When present, (urethral infection): o dysuria or a white, yellow, or green urethral discharge that usually appears 1 to 14 days after infection. What are the signs and symptoms? I. GONORRHEA Most women with gonorrhea are asymptomatic. Mild and nonspecific that they are mistaken for a bladder or vaginal infection. o Dysuria o increased vaginal discharge o or vaginal bleeding between periods What are the signs and symptoms? I. GONORRHEA Symptoms of rectal infection in both men and women: o discharge o anal itching o soreness o bleeding o or painful bowel movements may be asymptomatic What are the signs and symptoms? I. GONORRHEA Pharyngeal infection may cause a sore throat, but usually is asymptomatic.  N. gonorrhoeae-gram negative diplococci Diplococci Credit: Negusse Ocbamichael and Seattle STD/HIV Prevention Training Center Gonorrhea Symptoms in Men Discharge from the penis (may be thick, milky white, yellowish, or greenish) Burning on urination Ocular and periocular symptoms Gonorrhea Symptoms in Women Usually asymptomatic Painful urination Abnormal vaginal bleeding Pain during sex What are the complications of gonorrhea? I. GONORRHEA Bartholin’s Abscess (women) Pelvic inflammatory disease (PID) (women) Epididymitis (men) Both men and women Disseminated gonococcal infection (DGI) Bartholin’s Abscess Pelvic Inflammatory Disease (PID) 42 Epididymitis Swollen or Tender Testicles Disseminated Gonococcal (Gonorrhea) Infection What about Gonorrhea and HIV? I. GONORRHEA Untreated gonorrhea can increase a person’s risk of acquiring or transmitting HIV, the virus that causes AIDS. How does gonorrhea affect a pregnant woman and her baby? If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. o blindness, joint infection, or a life-threatening blood infection in the baby Who should be tested for gonorrhea? I. GONORRHEA Anyone with genital symptoms Anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with an STD. Some people should be tested for gonorrhea even if they do not have symptoms or know of a sex partner who has gonorrhoea. Who should be tested for gonorrhea? I. GONORRHEA Anyone who is sexually active with high risk behaviour. People who have gonorrhea should also be tested for other STDs. How is gonorrhea diagnosed? I. GONORRHEA nucleic acid amplification testing (NAAT) o urine, urethral (for men) o or endocervical or vaginal (for women) specimens gonorrhea culture o endocervical o urethral swab specimens How is gonorrhea diagnosed? I. GONORRHEA If a person has had oral and/or anal sex, pharyngeal and/or rectal swab specimens should be collected either for culture or for NAAT. What is the treatment for gonorrhea? I. GONORRHEA Gonorrhea can be cured with the right treatment. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not repair any permanent damage done by the disease. What is the treatment for gonorrhea? I. GONORRHEA Antimicrobial resistance in gonorrhea is of increasing concern, and successful treatment of gonorrhea is becoming more difficult. If a person’s symptoms continue for more than a few days after receiving treatment, he or she should return to a health care provider to be reevaluated. What is the treatment for gonorrhea? I. GONORRHEA Patients infected with N. gonorrhoeae frequently are coinfected with C. trachomatis. Most gonococci are susceptible to doxycycline and azithromycin, routine cotreatment might also hinder the development of antimicrobial- resistant N. gonorrhoeae. What about partners? I. GONORRHEA If a person has been diagnosed and treated for gonorrhea, he or she should tell all recent anal, vaginal, or oral sex partners (all sex partners within 60 days before the onset of symptoms or diagnosis) so they can see a health provider and be treated. What about partners? I. GONORRHEA A person with gonorrhea and all of his or her sex partners must avoid having sex until they have completed their treatment for gonorrhea and until they no longer have symptoms. How can gonorrhea be prevented? I. GONORRHEA Latex condoms, when used consistently and correctly, can reduce the risk of transmission. The surest way to avoid transmission is to abstain from sexual intercourse. Or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be unifected.  II. SYPHILIS MICROSCOPY Your Logo What is syphilis? II. SYPHILIS Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. Syphilis can cause long-term complications and/or death if not adequately treated. Incubation period – 10 days to 3 months, with average of 21 days What is syphilis? II. SYPHILIS Syphilis is easy to cure in its early stages. Syphilis is most common during the years of peak sexual activity. Most new cases occur in men and women aged 15-40 years. Men are affected more frequently with primary or secondary syphilis than women. What is syphilis? II. SYPHILIS Syphilis remains prevalent in many developing countries and in some areas of North America, Asia, and Europe, especially Eastern Europe. The highest rates are in South and Southeast Asia, followed closely by sub- Saharan Africa. How common is syphilis? II. SYPHILIS Preliminary 2007 syphilis data showed that the US rate of primary and secondary syphilis increased 12% between 2006 and 2007, from 3.3 to 3.7 cases per 100,000 population. A total of 11,466 cases were reported in 2007. (USA) How do people get syphilis? II. SYPHILIS Syphilis is transmitted from person to person by direct contact with a syphilitic sore, known as a chancre. Chancres occur mainly on the external genitals, vagina, anus, or in the rectum. Chancres also can occur on the lips and in the mouth. How do people get syphilis? II. SYPHILIS Transmission of syphilis occurs during vaginal, anal, or oral sex. Pregnant women with the disease can transmit it to their unborn child. Signs and symptoms in adults II. SYPHILIS Syphilis has been called “The Great Pretender”, as its symptoms can look like many other diseases. Syphilis typically follows a progression of stages that can last for weeks, months, or even years: primary, secondary, latent and late stages Signs and symptoms in adults II. SYPHILIS Primary Stage o A painless sore called a chancre may be located on the genitals, lips, anus, or other area of direct contact o The chancre lasts 3 to 6 weeks and heals regardless of whether a person is treated or not. o Inadequate treatment could lead to secondary stage. Syphilitic chancre Oral Primary Syphilis Chancre Signs and symptoms in adults II. SYPHILIS Secondary Stage o Skin rashes and/or mucous membrane lesions (sores in the mouth, vagina, or anus) o The rash usually does not cause itching. o The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. Signs and symptoms in adults II. SYPHILIS Secondary Stage o Large, raised, gray or white lesions, known as condyloma lata, may develop in warm, moist areas such as the mouth, underarm or groin region. o fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. Signs and symptoms in adults II. SYPHILIS Secondary Stage o The symptoms of secondary syphilis will go away with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease. Secondary syphilis rash Secondary Syphilis Rash  Syphilitic Rash Image:Secondary syphilitic rash Treponema pallidum 6756 lores.jpg Credit: Dr. Gavin Hart and CDC Credit: Connie Celum and Walter Stamn and Seattle STD/HIV Prevention Training Center Secondary Syphilis Palm Rash Stage II Condyloma lata Condyloma lata Credit: CDC 77 Signs and symptoms in adults II. SYPHILIS Latent and Late Stages o The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. o Without treatment, the infected person will continue to have syphilis infection in their body even though there are no signs or symptoms. Signs and symptoms in adults II. SYPHILIS Latent and Late Stages o Early latent syphilis (occurred within the past 12 months) o Late latent syphilis (occurred more than 12 months ago) o Latent syphilis can last for years. Signs and symptoms in adults II. SYPHILIS Latent and Late Stages o Symptoms: o difficulty coordinating muscle movements o paralysis, numbness, gradual blindness, and dementia Signs and symptoms in adults II. SYPHILIS Neurosyphilis o Syphilis can invade the nervous system at any stage of infection. o Asymptomatic/symptomatic o headache, altered behavior, and movement problems Effects to a pregnant woman and her baby The syphilis bacterium can infect the baby of a woman during her pregnancy. high risk of having a stillbirth Untreated babies may become developmentally delayed, have seizures, or die. Effects to a pregnant woman and her baby For pregnant women only penicillin therapy can be used to treat syphilis and prevent passing the disease to her baby. Treatment with penicillin is extremely effective (success rate of 98%) in preventing mother-to-child transmission. How is syphilis diagnosed? II. SYPHILIS Darkfield microscopy - rarely performed today because it is a technologically difficult method. Blood test o nontreponemal tests (VDRL and RPR) - produce false-positive results o treponemal tests (confirmatory) - antibodies usually remain detectable for life What is the treatment for syphilis? II. SYPHILIS There are no home remedies or over-the- counter drugs that will cure syphilis, but syphilis is easy to cure in its early stages. A single intramuscular injection of long acting Benzathine penicillin G (2.4 million units administered intramuscularly) will cure (primary, secondary, early latent syphilis) What is the treatment for syphilis? II. SYPHILIS Three doses of long acting Benzathine penicillin G (2.4 million units administered intramuscularly) at weekly intervals (late latent syphilis or latent syphilis of unknown duration) What is the treatment for syphilis? II. SYPHILIS Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary. Will syphilis recur? II. SYPHILIS Syphilis does not recur. Having syphilis once does not protect a person from becoming infected again. How can syphilis be prevented? II. SYPHILIS Correct and consistent use of latex condoms Syphilis sore outside of the area covered by a latex condom can still allow transmission. abstain from sexual contact Mutually monogamous relationship (uninfected) How can syphilis be prevented? II. SYPHILIS Transmission of an STD, including syphilis, cannot be prevented by washing the genitals, urinating, and/or douching after sex. Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior.  III. CHLAMYDIA MICROSCOPY Your Logo What is Chlamydia? III. CHLAMYDIA Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs. Symptoms of chlamydia are usually mild or absent. What is Chlamydia? III. CHLAMYDIA Serious complications that cause irreversible damage, including infertility, can occur "silently“. Can cause discharge from the penis of an infected man. Incubation: 2-3 weeks for males; usually no symptoms in female How common is chlamydia? III. CHLAMYDIA According to WHO, there were more than 140 million cases of Chlamydia trachomatis infection worldwide. prevalent in persons aged 15-24 years Acquisition rates are comparable for the 2 sexes. How common is chlamydia? III. CHLAMYDIA Women are more likely to be asymptomatic than men (80% vs 50%) Women are also more likely to develop long-term complications (eg, PID and infertility). How do people get chlamydia? III. CHLAMYDIA Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth. Men who have sex with men are also at risk for chlamydial infection. Signs and symptoms of chlamydia III. CHLAMYDIA Chlamydia is known as a "silent" disease because the majority of infected people have no symptoms. Women: initial infection (cervix & urethra) o abnormal vaginal discharge o burning sensation when urinating o lower abdominal pain o low back pain, nausea, fever Signs and symptoms of chlamydia III. CHLAMYDIA Women: initial infection (cervix & urethra) o bleeding between menstrual periods o infection of the cervix can spread to the fallopian tube and rectum Signs and symptoms of chlamydia III. CHLAMYDIA Men: o discharge from their penis o or a burning sensation when urinating o burning and itching around the opening of the penis o Pain and swelling in the testicles are uncommon Signs and symptoms of chlamydia III. CHLAMYDIA Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum: o rectal pain, discharge, or bleeding Chlamydia can also be found in the throats (oral sex) Cervicitis 103 Credit: University of Washington and Seattle STD/HIV Prevention Training Center Chlamydia What complications can result from untreated chlamydia? Pelvic inflammatory disease (PID) Infertility Potentially fatal ectopic pregnancy Increase risk of becoming infected with HIV Epididymitis - swollen and tender testicles How does chlamydia affect a pregnant woman and her baby? premature delivery early infant pneumonia and conjunctivitis (pink eye) in newborns How is chlamydia diagnosed? III. CHLAMYDIA Urine test Chlamydia culture What is the treatment for chlamydia? III. CHLAMYDIA Chlamydia can be easily treated and cured with antibiotics. A single dose of azithromycin or a week of doxycycline (twice daily). Persons with chlamydia should abstain from sexual intercourse for 7 days after single dose or until completion of a 7-day course of antibiotics. How can chlamydia be prevented? III. CHLAMYDIA Similar to other STD prevention  IV. TRICHOMONIASIS (Trich) MICROSCOPY Your Logo What is trichomoniasis? IV. TRICHOMONIASIS Trichomoniasis (or “trich”) is a very common sexually transmitted disease (STD) that is caused by infection with a protozoan parasite called Trichomonas vaginalis. Most women and men who have the parasite cannot tell they are infected. How common is trichomoniasis? IV. TRICHOMONIASIS Estimates of the worldwide prevalence of trichomoniasis range from 170-180 million cases annually. The World Health Organization estimates the worldwide incidence of trichomonas infection at over 170 million cases annually. How common is trichomoniasis? IV. TRICHOMONIASIS It is typically found in sexually active adolescents and adults. Prevalence of 2.3% among adolescents aged 18-24 years and 4% among adults 25 years and older Symptomatic trichomoniasis is more common in women than in men. How do people get trichomoniasis? IV. TRICHOMONIASIS Usually passed by direct sexual contact In women, the most commonly infected part of the body is the lower genital tract (vulva, vagina, or urethra). In men, the most commonly infected body part is the inside of the penis (urethra). Signs and symptoms IV. TRICHOMONIASIS About 70% of infected people do not have any signs or symptoms. Incubation: 4 – 20 days, average 7 days MEN: o itching or irritation inside the penis o burning after urination or ejaculation o or some discharge from the penis Signs and symptoms IV. TRICHOMONIASIS WOMEN: o itching, burning, redness or soreness of the genitals o discomfort with urination o or a thin discharge with an unusual smell that can be clear, white, yellowish, or greenish Without treatment, the infection can last for months or even years. Strawberry Cervix 117 Credit: Claire E. Stevens and Seattle STD/HIV Prevention Training Center What are the complications of trichomoniasis? IV. TRICHOMONIASIS Trichomoniasis can increase the risk of getting or spreading other sexually transmitted infections. How does trichomoniasis affect a pregnant woman and her baby? preterm delivery low birth weight (less than 5.5 pounds) How is trichomoniasis diagnosed? IV. TRICHOMONIASIS ▪ Flagellated, motile trichomonads on wet mount ▪ Vaginal pH > 4.5 ▪ Diagnosis confirmed by microscopy ▪ Culture test What is the treatment for trichomoniasis? Can be cured with a single dose of prescription antibiotic medication (either metronidazole or tinidazole) – taken orally People who have been treated for trichomoniasis can get it again. How can trichomoniasis be prevented? Similar to syphilis prevention  V. HEPATITIS B MICROSCOPY Your Logo What is Hepatitis B? V. HBV Hepatitis B is caused by infection with the Hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. What is Hepatitis B? V. HBV HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infection can be self-limited or chronic. How common is hepatitis B? V. HBV The HBV carrier rate variation is 1-20% worldwide. High-prevalence areas (rate of 10-20%) include China, Indonesia, sub-Saharan Africa, the Pacific Islands, and Southeast Asia More cases of HBV disease occur in males than in females. How is HBV transmitted? V. HBV Sex with an infected partner Injection drug use that involves sharing needles, syringes, or drug-preparation equipment Birth to an infected mother How is HBV transmitted? V. HBV Contact with blood or open sores of an infected person Needle sticks or sharp instrument exposures Sharing items such as razors or toothbrushes with an infected person How is HBV transmitted? V. HBV HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing. How long does HBV survive outside the body? HBV can survive outside the body at least 7 days and still be capable of causing infection. What should be used to remove HBV from environmental surfaces? Any blood spills — including dried blood, which can still be infectious — should be cleaned using 1:10 dilution of one part household bleach to 10 parts of water for disinfecting the area. Gloves should be used when cleaning up any blood spills. Who is at risk for HBV infection? V. HBV Infants born to infected mothers Sex partners of infected persons Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., >1 sex partner during the previous 6 months) Who is at risk for HBV infection? V. HBV Men who have sex with men Injection drug users Household contacts of persons with chronic HBV infection Hemodialysis patients Who is at risk for HBV infection? V. HBV Health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids Residents and staff of facilities for developmentally disabled persons What are the signs and symptoms of HBV infection? Most children under age 5 years and newly infected immunosuppressed adults are asymptomatic. Whereas 30%–50% of persons aged ≥5 years have initial signs and symptoms. What are the signs and symptoms of HBV infection? Fever Fatigue Loss of appetite Nausea Vomiting What are the signs and symptoms of HBV infection? Abdominal pain Dark urine Clay-colored bowel movements Joint pain Jaundice When symptoms of acute Hepatitis B occur, how long do they usually last? Symptoms typically last for several weeks but can persist for up to 6 months. How serious is acute HBV infection? Acute infection ranges from asymptomatic or mild disease to — rarely — fulminant hepatitis. Disease is more severe among adults aged >60 years. The fatality rate among acute cases reported to CDC is 0.5%–1%. How serious is chronic HBV infection? Chronically infected after childhood die prematurely from cirrhosis or liver cancer. Majority remain asymptomatic until onset of cirrhosis or end-stage liver disease. How is HBV infection treated? V. HBV For acute infection, no medication is available; treatment is supportive. For chronic infection, several antiviral drugs (adefovir dipivoxil, interferon alfa-2b, pegylated interferon alfa-2a, lamivudine, entecavir, and telbivudine) are available. Can Hepatitis B be prevented? V. HBV Yes. The best way to prevent Hepatitis B is by getting the Hepatitis B vaccine. The Hepatitis B vaccine is safe and effective and is usually given as 3-4 shots over a 6-month period.  Hepatitis ◼jaundice ◼ Cirrhosis of the liver  VI. HIV/AIDS MICROSCOPY Your Logo KEY FACTS VI. HIV/AIDS HIV continues to be a major global public health issue, having claimed more than 25 million lives over the past three decades. There were approximately 34 [31.4–35.9] million people living with HIV in 2011. KEY FACTS VI. HIV/AIDS Sub-Saharan Africa is the most affected region, with nearly 1 in every 20 adults living with HIV. Sixty nine per cent of all people living with HIV are living in this region. HIV infection is usually diagnosed through blood tests detecting the presence or absence of HIV antibodies. KEY FACTS VI. HIV/AIDS There is no cure for HIV infection. However, effective treatment with antiretroviral drugs can control the virus so that people with HIV can enjoy healthy and productive lives. KEY FACTS VI. HIV/AIDS In 2011, more than 8 million people living with HIV were receiving antiretroviral therapy (ART) in low- and middle-income countries. Another 7 million people need to be enrolled in treatment to meet the target of providing ART to 15 million people by 2015. Human Immunodeficiency Virus (HIV) HIV targets the immune system and weakens people's surveillance and defense systems against infections and some types of cancer. Immune function is typically measured by CD4 cell count. Human Immunodeficiency Virus (HIV) The most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS), which can take from 2 to 15 years to develop depending on the individual. AIDS is defined by the development of certain cancers, infections, or other severe clinical manifestations. Signs and symptoms VI. HIV/AIDS The first few weeks after initial infection: o no symptoms or an influenza-like illness including fever, headache, rash or sore throat. The following may be warning signs of advanced HIV infection: o rapid weight loss o dry cough o recurring fever or profuse night sweats Signs and symptoms VI. HIV/AIDS The following may be warning signs of advanced HIV infection: o profound and unexplained fatigue o swollen lymph glands in the armpits, groin, or neck o diarrhea that lasts for more than a week o white spots or unusual blemishes on the tongue, in the mouth, or in the throat Signs and symptoms VI. HIV/AIDS The following may be warning signs of advanced HIV infection: o Pneumonia o red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids o memory loss, depression, and other neurological disorders Kaposis sarcoma in AIDS Oral leukoplakia in AIDS Oral candidiasis Oral candidiasis in AIDS Seborrheic dermatitis in AIDS Herpes zoster Go to fullsize image Go to fullsize image AIDS Transmission VI. HIV/AIDS HIV can be transmitted via the exchange of a variety of body fluids from infected individuals, such as blood, breast milk, semen and vaginal secretions. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water. Structure of HIV-1 Life Cycle of HIV-1 Risk factors VI. HIV/AIDS having unprotected anal or vaginal sex; having another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhoea, and bacterial vaginosis; Risk factors VI. HIV/AIDS sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs; receiving unsafe injections, blood transfusions, medical procedures that involve unsterile cutting or piercing; and experiencing accidental needle stick injuries, including among health workers. Diagnosis VI. HIV/AIDS An HIV test reveals infection status by detecting the presence or absence of antibodies to HIV in the blood. Most people have a "window period" of usually 3 to 6 weeks during which antibodies to HIV are still being produced and are not yet detectable. Diagnosis VI. HIV/AIDS Screening assays o enzyme-linked immunoabsorbent assay (ELISA) o Western blot assays or similar specific assay (CONFIRMATORY) Prevention VI. HIV/AIDS Male and female condom use Testing and counselling for HIV and STIs Voluntary medical male circumcision o Male circumcision reduces the risk of female- to-male sexual transmission of HIV by around 60%. Prevention VI. HIV/AIDS Antiretroviral therapy (ARV) based prevention o ART as prevention o Pre-exposure prophylaxis (PrEP) for HIV- negative partner o Post-exposure prophylaxis for HIV (PEP) ✓use of ARV drugs within 72 hours of exposure to HIV in order to prevent infection ✓administering of a 28-day course of antiretroviral drugs with follow-up care Prevention VI. HIV/AIDS Antiretroviral therapy (ARV) based prevention o Harm reduction for injecting drug users o Elimination of mother-to-child transmission of HIV (eMTCT) Treatment VI. HIV/AIDS HIV can be suppressed by combination antiretroviral therapy (ART) consisting of three or more antiretroviral (ARV) drugs. With ART, people living with HIV can live healthy and productive lives.  VII. GENITAL HERPES MICROSCOPY Your Logo KEY FACTS VII. GENITAL HERPES Genital herpes is a common STD, and most people with genital herpes infection do not know they have it. o You can get genital herpes even if your partner shows no signs of the infection. o If you have any symptoms (like a sore on your genitals, especially one that periodically recurs) laboratory tests can help determine if you have genital herpes. KEY FACTS VII. GENITAL HERPES o There is no cure for herpes, but treatment is available to reduce symptoms and decrease the risk of transmission to a partner. What is genital herpes? VII. GENITAL HERPES Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). How common is genital herpes? VII. GENITAL HERPES HSV is well distributed worldwide. An increase in seroprevalence of antibodies to HSV-2 has been documented throughout the world (including the United States) over the last 20 years. How common is genital herpes? VII. GENITAL HERPES Globally, the large majority of cases are caused by HSV-2; infection is common in both the industrialized and developing worlds, and HSV-2 uncommonly causes infection by non-sexual means. How common is genital herpes? VII. GENITAL HERPES HSV-1 is usually acquired in childhood by contact with oral secretions that contain the virus. Seropositivity to antibodies to HSV-2 is more common in women (25%) than in men (17%). How common is genital herpes? VII. GENITAL HERPES The mortality rate associated with herpes simplex infections is related to 3 situations: perinatal infection, encephalitis, and infection in the immunocompromised host. How common is genital herpes? VII. GENITAL HERPES 2 types of HSV: o HSV-2 causes most genital infections. o HSV-1 causes oral infections (cold sores, fever blisters) and some genital infections. How do people get genital herpes? VII. GENITAL HERPES Infections are transmitted through contact with lesions, mucosal surfaces, genital secretions, or oral secretions. HSV-1 and HSV-2 can also be shed from skin that looks normal. What are the signs & symptoms? VII. GENITAL HERPES Most individuals infected with HSV-1 or HSV-2 are asymptomatic, or have very mild symptoms that go unnoticed or are mistaken for another skin condition. The average incubation period after exposure is 4 days (range, 2 to 12). What are the signs & symptoms? VII. GENITAL HERPES Signs & symptoms (typical): o one or more vesicles on or around the genitals, rectum or mouth o The vesicles break and leave painful ulcers that may take two to four weeks to heal. What are the signs & symptoms? VII. GENITAL HERPES Signs & symptoms (first infection): o longer duration of herpetic lesions o increased viral shedding (making HSV transmission more likely) o fever, body aches, swollen lymph nodes, and headache What are the signs & symptoms? VII. GENITAL HERPES Prodromal symptoms (recurrence): o mild tingling or shooting pains in the legs, hips and buttocks occurring hours to days before eruption of herpetic lesions o typically shorter in duration and less severe o episodes tends to decrease over time o Recurrences are much less frequent for genital HSV-1 infection than for genital HSV-2 infection. STD 101 for Non-Clinicians Herpes Herpes in a Man Source: Cincinnati STD/HIV Prevention Training Center STD 101 for Non-Clinicians Herpes Herpes in a Woman Source: CDC/NCHSTP/Division of STD, Source: Cincinnati STD/HIV Prevention Training Center STD Clinical Slides What are the complications? VII. GENITAL HERPES rare but serious complications: o blindness o encephalitis o aseptic meningitis o extragenital lesions in the buttocks, groin, thigh, finger, and eye STD 101 for Non-Clinicians Herpes You can get herpes anywhere... Source: Cincinnati STD/HIV Prevention Training Center Herpes Simplex in Women with AIDS Credit: Jean R. Anderson, MD How does genital herpes affect a pregnant woman and her baby? Herpes infection can be passed from mother to child. fatal infection (neonatal herpes) If herpes symptoms are present a cesarean delivery is recommended to prevent HSV transmission to the infant. How is genital herpes diagnosed? VII. GENITAL HERPES Viral culture is currently the reference standard for diagnosing genital herpes. PCR (Direct/virologic test) Indirect/serologic test - ELIZA Is there a cure or treatment for herpes? There is no cure for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication. Antiviral can reduce the likelihood of transmission. no commercially available vaccine How can herpes be prevented? VII. GENITAL HERPES Correct and consistent use of latex condoms can reduce the risk of genital herpes. Outbreaks can occur in areas that are not covered by a condom. The surest way to avoid transmission is to abstain from sexual contact. How can herpes be prevented? VII. GENITAL HERPES Long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected. Even if a person does not have any symptoms, he or she can still infect sex partners. How can herpes be prevented? VII. GENITAL HERPES Persons with herpes should abstain from sexual activity with partners when sores or other symptoms of herpes are present.  VIII. HPV/GENITAL WARTS MICROSCOPY Your Logo What is genital HPV infection? VIII. HPV/GENITAL WARTS Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. What is genital HPV infection? VIII. HPV/GENITAL WARTS These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it. What is genital HPV infection? VIII. HPV/GENITAL WARTS HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems. What are the signs, symptoms and potential health problems of HPV? Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years. What are the signs, symptoms and potential health problems of HPV? But, sometimes, HPV infections are not cleared and can cause: – Genital warts – Rarely, warts in the throat – Cervical cancer and other, less common but serious cancers, cancers of the vulva, vagina, penis, anus, and oropharynx What are the signs, symptoms and potential health problems of HPV? The types of HPV that can cause genital warts are not the same as the types that can cause cancers. STD 101 for Non-Clinicians HPV HPV Penile Warts Source: Cincinnati STD/HIV Prevention Training Center STD 101 for Non-Clinicians HPV Genital Warts in a Woman Source: CDC/NCHSTP/Division of STD, STD Clinical Slides STD 101 for Non-Clinicians HPV Perianal Wart Source: Cincinnati STD/HIV Prevention Training Center How do people get HPV? VIII. HPV/GENITAL WARTS HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. How do people get HPV? VIII. HPV/GENITAL WARTS HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms. A person can have HPV even if years have passed since he or she had sexual contact with an infected person. How does HPV cause genital warts and cancer? HPV can cause normal cells on infected skin to turn abnormal. Warts can appear within weeks or months after getting HPV. Cancer often takes years to develop after getting HPV. How common are HPV? VIII. HPV/GENITAL WARTS Globally, HPV infection is the most common STD. Genital warts have affected as many as 30 million individuals worldwide. In US, 50% of sexually active men and women get HPV at some point in their lives. How can people prevent HPV? VIII. HPV/GENITAL WARTS Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer. The vaccines are most effective when given at 11 or 12 years of age. How can people prevent HPV? VIII. HPV/GENITAL WARTS Consistent and correct use of condom Mutually monogamous relationship with an uninfected partner. Avoid sexual activity. Is there a test for HPV? VIII. HPV/GENITAL WARTS There is no general test for men or women to check one’s overall "HPV status“ Regular Pap smear for females Is there a treatment for HPV or related diseases? There is no treatment for the virus itself, but there are treatments for the diseases that HPV can cause. THANK YOU! THANK YOU!