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TopicsinHumanSexuality:SexuallyTransmittedDiseases
CaseVignette
Marlaisa15-year-oldhighschoolsophomore.Shehasbeensexuallyactivesinceage
13andhashadmultiplesexualpartners.Althoughshetriestodothe“responsible
thing”byusingprotection,shehashadunprotectedsexattimes,particularlywhenshe
hasbeendrunkorhigh.Marlahasrecentlybeenexperiencinglowerabdominalpain
andfoulsmellingvaginaldischargeandhasnotedthatintercoursewithhercurrent
boyfriendhasbeenpainful.Shehasherfirstgynecologicalexaminationandis
dismayedtofindthatshehaspelvicinflammatorydisease(PID).
Nodiscussionofhumansexualityiscompletewithoutconsiderationofsexually
transmitteddiseases(STDs).Sexuallytransmitteddiseasesareinfectionsthatcan
betransferredfromonepersontoanotherthroughsexualcontact.Accordingtothe
CentersforDiseaseControlandPrevention,thereareover15millionnewcasesof
sexuallytransmitteddiseasesintheUnitedStateseachyear(CDC,2015a).Thereare
morethan25varietiesofSTDs.AlthoughHIVremainsthemostwellknownSTD
withapproximately40millionpeoplearecurrentlylivingwithHIVinfection,other
commonSTDsincludechalymidia,gonorrhea,genitalherpesandgenitalwarts.
AdolescentsandyoungadultsareatgreatriskforcontractinganSTDbecauseofa
varietyofbehavioral,biological,andculturalreasons(CDC,2013).Prevalence
estimatessuggestthatyoungpeopleaged15–24yearsacquirehalfofallnew
sexuallytransmitteddiseasesandthat1in4sexuallyactiveadolescentfemaleshave
anSTD,suchaschlamydiaorhumanpapillomavirus(HPV).
ManySTDscanhaveseriousconsequence,bothphysicalandemotional.For
example,someSTDscanleadtopelvicinflammatorydisease,pelvicinflammatory
disease,whichcancauseinfertility.OtherSTDs,suchasHIV,canbefatal.Onan
emotionallevel,peoplewithillnessessuchasgenitalherpes,whichisincurable,
oftenfeellikeoutcastsandshunrelationshipsduetoshamearoundthedisease.
Itisimportantformentalhealthprofessionalsworkingwithpeopleofallagestobe
awareofSTDs,theirsymptoms,treatmentsandthedifficultiessurroundingthem.
Objectives:
Afterfinishingthiscourse,theparticipantwillbeableto:
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1. DiscussChlamydiaincludingsymptoms,complicationsandtreatment
2. DefinePelvicInflammatoryDisease(PID)
3. Discussgonorrhea,includingsymptoms,complications,pregnancyand
treatment
4. Discusssyphilis,includingstages,symptoms,complications,pregnancyand
treatment
5. ListthemedicalissuesassociatedwithHPV,aswellaspreventionand
treatmentofthisvirus
6. Describethesymptoms,psychologicalconsequencesandpreventionof
genitalherpes
7. Discusssymptoms,diagnosisandtreatmentofpubiclice
8. DiscussHIVinfection,includingpopulationsaffected,transmission,
symptomsandtreatment
9. Describethesigns,symptomsandtreatmentoftrichomoniasis
10. Discussothergenitalinfections
11. DescribetheincidenceandreasonsforSTDsamongadolescents,pregnant
womenandmenwhohavesexwithmen(MSM)andtransgendermenand
women
Chlamydia
Chlamydiaisthemostfrequentlyreportedbacterialsexuallytransmitteddiseasein
theUnitedStates.1,526,658ChlamydialinfectionswerereportedtotheCDCin2015
(alargenumberofcasesarenotreportedbecausemostpeoplewithchlamydiaare
asymptomatic).Chlamydiaismostcommonamongyoungpeople.Almosttwo-thirds
ofnewchlamydiainfectionsoccuramongyouthaged15-24(Torrone,Papp,&
Weinstock,2014).
Chlamydiaiscausedbythebacterium,Chlamydiatrachomatis.Thediseaseis
particularlydangerousforwomenandcancauseseriouscomplicationsthatresult
inirreversibledamage.MenwithChlamydiainfectionintheurethraaresaidtohave
nongonoccalurethritisorNGU(Webmd,2010).
Symptoms
Chlamydiaisknownasa"silent"diseasebecausethemajorityofinfectedpeople
havenosymptom.Whentheydooccur,symptomsusuallyappearwithin1to3
weeksafterexposure.
Inwomen,thebacteriainitiallyinfectthecervixandtheurethra.Womenmighthave
anabnormalvaginaldischargeoraburningsensationwhenurinating.Ifthe
infectionspreadsfromtothefallopiantubes,womenmayhavelowerabdominal
pain,lowbackpain,nausea,fever,orbleedingbetweenmenstrualperiods.
Chlamydialinfectionofthecervixcanspreadtotherectum.
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Menarealsogenerallyasymptomatic(only50%experiencesymptoms).Thosewho
dohavesignsmayhaveadischargefromtheirpenis,aburningsensationwhen
urinatingorburninganditchingaroundtheopeningofthepenis.
Complications/PID
ThecomplicationsofChlamydiaareofparticularconcernforwomen.Becausethe
diseaseisoftenasymptomatic,womenmaynotbetreatedforthedisease.Inabout
10-15%ofwomenwithuntreatedinfection,Chlamydiaspreadstotheuterusor
fallopiantubes,causingpelvicinflammatorydisease(PID).PIDisalsocommonin
gonorrhea.EachyearaboutonemillionwomendevelopPID.PIDcancause
infertility,ectopicpregnancy(apregnancyinthefallopiantubeorelsewhere
outsideofthewomb),abscessformation,andchronicpelvicpain.Chlamydiamay
alsoincreasethechancesofbecominginfectedwithHIV.
Treatment
Chlamydiaistreatedwithantibiotics,mostcommonlyAzithromycinorDoxycycline.
Alternativeantibiotictreatmentisusedforthosewithsensitivitytothesedrugs.Itis
importantforpartnerstobothbetreatedconcurrently.
Gonorrhea
Gonorrhea(“theclap”)istheoldestSTDonrecord.Symptomsofgonorrheaare
describedintheOldTestament.Therehasbeenarecentresurgenceofthisdisease
andtheCDCestimatesapproximately820,000newgonococcalinfectionsoccurin
theUnitedStateseachyear,andthatlessthanhalfoftheseinfectionsaredetected
andreportedtoCDC(CDC,2015d).
GonorrheaiscausedbyNeisseriagonorrhoeae,abacteriumthatcangrowand
multiplyinwarm,moistareasofthereproductivetract,includingthecervix,uterus,
fallopiantubesandurethra.Gonorrheacanalsogrowinthemouth,throat,eyes,and
anus.
Gonorrheaisspreadthroughcontactwiththepenis,vagina,mouth,oranus.
Ejaculationneednotoccurforgonorrheatobetransmitted.Thediseasecanalsobe
spreadfrommothertobabyduringdelivery.
Symptoms
Peoplewhoareinfectedwithgonorrheamaybeasymptomatic.Mostwomenare
eitherasymptomaticorhavemildsymptoms.Symptomscanbemistakenfora
urinarytractinfection,andmayincludeapainfulorburningsensationwhen
urinating,increasedvaginaldischarge,orbleedingbetweenperiods.Womenwith
gonorrheaareatriskofdevelopingcomplicationsfromtheinfection,regardlessof
theseverityofsymptoms.GonorrheaisacommoncauseofPID.
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Menmayalsobeasymptomatic.Whensymptomsdoappear,theygenerallyoccur
withinfivetoeightdaysofinfectionbutcantakeaslongas30days.Symptoms
includeaburningsensationwhenurinating,orawhite,yellow,orgreendischarge
fromthepenis.Somemenexperiencepainfulorswollentesticles.Gonorrheacan
causeepididymitis,apainfulconditionoftheductsattachedtothetesticlescausing
infertility.
Symptomsofrectalinfectionincludedischarge,analitching,soreness,bleeding,or
painfulbowelmovements.
AdditionalComplications
Gonorrheacanspreadtothebloodorjoints,causingapotentiallylifethreatening
condition.PeopleinfectedwithgonorrheacanalsomoreeasilycontractHIV
Pregnancy
Womenwhohavegonorrheaduringpregnancyhavehigherratesofmiscarriage,
infectionoftheamnioticsacandfluid,pretermbirth,andpretermpremature
ruptureofmembranes(PPROM).
Gonorrheacanbetransmittedtothebabyduringdelivery,andcancauseserious
complicationsincludingblindness.Moststatesrequirethatallbabiesbetreated
withmedicatedeyedropssoonafterbirthasapreventivemeasure.
Treatment
Gonorrheaisverytreatable.Treatmentgenerallyinvolveseitheraninjectibleororal
antibiotic.Asingledoseisusuallyallthatisrequired,butsomeantibioticsrequire
longercourses.Ofloxacin,Cefixine,andCeftriaxinearecommonlyprescribed.
Syphilis
SyphilisisaSTDcausedbythebacteriumTreponemapallidum.Ithasbeencalled
"thegreatimitator"becausesomanyofthesignsandsymptomsare
indistinguishablefromthoseofotherdiseases.Historicallysyphiliswasalsoknown
as“thegreatpox.”ItfirstappearedinEuropeduringthe1400sandbecamea
pandemicby1500.
AccordingtotheCDC,therewere74,702reportednewcasesofsyphilisin2015
(CDC,2015a).Thegroupwiththehighestreportedprevalencearemenwhohave
sexwithmen(MSM),accountingfor81.7%ofallprimaryandsecondarysyphilis
cases(CDC,2015e).
AccordingtotheCDC(2015e),congenitalsyphilis(passedfrompregnantwomento
theirbabies)continuestobeaproblem.During2015,487casesofcongenital
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syphiliswerereported.Congenitalsyphilisrateswere8.0timesand3.5times
higheramonginfantsborntoblackandHispanicmothersascomparedtowhite
mothers.
AlthoughsyphilisislesscommonthanmanyoftheotherSTDs,itsaffectsarequite
serious.Itcancausesterility,andifleftuntreatedresultindamagetothenervous
systemanddeath.
Transmission
Syphilisistransmittedthroughdirectcontactwithasyphilissore.Sorescanoccur
ontheexternalgenitals,vagina,anus,orintherectum.Soresalsocanoccuronthe
lipsandinthemouth.Syphiliscanalsobetransmittedfrompregnantwomento
theirbabies.
Symptoms
Manypeopleinfectedwithsyphilisdonothaveanysymptomsforyears,whichis
quiteproblematicgiventheseriouscomplicationsthatcanensurefromleavingthe
diseaseuntreated.Additionallysymptomsofsyphiliscanoftenlooklikeother
diseases.Forthisreason,syphilisissometimescalled“TheGreatPretender.”
Althoughtransmissionoccurscontactwithasyphilissore(carriersintheprimary
orsecondarystagethesesoresmaynotbeevident.Transmissionmayoccurfrom
personswhoareunawareoftheirinfection.
Thestagesare:
• PrimaryStageMarkedbytheappearanceofasinglesore(calledachancre),
buttheremaybemultiplesores.Thetimebetweeninfectionandthestartof
thefirstsymptomcanrangefrom10to90days(average21days).The
chancreisgenerallyfirm,round,small,andpainless,lasts3to6weeks,and
healsonitsown.However,ifthesyphilisisnottreated,theinfection
progressestothesecondarystage.
• SecondaryStageThisstageischaracterizedbyskinrashandmucous
membranelesions.Thisstagetypicallystartswiththedevelopmentofarash
ononeormoreareasofthebody.Therashgenerallyconsistsofreddish
brownspotsbothonthepalmsofthehandsandthebottomsofthefeet.
Sometimesrashesassociatedwithsecondarysyphilisaresofainttheyare
barelynoticeable.Inadditionaninfectedpersonmayexperiencefever,
swollenlymphglands,patchyhairloss,headaches,weightloss,muscleaches,
andfatigue.
• LateandLatentStages.Thelatestagesofsyphiliscandevelopinabout15%
ofpeoplewhohavenotbeentreated.Theycanappearaslongas10–20years
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afterthepersonwasfirstinfected.Inthelatestagesofsyphilis,thedisease
maydamagetheinternalorgans,includingthebrain,nerves,eyes,heart,
bloodvessels,liver,bones,andjoints.Signsandsymptomsofthisstage
includedifficultycoordinatingmusclemovements,paralysis,numbness,
gradualblindness,anddementia.Thepersonmaydieinthisstageofthe
illness.
Syphiliscaninvadethenervoussystem(neurosyphilis)atanystageofinfection,and
causesawiderangeofsymptomsvaryingfromnosymptomsatall,toheadache,
alteredbehavior,andmovementproblemsthatlooklikeotherneurologicdiseases,
suchasParkinson’sorHuntington’sdisease.
Treatment
Initsearlystagessyphilisiseasytocure.Forapersonwhohashadsyphilisless
thanayear,treatmentinvolvesasingleintramuscularinjectionofpenicillin.
Additionaldosesareneededtotreatsomeonewhohashadsyphilisforlongerthana
year.Penicillin(oranotherantibioticforthosewhoareallergic)willkillthesyphilis
bacteriumandpreventfurtherdamage,butitwillnotrepairdamagealreadydone.
Peoplewhoreceivesyphilistreatmentmustabstainfromsexualcontactwithnew
partnersuntilthesyphilissoresarecompletelyhealed.
HPV(HumanPapillomaVirus)
HPVstandsforhumanpapillomavirus,andisthemostcommonsexually
transmitteddisease.HPVistransmittedthroughgenitalcontact,mostoftenduring
vaginalandanalsex.HPVmayalsobepassedonduringoralsexandgenital-togenitalcontact.
MostpeoplewhocontractHPVdonotdevelopsymptomsorhealthproblems.But
other,moreaggressivestrainsofHPVcancausesignificantproblemsincluding:
• Genitalwarts.Smallwartsinthegenitalarea.Wartscanappearwithin
weeksormonthsaftersexualcontactwithaninfectedpartner,evenifthe
partnerhasnosignsofgenitalwarts.Genitalwartsarenotdangerous,but
theycanincreaseinnumberifleftuntreated.
• CervicalcancercanbecausedbyuntreatedHPV.Womenshouldreceive
regularscreeningsforcervicalandothergynecologicalcancers.
• OtherHPV-relatedcancersincludecancersofthevulva,vagina,penis,anus,
andheadandneck.
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• RRP.TheHPVviruscancausewartstogrowinthethroat,aconditioncalled
recurrentrespiratorypapillomatosisorRRP.Thesewartscanblockairways,
causingtroubledbreathing.
Prevention
VaccinesareeffectiveprotectionagainstHPV.Thesevaccinesaregiveninthree
shots,andaremosteffectivepriortoaperson'sfirstsexualcontact.
• Girlsandwomen:CervarixandGardasilprotectfemalesagainstthetypesof
HPVthatcausemostcervicalcancers.Gardasilalsoprotectsagainstmost
genitalwarts.Bothvaccinesarerecommendedfor11and12year-oldgirls,
andforfemales13through26yearsofage,whowerenotpreviously
vaccinated
• Boysandmen:Gardasilprotectsmalesagainstmostgenitalwarts.This
vaccineisavailableforboysandmen,11through26yearsofage.
• TheCDCnowrecommends11to12yearoldsgettwodosesofHPVvaccine—
ratherthanthepreviouslyrecommendedthreedoses—toprotectagainst
cancerscausedbyHPV.Theseconddoseshouldbegiven6-12monthsafter
thefirstdose.
LatexcondomsalsolowertheriskofHPVinfectionasdoeslimitingsexualpartners.
Treatment
GenerallypeoplewithHPVaretreatedforthesymptomsofthedisease,suchas
genitalwarts.MedicationsforwartsincludePodophyllin.Cryocauterycanfreeze
warts.Inhardertotreatcases,lasertherapyorsurgicalexcisionmaybe
recommended.
GenitalHerpes
CaseVignette
Jenniferisa35-year-oldwomanwhocontractedgenitalherpesduringcollege.Shehas
struggledemotionallysincecontractingtheillnessandhasgenerallyavoided
relationships,fearingthattheycouldleadtosexualcontact.Theillnesshascaused
severeemotionalpainanddistress.
GenitalherpesisanSTDcausedbytheherpessimplexviruses,mostfrequentlytype
2.GenitalherpesinfectioniscommonintheUnitedStates.Herpesispassedthrough
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genitalcontactandcanoccurevenwhenaninfectedpartnerdoesnothavevisible
signsofthevirus.
GenitalherpesinfectioniscommonintheUnitedStates.CDCestimatesthat,
annually,776,000peopleintheUnitedStatesgetnewherpesinfections.Overthe
pastdecade,thepercentageofAmericanswithgenitalherpeshasremainedstable
(CDC,2015a).OfallSTDs,genitalherpesisoneofthemostdevastatingasthereisno
cure.Outbreaksofthediseaseareunpredictable,andhavesignificantconsequences
onaperson’ssexualfreedom,frequencyandspontaneity.
Infectionsaretransmittedthroughcontactwithlesions,genitalsecretionsororal
secretions.Theherpesinfectioncanalsobeshedfromskinthatlooksnormal.
Generally,apersoncanonlygetherpessimplex2infectionduringsexualcontact
withsomeonewhohasagenitalherpessimplex2infection.
Mostindividualshavenooronlyminimalsignsherpesinfection.Symptomsmay
appearasoneormoreblistersonoraroundthegenitalsorrectum.Theblisters
break,leavingtendersoresthatmaytaketwotofourweekstohealthefirsttime
theyoccur.Typically,anotheroutbreakcanappearweeksormonthsafterthefirst,
butitgenerallyislesssevere.Althoughtheinfectioncanstayinthebody
indefinitely,thenumberofoutbreakstendstodecreaseovertheyears.
Complications
Regardlessofseverityofsymptoms,genitalherpesfrequentlycausespsychological
distressinpeoplewhoknowtheyareinfected.
GenitalHSVcanleadtopotentiallyfatalinfectionsinbabies.Ifawomanhasactive
genitalherpesatdelivery,acesareandeliveryisusuallyperformed.
Treatment
ThereisnoknowndrugthatwillkillHSV.Acylovircanbeusedtopreventorreduce
recurringsymptoms.
Prevention
Themosteffectivepreventionforgenitalherpesisabstinencefromsexualcontact,
oramutuallymonogamousrelationshipwithanuninfectedpartner.
Althoughlatexcondomsreducetheriskofgenitalherpes,genitalulcersinbothmale
andfemalegenitalareascanoccurinareasthatarenotcoveredbycondoms.
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Personswithherpesshouldabstainfromsexualactivitywithuninfectedpartners
whentheyhavelesionsorothersymptoms.Evenifapersondoesnothave
symptomsheorshecanstillinfectsexpartners.Sexpartnerscanseektestingto
determineiftheyareinfectedwithHSV.
PubicLice
PubicLice(Phthiruspubis,)arealsocalledcrabliceor"crabs,"areparasiticinsects
foundprimarilyinthepubicorgenitalareaofhumans.Theselicecanalsobefound
inarmpithairandeyebrows.Theprimaryagegroupinfectedbypubicliceare
teenagers.Liceinfestationisusuallyspreadduringsexualactivity.Lesscommonly
canbespreadthroughcontactwithobjectssuchastoiletseats,sheets,blankets,or
bathingsuits.
Riskfactorsforpublicincludehavingmultiplesexualpartners,sexualcontactwith
aninfectedpersonandsharingbeddingorclothingwithaninfectedperson.
Symptoms
Themostcommonsymptomofpubicliceisitchinginthepubicarea.Theitching
oftenintensifiesatnight).Thisitchingmaystartsoonafterbeinginfectedwithlice,
oritmaynotstartforupto2to4weeksaftercontact.Othersymptomsincludeskin
reactionthatisbluish-grayincolor,andinthegenitalareaduetobitesand/or
scratching.Scratchingtheskininthisareacouldalsoresultinirritationleadingtoa
secondaryinfection.
Treatment
Publicliceareverytreatableusingaprescriptionwashcontainingpermethrin.Two
ofthesewashesareElimiteandKwell.Followingthewash,thepersonmustcomb
thepubichairwithafine-toothedcombtoremovenits.Generallyasingletreatment
isallthatisnecessary.Inadditiontothistreatment,allclothingandlinensshouldbe
thoroughlywashedinhotwater.
HumanImmunodeficiencyVirus(HIV)
HIVorHumanImmunodeficiencyVirusistheretrovirusresponsibleforAIDS.HIV
andAIDSremainapersistentproblemfortheUnitedStatesandglobally.Whilea
greatdealofprogresshasbeenmadeinpreventingandtreatingHIV,thereisstill
muchtodo.In2015,39,513peoplewerediagnosedwithHIV.Theannualnumberof
newdiagnosesdeclinedby9%from2010to2014(CDC,2015b).Thismayinpartbe
duetotargetedHIVpreventionefforts.Gayandbisexualmenaccountedfor82%of
HIVdiagnosesamongmalesand67%ofalldiagnoses.Heterosexualcontact
accountedfor24%ofHIVdiagnosesandsixpercentwereattributedtoinjection
druguse(CDC,2015b).
Amongyoungerpeople,minoritieshavebeenhardhitbyHIV/AIDS.African
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Americans(45%ofHIVdiagnoses)continuetoexperiencethegreatestburdenof
HIVcomparedtootherracesandethnicities.Hispanics/Latinos(24%ofHIV
diagnoses)arealsodisproportionatelyaffectedbyHIV(CDC,2015c).
Transmission
ThereareanumberofpossibleroutesoftransmissionforHIV.
1.Mostcommonly,HIVisspreadbyhavingsexwithaninfectedpartner.Thevirus
entersthebodythroughtheliningofthevagina,vulva,penis,rectum,ormouth
duringsex.Unprotectedanalintercoursecarriesahigherriskthanmostotherforms
ofsexualactivity.
2.HIVcanbespreadamonginjection-druguserswhoshareneedlesorsyringesthat
arecontaminatedwithbloodfromaninfectedperson.
3.WomencantransmitHIVtotheirbabiesduringpregnancy,childbirthor
breastfeeding.ForwomenwhoarepregnantandHIVpositive,doctorsgenerally
recommendedanti-HIVmedicationstopreventbabiesfrombecominginfected.
4.HIVcanspreadthroughaccidentalneedlesticksorcontactwithinfectedfluids.It
israrenowadaysthatHIVwouldbespreadfromcontaminatedbloodproducts.
5.Other(rare)riskfactors:a)Eatingfoodthathasbeenpre-chewedbyanHIVinfectedperson.Thecontaminationoccurswheninfectedbloodfromacaregiver’s
mouthmixeswithfoodwhilechewing.Theonlyknowncasesareamonginfants.b)
BeingbittenbyapersonwithHIV.c)Contactbetweenbrokenskin,wounds,or
mucousmembranesandHIV-infectedbloodorblood-contaminatedbodyfluids.
HIVcannotbespreadbycasualcontact.HIVisnotanairborne,water-borneorfoodbornevirus,anddoesnotsurviveforverylongoutsidethehumanbody.Ordinary
socialcontactsuchaskissing,shakinghands,coughingorsharingsilverwaredoes
notresultinthevirusbeingpassedfrompersontoperson.
Symptoms
TherearetypicallyanumberofphasesofHIVsymptoms.Thereisasymptom-free
period,aperiodofearlyinfection.ThediseasemaythenprogresstoAIDs(acquired
immunedeficiencydisorder).
ManypeoplewithHIVdonotknowtheyareinfected.Symptomsmaynotoccur
immediately.SomepeoplewhoareexposedtoHIVdonotshowanysignsofthe
illnessforupto10years.Inothercasespeoplehaveflu-likesymptomswithindays
ofexposure,butthesesymptomsremitquickly.Duringthisasymptomaticphase,the
viruscontinuestomultiplyandinfectsandkillsthecellsoftheimmunesystem.The
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HIVvirusdestroysthecellsthataretheprimaryinfectionfighters,atypeofwhite
bloodcellcalledCD4cells.Althoughtherearenosymptomsassociatedwiththis
stageofthedisease,itisstillcontagiousandcanbepassedalongtoothers.
ThelaterstageofthediseaseisAIDS.Inthisstagethebodylosesitsabilitytofight
infections.PeoplewhohaveAIDSmaycontractanumberofseriousandpotentially
illnesses.Theseillnessesareknownasopportunisticinfectionsbecausetheyoccur
asaresultoftheweakenedimmunesystem.Opportunisticinfectionsassociated
withAIDSinclude:
•Pneumonia
•Toxoplasmosis
•Yeastinfectionsoftheesophagus
TheweakenedimmunestateofAIDscanalsoleadtocancers.Thesecancersare
difficulttotreatandmaybefatal.
•lymphomainthebrain
•Kaposi’ssarcoma.ThiscancerwasrarepriortoAIDsanditsincidencehelpedthe
CDCfirstidentifyAIDsasamedicalcondition.
Treatment
TreatmentofHIVhasprogressedconsiderablysinceitwasfirstrecognizedinthe
1980sprimarilyduetonewerantiretroviraltherapies.HAART(highlyactive
antiretroviraltherapy)isapotentdrugcocktailusedtosuppressthegrowthofHIV,
theretrovirusresponsibleforAIDS.Acombinationofatleastthreedrugsisthe
recommendationtokeepthevirusfromreplicating.Thefollowingmedicationsare
widelyusedintreatment(EMedicineHealth,2010):
Thefollowingarethedifferentclassesofmedicationsusedintreatment.
Reversetranscriptaseinhibitors(AZT/Retrovir):Inhibittheabilityofthe
virustomakecopiesofitselfandtokeepthevirusfrommultiplying.
Proteaseinhibitors(PIs):Interruptvirusreplicationatalaterstepinitslife
cycle,preventingcellsfromproducingnewviruses.Whenusedinacocktail
theyalsoreducethechancesthattheviruswillbecomeresistantto
medications.
Fusionandentryinhibitors:NeweragentsthatkeepHIVfromentering
humancells.
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IntegraseinhibitorsstopHIVgenesfrombecomingincorporatedDNA.Thisis
anewerclassofdrugsrecentlyapprovedtohelptreatthosewhohave
developedresistancetotheothermedications.
ThesemedicationsarehelpfulinallowingapersonwhoisinfectedwithHIVtolive
longerandbelesssymptomatic.TheydonotcureHIVorAIDS.
Trichomoniasis
Trichomoniasisisasexuallytransmitteddiseasethataffectsbothwomenand men,
althoughsymptomsaremorecommoninwomen.Itisthemostcommoncurable
STDinyoung,sexuallyactivewomen.Thereareanestimated7.4millionnewcases
eachyear.
Trichomoniasisiscausedbytheparasite,Trichomonasvaginalis.Thevaginaisthe
mostcommonsiteofinfectioninwomen,andtheurethraisthemostcommonsite
ofinfectioninmen.
Symptoms
Mostmenwithtrichomoniasisdonothavesymptoms,butsomemayexperiencea
mildirritationinsidethepenis,discharge,orburningafterurinationorejaculation.
Signsoftheinfectioninwomenincludeafrothy,yellow-greenvaginaldischarge
withastrongodor.Theinfectionmaycausediscomfortduringintercourseand
urination,andirritationanditchingofthevagina.Symptomsusuallyappearwithin
5to28daysofexposure.
OtherGenitalInfections
Vaginitis.VaginitisisnotconsideredanSTDbecauseitisnottransmittedbysexual
contact.Vaginitisisaninflammationofthevaginathatcanresultindischarge,
itchingandpain.Itiscommonamongwomen,particularlythoseofcollegeage.
Vaginitisisgenerallycausedbyachangeinthenormalbalanceofvaginalbacteriaor
aninfection.Vaginitiscanalsoresultfromreducedestrogenlevelsaftermenopause.
Themostcommontypesofvaginitisare:
Bacterialvaginosis,whichresultsfromovergrowthofoneofseveral
organismsnormallypresentinthevagina.Bacterialvaginosisisacommon
causeofvaginaldischargeinwomenofchildbearingage,isapolymicrobial
clinicalsyndromeresultingfromachangeinthevaginalcommunityof
bacteria.AlthoughBVisoftennotconsideredanSTD,ithasbeenlinkedto
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sexualactivity.Womenmayhavenosymptomsormaycomplainofafoulsmelling,fishy,vaginaldischarge.Womenwithbacterialvaginosisarealsoat
agreaterriskofcontractingHIVandothersexuallytransmittedinfections.In
pregnancy,bacterialvaginosiscanleadtoseriouspregnancycomplications,
includingprematureruptureofthemembranessurroundingthebabyinthe
uterus,pretermlabororprematurebirth.
Moniliaoryeastinfections,whichareusuallycausedbyanaturallyoccurring
funguscalledCandidaalbicans.
Vaginalatrophy(atrophicvaginitis),whichresultsfromreducedestrogen
levelsaftermenopause
Vaginitissymptomsmayincludeachangeincolor,odororamountofvaginal
discharge,itchingorirritation,painduringintercourseorurinationorspotting.
Treatmentoptionsdependonthetypeofvaginitisandmayincludeprescriptionand
OTCsuppositories.
SpecialPopulations
Adolescents
MostSTDsarefoundinallagegroups,withtheexceptionofpubiclice,whichis
foundprimarilyinadolescents.Comparedtoolderadults,adolescents(10-to19year-olds)areathigherriskforacquiringSTDsforanumberofreasons,including
limitedaccesstopreventiveandregularhealthcareandphysiologicallyincreased
susceptibilitytoinfection,failingtousebarrierprotection,andhavingconcurrent
multiplesexualpartners.Approximatelyoneinfoursexuallyactiveteenscontractsa
sexuallytransmitteddiseaseeveryyear.AnestimatedhalfofallnewHIVinfections
occurinpeopleunderage25.Reportedratesofchlamydiaandgonorrheaare
highestamongfemalesduringtheiradolescentandyoungadultyears,andmany
personsacquireHPVinfectionatthistime(CDC,2015b;Forhan,Gottlieb&
Sternberg,etal.,2009).
All50statesandtheDistrictofColumbiaexplicitlyallowminorstoconsentfortheir
ownhealthcareservicesforsexuallytransmitteddiseases.Nostaterequiresthat
providersnotifyparentsthatanadolescentminorhasreceivedsexuallytransmitted
diseaseservices,exceptinlimitedorunusualcircumstances(CDC,2015b).
Giventhesestatistics,routinescreeningshouldbeapartofgoodclinicalcare.With
regardtoprevention,educationefforts,especiallywithregardtosafe-sexguidelines
arekey.TheCDC(2015)recommendsthatHealth-careproviderswhocarefor
adolescentsandyoungadultsshouldintegratesexualityeducationintoclinical
practice,particularlyforallsexuallyactiveadolescents.Mason-Jonesetal.(2016)
lookedatschool-basedsexualandreproductivehealthprogramsasanapproachto
reducinghigh-risksexualbehavioramongadolescents.Whatwasuniqueaboutthis
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studywasthattheresearchersweremeasuringbiologicaldata(e.g.,contractinga
sexuallytransmitteddisease)ratherthanassessingadolescentknowledgeabout
sexualriskbehaviors.
Whilefurtherstudyisneeded,thereissomeevidencetosuggestthatschool-based
interventionsmaybehelpfulinreducingtheincidenceofsexuallytransmitted
diseasesinadolescents,especiallywhensuchprogramsarecombinedwith
measuressuchasaccesstocondoms(Kannetal.,2015).
SafeSexGuidelines
WithallSTDs,andparticularlyHIV,themosteffectivecounselissafesexor
abstinence.HydeandDeLamater(2003)providethefollowingsafesexguidelines:
1. Forthosewhochoosetobesexuallyactive,havesexonlywithoneconsistent
stablesexualpartner.
2. Forthosewhoareactivewithmultiplepartners,usealatexcondom,whichis
themosteffectiveprotectionagainstHIV.
3. Ifthereisriskthatapartnerisinfected,abstainfromsexorusealternative
formsofsexualexpressionthatdonotinvolvegenitalcontact.
4. Abstainfrombeingsexuallyactivewithpeoplewhohavehadmultiplesexual
partners.
5. DonotengageinanalsexifthereisanychancethatapartnerhasanSTD.
6. IfthereisanychanceofhavingbeenexposedtoanSTD,haveabloodtestto
verify.
Additionallyitishelpfultoprovideadolescentswithinformationonrecommended
preventionvaccinations,suchasHPVvaccinations(recommendedroutinelyfor
femalesaged11and12)andHepatitisAandBvaccinations.
PregnantWomen
Sexuallytransmitteddiseasescanhaveseverelydebilitatingeffectsonpregnant
womenandtheirbabies.Allpregnantwomenandtheirsexpartnersshouldbe
askedaboutsexuallytransmitteddiseasesandcounseledaboutthepossibilityof
suchinfections.TheCDCrecommendsroutinescreeningformostsexually
transmitteddiseases(e.g.,chlamydia,gonorrhea,syphilis,HIV,hepatitisBandC)
duringthefirstprenatalvisitforpregnantwomenunder25whodemonstraterisk
factorsfordevelopingtheseillnesses.Dependingonriskfactors,cliniciansmayalso
recommendrescreening.
Overallriskfactorsinclude:
• Newormultiplesexpartners
• Sexpartnerwithconcurrentpartners
• Sexpartnerwhohasasexually-transmitteddiseaseLiving in a high-morbidity area
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•
•
•
Previousorcoexistingsexuallytransmittedinfection
Inconsistentcondomuseamongpersonsnotinmutuallymonogamous
relationships
Exchangingsexformoneyordrugs
SpecifictoHepatitisC:
• Pastorcurrentinjection-druguse
• HavingreceivedabloodtransfusionbeforeJuly1992
• Receiptofunregulatedtattoo
• Long-termdialysis
• KnownexposuretoHepatitisC
PregnancyTransmissionandResults(CDC,2015b)
Associatedwithseriouspregnancycomplications,
Bacterial Vaginosis
includingprematureruptureofthemembranes
surroundingthebabyintheuterus,pretermlabor,
prematurebirth,chorioamnionitis(inflammationofthe
fetalmembranes)andendometritis
Untreatedchlamydialinfectionhasbeenlinkedto
Chlamydia
problemsduringpregnancy,includingpretermlabor,
prematureruptureofmembranesandlowbirthweight.
Newbornsmaybecomeinfectedduringdelivery.Exposed
newbornscandevelopeyeandlunginfections.
Lnkedtomiscarriages,prematurebirthandlowbirth
Gonorrhea
weight,prematureruptureofmembranes,and
inflammationofthefetalmembranes.Newbornsmay
becomeinfectedduringdelivery.Exposednewbornscan
developeyeandlunginfections.Treatwithantibiotics.
Canbetransmittedtothebabyduringpregnancy.Infected
Hepatitis B
newbornsalsohaveahighrisk(upto90%)ofbecoming
(HBV)
chronicHBVcarriersthemselves.Infantswhohavea
lifelonginfectionwithHBVareatanincreasedriskfor
developingchronicliverdiseaseorlivercancerlaterin
life.
Canbepassedfromaninfectedmothertoherchildduring
Hepatitis C
pregnancy.InfantsborntoHCV-infectedwomenhave
beenshowntohaveanincreasedriskforbeingsmallfor
gestationalage,premature,andhavingalowbirthweight.
Herpes Simplex Virus Transmissionmayoccurduringpregnancyandafter
delivery.Symptomsappearshortlyafterbirthandare
serious.Thebabymayhaveclustersoffluid-filledblisters
ontheirtorsooraroundtheireyes.Congenitalherpescan
causeseizures,encephalitisandinsomecasesdeath.
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Human
Immunodeficiency
Virus (HIV)
HIVcanpassfrommothertochildareduringpregnancy,
labor,anddelivery,orthroughbreastfeeding.Likeadult
HIV,acquiredHIVcandestroyspecificbloodcellsthatare
crucialtohelpingthebodyfightdiseases.
Human
Papillomavirus
(HPV)
Infectionofthemothermaybelinkedtothedevelopment
oflaryngealpapillomatosisinthenewborn—arare,
noncancerousgrowthinthelarynx.
Syphilis
Canbetransmittedfrommothertobabyduring
pregnancy.Syphilishasbeenlinkedtoprematurebirths,
stillbirths,and,insomecases,deathshortlyafterbirth.
Untreatedinfantsthatsurvivetendtodevelopproblemsin
multipleorgans,includingthebrain,eyes,ears,heart,skin,
teeth,andbones.
Thefemalenewborncanacquiretheinfectionwhen
passingthroughthebirthcanalduringdeliveryandhave
vaginaldischargeafterbirth.Thisisuncommon.Infection
inpregnancyhasbeenlinkedtoprematureruptureof
membranes,pretermbirth,andlowbirthweightinfants.
Trichomoniasis
Sexuallytransmitteddiseasessuchaschlamydia,gonorrhea,syphilis,and
trichomoniasiscanallbetreatedandcuredwithantibioticsthataresafetotake
duringpregnancy.ViralSTDs,includinggenitalherpes,hepatitisB,andHIVcannot
becured.Insomecasestheseinfectionscanbetreatedwithantiviralmedicationsor
otherpreventivemeasurestoreducetheriskofpassingtheinfectiontothebaby.
MenWhoHaveSexwithotherMen(MSM)
Menwhohavesexwithothermen(MSM)alsohavespecialriskfactorswithregard
tosexuallytransmitteddiseasesandinfections(CDC,2015b).Likeothergroups
discussedpreviously,safesexpracticesgreatlyreduceriskingayandbisexualmen.
Riskincreaseswithsexualpracticessuchasanalsex.Otherfactorsthatincreaserisk
includeanalsex,multiplesexpartners(especiallyanonymouspartners),seekingsex
partnersthroughtheInternetandsubstanceabuse(e.g.,suchmethamphetamine).
Theseriskfactorsarealsopresentinheterosexualpeoplewhoengageinthese
behaviors.Cliniciansworkinginmedicalsettingsshouldinquireaboutsymptoms
consistentwithcommonsexuallytransmittedinfections,includingurethral
discharge,discomfortwhenurinating,genitalandanalsores,rashes,anddischarge
andpainondefecationorduringanalintercourse.)Theofanyofthesesymptoms
indicatestheneedtoreferfordiagnostictesting.
IncreasedriskforsexuallytransmitteddiseasesinMSMareasfollows(CDC,
2015b):
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Gonorrhea
HepatitisA,BandC
HIV
HPV
Syphilis(primary
andsecondary)
Riskfactorsaspreviouslyindicated.Insertiveoralsexhas
beenassociatedwithurethralgonorrheaacquisition(x
pharyngealgonorrhea).Rectalgonorrheaandrectal
chlamydiaprevalenceratesamongMSMwere5.4%and
8.9%,respectively.MSMwithnewHIVinfectiondiagnoses
aremorelikelytoreceiveadiagnosisofasymptomatic
gonorrhea.
TestingofallstrainsofhepatitisrecommendedforallMSM.
VaccinationagainsthepatitisAandBisrecommendedforall
MSMinwhompreviousinfectionorvaccinationcannotbe
documented.SexualtransmissionofhepatitisCcanoccur,
especiallyamongMSMwithHIVinfection.
Riskremainshigh,particularlyinmalesofAfricanAmerican
andHispanicdescent.Riskfactorsincludeeither
receptive/insertiveanalsexwithoutacondom,having
anotherSTD,havingsexwithanonymouspartnerswithouta
condom,andusingmethamphetaminesordrugsthat
enhancesexualperformance.TheCDCrecommendsroutine
HIVscreeningforallMSMsthataresexuallyactive
(regardlessofcondomuse).
RemainshighlyprevalentinMSM.TheHPVvaccinationis
recommendedroutinelyforMSM(throughage26).
ApproximatelytwothirdsofthecasesinMSM.Riskfactors
includesyphilissecondarytoacuteHIVinfection,substance
abuse(e.g.,methamphetamine),havingmultipleanonymous
partners,andseekingsexpartnersthroughtheInternet.
TransgenderMenandWomen
Transgenderpeoplepresentadiversepicturewithregardtosexualorientationand
practices,butareagroupthatneedsscreeningforanumberofsexuallytransmitted
infections.
Muchoftheresearchrelatedtodiseaseriskamongtransgenderpeoplehasalmost
focusedontransgenderwomen(i.e.,male-to-femaletransgenderpeople).
Amongtransgenderwomen,theincidenceofsexuallytransmitteddiseases,
particularlyHIV,continuestobehigh.Herbst,Jacobs,Finlaysonetal.(2008)intheir
review,estimatetheprevalenceofHIVintheUnitedStatesis27.7%amongall
transgenderwomenand56.3%amongblacktransgenderwomen.Thisalsoappears
tobeanissueglobally.Itisimportantthatprovidersbeawareofpatient’sphysically
anatomyandsexualpracticesinordertoproperlycounseltransgenderwomen
aboutrisk.Becausemanytransgenderwomenretainafunctionalpenis,theymight
engageininsertiveoral,vaginal,oranalsexwithmenandwomen,makingrisk
factorsforallsexuallytransmitteddiseasessimilartothoseoutlinedearlierinthis
material.
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Transgendermenalsohaveavarietyofsexualorientationsandhavesexwith
varioustypesofsexualpartners.Thisvariabilitymakesitdifficulttofullyassessrisk
ofsexuallytransmitteddiseaseamongthisgroup.Whilemoreresearchisneededto
fullyunderstandthis,preliminaryresearchsuggeststhatthismaybean
underservedgroupintermsofpreventionefforts.Sevelius(2009)conducted
qualitative(n=15)andquantitative(n=45)researchwithasmallsampleof
transgendermen.Theresearcherfocusedonriskbehaviors,protectivestrategies,
andperceptionsoftheimpactoftransgenderidentityonsexualdecision-making
amongtransMSM.Manyparticipantsreportedinconsistentcondomuseduring
receptivevaginalandanalsexwithnon-transmalepartners.HIVprevalencewas
reportedtobe2.2%.Riskfactorsincludedbarrierstosexualnegotiationincluding
unequalpowerdynamics,lowself-esteem,andneedforgenderidentityaffirmation.
Protectivestrategiesincludedmeetingandnegotiatingwithpotentialpartners
online.Seveliusconcludedthatpreventionprogramsmusttailorservicestoinclude
issuesuniquetotransMSMandtheirnon-transmalepartners.
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