Chapter Fifteen Sexually Transmitted Infections and HIV/AIDS Agenda Discuss Attitudes and STIs Review Information about Sexually Transmitted Infections Discuss Human Immunodeficiency Virus (HIV) and.
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Transcript Chapter Fifteen Sexually Transmitted Infections and HIV/AIDS Agenda Discuss Attitudes and STIs Review Information about Sexually Transmitted Infections Discuss Human Immunodeficiency Virus (HIV) and.
Chapter Fifteen
Sexually Transmitted Infections and
HIV/AIDS
Agenda
Discuss Attitudes and STIs
Review Information about Sexually
Transmitted Infections
Discuss Human Immunodeficiency Virus
(HIV) and Acquired Immune Deficiency
Syndrome (AIDS)
Review Cross-Cultural Aspects of AIDS
Discuss Preventing STIs and AIDS
Introduction
Over 65 million people in the U.S. are living
with an incurable STI
19 million STI infections occur each year, half
to those to people 15-24 years old
There are more than 25 infections that spread
mainly through sexual activity
Design a Campaign
You have been chosen to develop a
campaign aimed at developing healthy
sexuality for high school students.
In this particular city the rate of STIs is the
highest in the country.
Develop the components of your ad
campaign.
Present your campaign plan to class.
Self Reflection Exercise
Do NOT discuss. Write down your thoughts
privately.
If I found out I was infected with herpes or
genital warts, I would …
If my partner were infected with chlamydia,
I would …
If I found out I had AIDS, I would …
Attitudes about Sexually
Transmitted Infections
Attitudes and the STI Epidemic
STIs have been viewed as a sign of corrupt
sexuality
Punishment concept of disease – that a
person got what they deserved
Negative beliefs and stigma about STIs
currently exist
These negative attitudes can interfere with
getting tested for an STI
Attitudes and the STI Epidemic
College students believe they are immune to
STIs and engage in high-risk sexual
behaviors
e.g. multiple partners, unprotected
intercourse
2/3 of STIs occur in people under 25
Sexually Transmitted
Infections: Trends
Reporting
Pregnancy Complications
Protection
Reporting Issues
All states must report syphilis, gonorrhea,
chancroid, chlamydia, HIV, & AIDS cases
Many states require that genital warts and
herpes be reported
Women are more susceptible to gonorrhea,
chlamydia, HIV
Women have more risk of complications from
STIs because vaginal tissue is fragile
Women are more likely to be asymptomatic
Pregnancy Complications
STIs can affect pregnancies
30-40% of preterm births and infant deaths
are due to STIs
Some can cross the placenta (syphilis, HIV)
Some can infect the newborn during delivery
(chlamydia, gonorrhea, herpes, HIV)
HIV can be transmitted through breastfeeding
Antibiotics and c-sections can minimize harm
Protection
Barrier methods can decrease the risk of STIs
Non-oxynol 9 may increase the risk of
infection by irritating the skin
Condoms are the most effective contraceptive
that reduces the STI risk
Condoms cannot cover all of the penis, vulva,
or scrotum
Protection: Partner Issues
Most effective way of avoiding STIs is to
abstain from oral, vaginal, and anal sex or be
in a long-term, mutually monogamous
relationship with someone free from STIs
If a person does have an STI, treatment
should include treatment of their sexual
partner(s)
Class Exercise: Condom Line Up
Penis becomes erect
Carefully open package and remove
condom
Buy/Get condoms
Store condoms in cool, dry place
Check expiration date
Decide with partner to have sexual
intercourse
Check to see which way condom unrolls
Talk about protection and safer sex
Lose erection
Pull back foreskin if uncircumcised
Place condom on head of penis
Orgasm and ejaculation
Gently squeeze air out of tip of condom
Roll condom all the way down erect
penis
Intercourse
Throw away condom in garbage – don’t
flush
Hold condom at base of penis and
withdraw penis
Remove condom from penis
Lose erection
1. Decide with partner to have sexual
intercourse
2. Talk about protection and safer sex
3. Buy/Get condoms
4. Store condoms in cool, dry place
5. Check expiration date
6. Penis becomes erect
7. Carefully open package and remove
condom
8. Check to see which way condom unrolls
9. Lose erection
10. Pull back foreskin if uncircumcised
11. Place condom on head of penis
12. Gently squeeze air out of tip of condom
13. Roll condom all the way down erect
penis
14. Intercourse
15. Orgasm and ejaculation
16. Hold condom at base of penis and
withdraw penis
17. Remove condom from penis
18. Lose erection
19. Throw away condom in garbage – don’t
flush
Sexually Transmitted
Infections
Ectoparasitic Infections
Bacterial Infections
Viral Infections
Ectoparasitic Infections
Parasites that live on the skin’s surface
Two sexually transmitted varieties:
Pubic Lice
Scabies
Pubic Lice
Also called “crabs”
Small, wingless insects that are difficult to
detect on light-skinned people
Attach to pubic hair (preferred) by their claws
& drink from tiny blood vessels under the skin
Cannot survive more than 24 hours off of the
body, however, they reproduce rapidly and
eggs are cemented to the hair
Highly contagious
Pubic Lice: Prevalence, Symptoms,
Treatment
Incidence: common
Symptoms: mild to severe itching (particularly
at night) thought to be due to allergic reaction
from their saliva
Diagnosis: lice and eggs are visible
Treatment: kill eggs & lice with Kwell ointment
(shampoo, cream); clothing & sheets dry
cleaned, boiled, or washed in hot water
Scabies
Mite Sarcoptes scabiei
Spread via any skin-to-skin contact
Mites can live up to 48 hours off of the body
Not visible to naked eye
Scabies: Prevalence, Symptoms, Treatment
Incidence: millions worldwide
Symptoms: rash and severe itching
Diagnosis: examination of the rash and a skin
scraping can confirm diagnosis
Typically less than 10 mites on the body
during an infection
Treatment: topical creams; clothing and
sheets washed in hot water
Bacterial Infections
Gonorrhea
Syphilis
Chlamydia and Nongonococcal Urethritis
Chancroid
Vaginal Infections
Pelvic Inflammatory Disease
Gonorrhea
Also called the “clap” or “drip”
Survives only in mucous membranes, such as
the cervix, mouth, urethra, rectum, throat,
eyes
Transmitted when mucous membranes
contact each other
Incidence: second most commonly reported
infectious disease in the U.S.; 600,000 to 1
million new cases each year
Gonorrhea: Symptoms
Women: most are asymptomatic, cervix is
most common infection site; urinary
frequency, abnormal bleeding
Men: 25% are asymptomatic; epididymitis,
urethral discharge, painful, frequent, & urgent
urination
Swelling, pain, & pus in the joints
Rectal gonorrhea: bloody stools & pus
Gonorrhea: Diagnosis & Treatment
Diagnosis: examine for bacteria in a sample
of the discharge; can also run DNA testing of
urine
Treatment: antibiotics (oral, injection)
Note: there are rare cases when they have
become drug-resistant
Syphilis
Live in the mucous membranes
Typically first infects the cervix, anus, penis,
lips, or nipples
Incidence: 7,177 cases reported in 2003
Symptoms: 3 stages
Primary/Early
Secondary (after chancres disappear)
Tertiary (remission, but still infectious; can
lead to long term health risks)
Syphilis: Stage 1
1: primary/early syphilis 10-90 days after
infection
Chancres (small, round, red-brown,
painless sores with a hard raised edge &
sunken center) may appear on the
vulva, penis, vagina, cervix, anus,
mouth, lips
Syphilis: Stage 2
2: secondary syphilis after chancres
disappear
Syphilis invades the central nervous
system
Reddish patches on the skin, possible
wart-like growths in area of infection
Lymph glands enlarge
Headaches, fever, anorexia, flu-like
symptoms, fatigue
Syphilis: Stage 3
3: tertiary/late syphilis
Stage of remission and a person feels
fine, though able to transmit the disease
for 1 year
If not treated, this stage can cause
neurological, muscular, sensory, &
psychological difficulties and is
eventually fatal
Syphilis: Diagnosis & Treatment
Diagnosis: culture taken from a lesion; blood
tests
Treatment: Penicillin; antibiotics can
temporarily increase the symptoms for a few
hours
Chlamydia and Nongonococcal
Urethritis
May also cause epididymitis and
nongonococcal urethritis in men
Incidence: most commonly reported
infectious disease in the U.S.; estimated 2.8
million new cases per year
Highest among African Americans
Higher in young women
Underdiagnosed in men
Chlamydia and Nongonococcal
Urethritis: Symptoms
Chlamydia is highly contagious
Symptoms: asymptomatic in 75% of women
and 50% of men
Female symptoms: burning while urinating,
painful intercourse, pain in lower abdomen,
bleeding/spotting, rare for discharge
40% will get PID, 20% will become infertile
Male symptoms: discharge from penis,
burning while urinating, burning & itching at
penile opening, pain or swelling of testicles
Chlamydia and Nongonococcal
Urethritis: Diagnosis & Treatment
Diagnosis: culture cervical discharge for
women, blood test, urine test for men
Treatment: antibiotics for 7-10 days; some
cases have become drug-resistant
Vaginal Infections
There are many common vaginal infections
related to sexual intercourse
Trichomoniasis
Bacterial vaginosis
Candiasis
Trichomoniasis
Trichomonas vaginalis
Female symptoms 3-28 days after infection:
increase in yellowish, frothy, & foul-smelling
vaginal discharge; burning/itching in vagina;
asymptomatic
Male symptoms: asymptomatic, discharge at
tip of penis, burning while urinating or
ejaculating
Treatment: metronidazole (Flagyl™)
Bacterial Vaginosis
Most common vaginal infection in women of
childbearing age, though half are
asymptomatic
Increased susceptibility with: multiple
partners, douching, low concentrations of
beneficial vaginal bacteria
Treatment: metronidazole or clindamycin
Candidiasis
Vulvovaginal candiasis; yeast infection
Caused by a variety of fungi, most commonly
Candida albicans
Fungi normally common in vagina, but will
multiply when the pH balance is disturbed
pH changes due to: pregnancy, oral
contraceptives, douching, antibiotics,
diabetes, fecal material contacting the vagina
Candidiasis
Symptoms: burning, itching, and increase in
vaginal discharge that may be thin, white, and
including white chunks
75% of women will have at least one yeast
infection
Recurrences are common
Treatment: antifungal prescription or over-thecounter drugs (cream is topical or inserted
into the vagina); plain yogurt
Pelvic Inflammatory Disease
Infection of the female genital tract
Most often caused by chlamydia and
gonorrhea
PID can cause long-term complications such
as ectopic pregnancies, chronic pelvic pain,
infertility
Estimated to affect 1 out of 7 women by age
35 at least once
Pelvic Inflammatory Disease:
Symptoms & Tratment
Characteristics of a typical PID sufferer:
young, unmarried, multiple partners, had an
STI, early age at first intercourse, minority,
use douches
Symptoms: acute pelvic pain, high fever,
abnormal vaginal discharge
Often asymptomatic
Treatment: antibiotics for 14 days
Viral Infections
Once a virus enters a body, it can reproduce
and the person will have it for the rest of their
life
Although they may not experience
symptoms while the virus lies dormant,
they are still infected
Common Viral STIs
Herpes
Human Papillomavirus
Viral Hepatitis
Herpes
Infection with herpes simplex virus (HSV)
The virus prefers the mouth and face (herpes
simplex I) or the genitals (herpes simplex II)
The symptoms may be less severe if the virus
infects a less preferred site
The virus exists in the sores, as well as from
the infected skin without the sores present
(viral shedding)
HSV can be spread without active symptoms
A person can reinfect themselves on another
body part
Herpes: Incidence & Symptoms
Incidence: one of the most common STIs in
the U.S.; 1 million infected each year
Symptoms: sores that last 8-10 days,
tingling/burning feeling, itching & red swollen
genitals, painful urination, blisters with pus,
fever, headaches, pain, itching, discharge,
fatigue
Over time, outbreak frequency diminishes
Psychological reactions: guilt, anger,
anxiety, helplessness, frustration,
depression, lowered self-esteem
Herpes: Diagnosis & Tratment
Diagnosis: presence of blisters, sometimes a
scraping will be taken
Treatment: no cure; therapy with antiviral
drugs (topical, oral, injected) to decrease
outbreaks, prevent complications, & reduce
viral shedding; ice pack; cooling or drying
agent; L-lysine; decrease sugar & nuts
Vaccines are undergoing trials
Human Papillomavirus
Over 30 types of HPV
Almost all cervical cancers can be attributed
to HPV and HPV can also cause genital warts
Transmitted through intercourse, oral sex,
vulva-to-vulva sex, anal sex
Incidence: estimated 50% of sexually active
people will get HPV
Related factors: intercourse before 16, 2+
sexual partners in a year, Hispanic women
Human Papillomavirus: Symptoms &
Treatment
Symptoms: asymptomatic; genital warts in
10% of HPV cases (highly contagious); foulsmelling discharge; itching & pain
Diagnosis: visual inspection of warts,
biopsies, Pap test
Treatment: chemical topical solutions,
cryotherapy, electrosurgical interventions,
laser surgery
May resolve itself or need many treatments
Viral Hepatitis
3 types & their transmission routes:
Hepatitis A (HAV) – fecal-oral contact;
vaccine-preventable
Hepatitis B (HBV) – high-risk sexual
behaviors
Hepatitis C (HCV) – sexual behavior, drug
use, unscreened blood transfusion
Incidence:
HAV: 1/3 in the U.S.
HBV: 1.25 million in the U.S.
HCV: 3.9 million in the U.S.
Viral Hepatitis: Symptoms
HAV: fatigue, abdominal pain, loss of
appetite, diarrhea
HBV: asymptomatic, nausea, vomiting,
headaches, jaundice, fever, fatigue, darkened
urine, liver enlargement, chronic liver disease
HCV: asymptomatic, mild illness, chronic liver
infection
Viral Hepatitis: Diagnosis & Treatment
Diagnosis: blood test
Treatment: 3 drugs that interfere with the life
cycle of the virus and induces an immune
response
Vaccines are available for HAV and HBV
Recommended for high risk individuals
HIV/AIDS
Incidence
Knowledge and Attitudes about AIDS
Symptoms
Diagnosis
Treatment
Prevention
Families and AIDS
CNN Video: Fighting AIDS in Africa
Overview of HIV and AIDS
AIDS is caused by HIV
HIV is transmitted through bodily fluids
(semen, vaginal fluid, blood) during vaginal &
anal intercourse or by sharing needles
The virus may remain dormant, however, it is
often fatal if untreated
Origin of HIV is unknown
HIV and AIDS: Progression
HIV attacks T-lymphocytes (T-helper cells) in
the blood, lowering the body’s ability to fight
infections
Immune system releases antibodies & many
white blood cells to fight the HIV infection
The lowered immune system response
means many opportunistic diseases infect
people with AIDS that a healthy person can
easily fight
Incidence of HIV/AIDS
Since 1981, 1.5 million Americans have
become infected; 35-42 million worldwide
Women are the fastest growing group in the
U.S. because vaginal tissue is more easily
damaged during intercourse, although men
drive the spread of HIV
Can be transmitted to a baby during
pregnancy, labor & delivery, & breastfeeding
71% of new AIDS cases are in minorities
Video: “One + One”
Discuss your response to this video.
What did you learn about HIV/AIDS?
Knowledge and Attitudes about AIDS
More knowledge about AIDS in the U.S. has
not been correlated with practice of safer sex
or behavior changes
3 unique aspects of AIDS:
Fear of transmission
Social worth of those with the disease
Incomprehensible magnitude of the
disease
AIDS remains stigmatized in the U.S.
Symptoms
Decline in T-helper cells takes 3 years if
depressed, and 5+ years if not depressed
AIDS develops within 8-10 years without
treatment
Early symptoms are flu like (fever, headaches,
fatigue, sore throat, swollen lymph nodes)
Later symptoms: weight loss, severe diarrhea,
night sweats, oral candidiasis, gingivitis, oral
ulcers, fever, dizziness, confusion
Opportunistic diseases: pneumonia,
toxoplasmosis, cryptococcosis, cytomegalovirus,
Kaposi’s sarcoma
Diagnosis
Tests typically look for antibodies that fight
HIV, though some may look for HIV in blood
Antibody tests can require 2 weeks for the
result
Rapid tests are less effective
False negative and false positive results are
possible with all tests
CNN Video: New HIV Testing Procedure
Treatment
Before treatment, a viral load test and CD4+ T cell
count are taken to determine how much HIV is in the
system and to provide a baseline to assess the
effectiveness of treatment
HAART – highly active antiretroviral therapy
Blend of 3+ HIV drugs (drug cocktails)
Can involve taking 25+ pills a day at different
times on a strict schedule
Expensive: $10,000 to $15,000 per year
Side effects: fatigue, fever, rashes, nightmares,
headaches, nausea, diarrhea, increased
cholesterol, diabetes, lowered bone density, liver
problems
Prevention
Requires behavior change
Many schools now include AIDS education
HAART has been related to an increase in
high risk sexual practices in homosexual
men, but not among heterosexuals
If infected, inform past partners that they
should be tested
Research into high risk behaviors is needed
First AIDS vaccine was found ineffective
Families and AIDS
Due to the social stigma, caretakers often
have no one to turn to
Adolescents that were told their parents had
AIDS had more emotional distress and
engaged in more high risk sexual practices
Cross-Cultural Aspects of AIDS
95% of HIV cases lack access to treatment
AIDS has largely affected children
Areas throughout the world:
Asia and the Pacific
Europe and Central Asia
Sub-Saharan Africa
Latin America and the Caribbean
The Middle East and North Africa
Other Issues
Asia and the Pacific
Over 7 million with HIV, many are young
Rising number of infections in India & China
China lacks an adequate supply of condoms
3% of Cambodia is infected
Indonesia’s rise in IV drug use adds to the
HIV epidemic
Thailand has shown a decrease due to the
copy of antiretroviral drugs for patients and a
100% condom use program for prostitutes
Europe and Central Asia
2 million people
Large increase of HIV infections in the
Russian Federation, mainly because of IV
drug use
Sub-Saharan Africa
Most of the people with HIV live in Africa
70% of HIV-positive people live in subSaharan Africa
Most people are not receiving HAART
therapy due to costs, and they are also not
being treated for opportunistic diseases
Male-female power disparity is problematic
HIV-positive men believe sex with a virgin will
cure them
Latin America and the Caribbean
2 million adults and children
Many countries offer free or low cost
antiretroviral therapy to those with HIV/AIDS
They are able to reproduce the drugs that are
not patented outside of the U.S.
The Middle East and North Africa
480,000 people
Due to IV drug use, men having sex with
men, prostitution, low condom usage
Prevention
Preventing STIs and AIDS
If sexually active, you should get tested
Have partner tested if in a sexual relationship
Carefully choose partners
Use barrier methods, such as condoms
Avoid high-risk sexual behaviors if not in a
monogamous relationship
Early detection & treatment is important
Notify your sexual partners
Talking about STIs – honesty & trust