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Chapter 18




© 2010 McGraw-Hill Companies. All Rights Reserved.
The Major STDs
 Also known as sexually transmitted infections (STIs)
 Spread of an infection from person to person mainly
  through sexual activity
 STDs that pose a major health threat:
      1.     HIV/AIDS
      2.     Hepatitis
      3.     Syphilis
      4.     Chlamydia
      5.     Gonorrhea
      6.     Herpes
      7.     Human papillomavirus (HPV)
     CDC (2008) estimated 65 million Americans were infected
      with an STD, and about 19 million Americans become
      newly infected with an STD each year



    © 2010 McGraw-Hill Companies. All Rights Reserved.          2
Table 18.1 Annual new cases of STDs in the
United States




 © 2010 McGraw-Hill Companies. All Rights Reserved.   3
Table 18.2 Sexually transmitted pathogens
and associated diseases




 © 2010 McGraw-Hill Companies. All Rights Reserved.   4
HIV Infection and AIDS
 Human immunodeficiency virus (HIV) is the
  virus which causes AIDS (acquired
  immunodeficiency syndrome)
 Leading cause of death in some parts of the
  world
 Approximately 65 million people around the
  world have been infected with HIV since the
  epidemic began
     Nearly 1% of the world’s population
     About 3 million new infections per year
   25% of HIV-infected Americans are unaware
    of their condition



 © 2010 McGraw-Hill Companies. All Rights Reserved.   5
What is HIV Infection?
     Chronic disease that progressively damages the
      body’s immune system
       HIV attacks and invades CD4 T-cells, monocytes and
        macrophages
       HIV enters a human cell and converts its own genetic
        material, RNA, into DNA
     People with AIDS are vulnerable to a number of
      serious opportunistic (secondary) infections
     Once initial symptoms resolve, the asymptomatic
      period may last from 2 to 20 years




    © 2010 McGraw-Hill Companies. All Rights Reserved.         6
Transmitting the Virus
   HIV lives only within cells and body fluids
   Three primary means of transmission:
     Specific kinds of sexual contact
     Direct contact to infected blood
     HIV-infected women to her fetus or to infant during
      breastfeeding
     Not through casual contact




 © 2010 McGraw-Hill Companies. All Rights Reserved.         7
Figure 18.1 The general pattern of untreated
HIV infection




 © 2010 McGraw-Hill Companies. All Rights Reserved.   8
Populations of Special Concern for
HIV Infection
   Most common means of exposure:
     Sexual activity between men
     Injection drug use
     Heterosexual contact
   African American men and women are
    vastly overrepresented among U.S.
    people newly diagnosed with AIDS



 © 2010 McGraw-Hill Companies. All Rights Reserved.   9
Figure 18.2 Routes of HIV transmission among
Americans




 © 2010 McGraw-Hill Companies. All Rights Reserved.   10
Symptoms of HIV Infection
   Within a few days or weeks, some people
    will develop flulike symptoms
     Specialized test HIV RNA assay
   Symptoms take months or years to
    develop, but as immune system weakens,
    variety of symptoms develop
       Pneumocystis pneumonia (fungal infection)
       Kaposi’s sarcoma
       Difficult-to-treat yeast infections in women
       Tuberculosis




 © 2010 McGraw-Hill Companies. All Rights Reserved.    11
Diagnosing HIV Infection
   Most common tests check for the
    presence of antibodies to the virus
     HIV antibody test
     ELISA (first test)
     Western blot or immunoflourescence assay
       is done to confirm results
   If HIV positive, the next step is to
    determine the disease’s severity to plan
    appropriate treatment


 © 2010 McGraw-Hill Companies. All Rights Reserved.   12
Diagnosing AIDS
    HIV-positive and either has developed an infection
     defined as an AIDS indicator or has a severely damaged
     immune system
    Reporting
      All diagnosed cases of HIV or AIDS must be reported to public
         health authorities
    Treatment
      No cure
      Antiviral drugs
      Postexposure prophylaxis (PEP)
      Treatments for opportunistic infections
      HIV and pregnancy
      Treatment challenges




    © 2010 McGraw-Hill Companies. All Rights Reserved.
                                         Sexually Transmitted Diseases   13
Figure 18.3 The life cycle of HIV: How antiviral
drugs work




 © 2010 McGraw-Hill Companies. All Rights Reserved.   14
What About a Vaccine?
 Vaccines are being tested in humans
 Licensed AIDS vaccine is not estimated
  to be at least a decade away
     Some experts concede the possibility that a
       vaccine may never be developed
   How can you protect yourself?
     Make careful choices about sexual activity
     Don’t share drug needles
     Participate in an HIV education program


 © 2010 McGraw-Hill Companies. All Rights Reserved.   15
Figure 18.4 What’s risky and what’s not: The
approximate relative risk of HIV transmission of various
sexual activities




  © 2010 McGraw-Hill Companies. All Rights Reserved.       16
Chlamydia
 Most prevalent bacterial STD in the U.S.
 Can cause sterility in men and women
     In women, it can lead to pelvic inflammatory disease
      and ectopic (tubal) pregancy
     In men, chlamydia is the most common cause of
      epididymitis, and causes half of all cases of urethritis
   Symptoms
     Usually asymptomatic in women
     Vaginal discharge, burning with urination, watery
       discharge from penis, pain around testicles and in
       lower abdominals
 © 2010 McGraw-Hill Companies. All Rights Reserved.              17
Chlamydia
   Diagnosis
     Examination of tissue samples or urine
   Treatment
     Once diagnosed, infected person and partner
       are given antibiotics




 © 2010 McGraw-Hill Companies. All Rights Reserved.   18
Gonorrhea
    350,000 new cases reported to the CDC in
     2007
    Bacterial infection
    Can cause sterility, arthritis, heart problems,
     PID, ectopic pregnancy, urethritis, and
     gonococcal conjunctivitis in infants of
     infected mothers
    Symptoms
      Usually asymptomatic in women, though frequent
       burning during urination, menstrual irregularities, pelvic
       pain, and discharge may occur
      Thick yellow-white discharge, and painful urination in
       men


    © 2010 McGraw-Hill Companies. All Rights Reserved.              19
Gonorrhea
 Diagnosis
    Microscopic exam of discharge can
       diagnose infection
 Treatment
    Oral antibiotics can be taken for treatment
      ○ Growing number of drug-resistant strains of
        gonorrhea is a major concern




© 2010 McGraw-Hill Companies. All Rights Reserved.    20
Pelvic Inflammatory Disease
   Leading cause of infertility in young women
   Symptoms
     Long and painful periods, discharge, spotting, low
        abdominal pain, fever, chills, nausea, and vomiting
   Diagnosis
     Diagnosis made on basis of symptoms, physical
        examination, ultrasound, and laboratory tests
   Treatment
     Antibiotics and hospitalization are normally required




    © 2010 McGraw-Hill Companies. All Rights Reserved.        21
Human Papillomavirus Infection
    Most common STD in the U.S.
    Causes a variety of human diseases:
      Common warts
      Genital warts
      Genital cancers
    Highly contagious
    New vaccination for HPV: Gardasil
      Protects against four types of HPV virus that account for
       90% of genital warts and 70% of cervical cancers
      Most effective before the onset of sexual activity




 © 2010 McGraw-Hill Companies. All Rights Reserved.                22
Human Papillomavirus Infection
   Symptoms
     Small bump on the skin or a large, warty growth
     Cauliflower-like mass
     May cause irritation and bleeding
   Diagnosis
     Diagnosed based on the appearance of lesions
     Often detected during routine PAP tests
   Treatment
     Treatment focuses on reducing the number and
       size of warts
       ○ Cryosurgery (freezing)
       ○ Electrocautery (burning)
       ○ Laser surgery




 © 2010 McGraw-Hill Companies. All Rights Reserved.     23
Genital Herpes
   1 in 5 adults in the U.S. has genital herpes
   Two forms cause genital herpes and oral-labial
    herpes
     HSV 1 (Type 1)
        ○ Associated with cold sores and fever blisters
        ○ Oral-labial herpes
        ○ 50-80% of U.S. adults have antibodies to HSV-1
     HSV 2 (Type 2)
        ○ Almost always sexually transmitted
        ○ Usually occurs during adolescence and early adulthood
        ○ Approximately 22% of adults have antibodies to HSV 2
   Remains in the body for life


© 2010 McGraw-Hill Companies. All Rights Reserved.                24
Genital Herpes
   Symptoms
     90% of infected people have no symptoms
     First episode causes flulike symptoms and genital
      lesions
     Virus remains alive in an inactive state and an
      outbreak can occur at any time
   Diagnosis
     Diagnosed through examination of sores and culturing
       of fluid taken from sores
   Treatment
     No cure
     Antiviral drugs taken at the beginning of an outbreak
       can shorten the severity and duration of symptoms


 © 2010 McGraw-Hill Companies. All Rights Reserved.           25
Hepatitis B
   Inflammation of the liver which can cause
    serious and permanent damage to the liver
   Highly contagious but preventable with vaccine
   Transmitted through the exchange of bodily
    fluids
   Symptoms
     Flulike symptoms, nausea, vomiting, dark-colored
       urine, abdominal pain, and jaundice
   Diagnosis and treatment
     Diagnosed through a blood test
     No cure
   Prevention

 © 2010 McGraw-Hill Companies. All Rights Reserved.      26
Syphilis
   Can be effectively treated with antibiotics
   Symptoms
     Primary phase: 10-90 days after exposure
         ○ Characterized by painless ulcers, called chancres
     Secondary phase: 3-6 weeks after exposure
         ○ Characterized by flulike symptoms and highly contagious
            skin rash
     Late, or tertiary, phase
         ○ Damage to organs, dementia, cardiovascular damage,
            blindness, and death
   Diagnosis and treatment
     Diagnosed by examination of infected tissues and
      with blood tests
     Treated by antibiotics but damage from late stages
      of infection can be permanent


© 2010 McGraw-Hill Companies. All Rights Reserved.                   27
Other STDs
   Trichomoniasis
     Most common curable STD among young
      women
     Single-celled organism
   Bacterial vaginosis (BV)
     Abnormal vaginal discharge caused by
       unhealthy species of normal vaginal bacteria
   Pubic lice and scabies
     Contagious parasitic infections




 © 2010 McGraw-Hill Companies. All Rights Reserved.   28
What You Can Do
   Education
   Diagnosis and treatment
       Get vaccinated
       Be alert for symptoms
       Get tested
       Inform your partners
       Get treated
   Prevention
     Talk openly about your concerns
     Know your potential partner



 © 2010 McGraw-Hill Companies. All Rights Reserved.   29
Chapter 18




© 2010 McGraw-Hill Companies. All Rights Reserved.

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Insel11e ppt18

  • 1. Chapter 18 © 2010 McGraw-Hill Companies. All Rights Reserved.
  • 2. The Major STDs  Also known as sexually transmitted infections (STIs)  Spread of an infection from person to person mainly through sexual activity  STDs that pose a major health threat: 1. HIV/AIDS 2. Hepatitis 3. Syphilis 4. Chlamydia 5. Gonorrhea 6. Herpes 7. Human papillomavirus (HPV)  CDC (2008) estimated 65 million Americans were infected with an STD, and about 19 million Americans become newly infected with an STD each year © 2010 McGraw-Hill Companies. All Rights Reserved. 2
  • 3. Table 18.1 Annual new cases of STDs in the United States © 2010 McGraw-Hill Companies. All Rights Reserved. 3
  • 4. Table 18.2 Sexually transmitted pathogens and associated diseases © 2010 McGraw-Hill Companies. All Rights Reserved. 4
  • 5. HIV Infection and AIDS  Human immunodeficiency virus (HIV) is the virus which causes AIDS (acquired immunodeficiency syndrome)  Leading cause of death in some parts of the world  Approximately 65 million people around the world have been infected with HIV since the epidemic began  Nearly 1% of the world’s population  About 3 million new infections per year  25% of HIV-infected Americans are unaware of their condition © 2010 McGraw-Hill Companies. All Rights Reserved. 5
  • 6. What is HIV Infection?  Chronic disease that progressively damages the body’s immune system  HIV attacks and invades CD4 T-cells, monocytes and macrophages  HIV enters a human cell and converts its own genetic material, RNA, into DNA  People with AIDS are vulnerable to a number of serious opportunistic (secondary) infections  Once initial symptoms resolve, the asymptomatic period may last from 2 to 20 years © 2010 McGraw-Hill Companies. All Rights Reserved. 6
  • 7. Transmitting the Virus  HIV lives only within cells and body fluids  Three primary means of transmission:  Specific kinds of sexual contact  Direct contact to infected blood  HIV-infected women to her fetus or to infant during breastfeeding  Not through casual contact © 2010 McGraw-Hill Companies. All Rights Reserved. 7
  • 8. Figure 18.1 The general pattern of untreated HIV infection © 2010 McGraw-Hill Companies. All Rights Reserved. 8
  • 9. Populations of Special Concern for HIV Infection  Most common means of exposure:  Sexual activity between men  Injection drug use  Heterosexual contact  African American men and women are vastly overrepresented among U.S. people newly diagnosed with AIDS © 2010 McGraw-Hill Companies. All Rights Reserved. 9
  • 10. Figure 18.2 Routes of HIV transmission among Americans © 2010 McGraw-Hill Companies. All Rights Reserved. 10
  • 11. Symptoms of HIV Infection  Within a few days or weeks, some people will develop flulike symptoms  Specialized test HIV RNA assay  Symptoms take months or years to develop, but as immune system weakens, variety of symptoms develop  Pneumocystis pneumonia (fungal infection)  Kaposi’s sarcoma  Difficult-to-treat yeast infections in women  Tuberculosis © 2010 McGraw-Hill Companies. All Rights Reserved. 11
  • 12. Diagnosing HIV Infection  Most common tests check for the presence of antibodies to the virus  HIV antibody test  ELISA (first test)  Western blot or immunoflourescence assay is done to confirm results  If HIV positive, the next step is to determine the disease’s severity to plan appropriate treatment © 2010 McGraw-Hill Companies. All Rights Reserved. 12
  • 13. Diagnosing AIDS  HIV-positive and either has developed an infection defined as an AIDS indicator or has a severely damaged immune system  Reporting  All diagnosed cases of HIV or AIDS must be reported to public health authorities  Treatment  No cure  Antiviral drugs  Postexposure prophylaxis (PEP)  Treatments for opportunistic infections  HIV and pregnancy  Treatment challenges © 2010 McGraw-Hill Companies. All Rights Reserved. Sexually Transmitted Diseases 13
  • 14. Figure 18.3 The life cycle of HIV: How antiviral drugs work © 2010 McGraw-Hill Companies. All Rights Reserved. 14
  • 15. What About a Vaccine?  Vaccines are being tested in humans  Licensed AIDS vaccine is not estimated to be at least a decade away  Some experts concede the possibility that a vaccine may never be developed  How can you protect yourself?  Make careful choices about sexual activity  Don’t share drug needles  Participate in an HIV education program © 2010 McGraw-Hill Companies. All Rights Reserved. 15
  • 16. Figure 18.4 What’s risky and what’s not: The approximate relative risk of HIV transmission of various sexual activities © 2010 McGraw-Hill Companies. All Rights Reserved. 16
  • 17. Chlamydia  Most prevalent bacterial STD in the U.S.  Can cause sterility in men and women  In women, it can lead to pelvic inflammatory disease and ectopic (tubal) pregancy  In men, chlamydia is the most common cause of epididymitis, and causes half of all cases of urethritis  Symptoms  Usually asymptomatic in women  Vaginal discharge, burning with urination, watery discharge from penis, pain around testicles and in lower abdominals © 2010 McGraw-Hill Companies. All Rights Reserved. 17
  • 18. Chlamydia  Diagnosis  Examination of tissue samples or urine  Treatment  Once diagnosed, infected person and partner are given antibiotics © 2010 McGraw-Hill Companies. All Rights Reserved. 18
  • 19. Gonorrhea  350,000 new cases reported to the CDC in 2007  Bacterial infection  Can cause sterility, arthritis, heart problems, PID, ectopic pregnancy, urethritis, and gonococcal conjunctivitis in infants of infected mothers  Symptoms  Usually asymptomatic in women, though frequent burning during urination, menstrual irregularities, pelvic pain, and discharge may occur  Thick yellow-white discharge, and painful urination in men © 2010 McGraw-Hill Companies. All Rights Reserved. 19
  • 20. Gonorrhea  Diagnosis  Microscopic exam of discharge can diagnose infection  Treatment  Oral antibiotics can be taken for treatment ○ Growing number of drug-resistant strains of gonorrhea is a major concern © 2010 McGraw-Hill Companies. All Rights Reserved. 20
  • 21. Pelvic Inflammatory Disease  Leading cause of infertility in young women  Symptoms  Long and painful periods, discharge, spotting, low abdominal pain, fever, chills, nausea, and vomiting  Diagnosis  Diagnosis made on basis of symptoms, physical examination, ultrasound, and laboratory tests  Treatment  Antibiotics and hospitalization are normally required © 2010 McGraw-Hill Companies. All Rights Reserved. 21
  • 22. Human Papillomavirus Infection  Most common STD in the U.S.  Causes a variety of human diseases:  Common warts  Genital warts  Genital cancers  Highly contagious  New vaccination for HPV: Gardasil  Protects against four types of HPV virus that account for 90% of genital warts and 70% of cervical cancers  Most effective before the onset of sexual activity © 2010 McGraw-Hill Companies. All Rights Reserved. 22
  • 23. Human Papillomavirus Infection  Symptoms  Small bump on the skin or a large, warty growth  Cauliflower-like mass  May cause irritation and bleeding  Diagnosis  Diagnosed based on the appearance of lesions  Often detected during routine PAP tests  Treatment  Treatment focuses on reducing the number and size of warts ○ Cryosurgery (freezing) ○ Electrocautery (burning) ○ Laser surgery © 2010 McGraw-Hill Companies. All Rights Reserved. 23
  • 24. Genital Herpes  1 in 5 adults in the U.S. has genital herpes  Two forms cause genital herpes and oral-labial herpes  HSV 1 (Type 1) ○ Associated with cold sores and fever blisters ○ Oral-labial herpes ○ 50-80% of U.S. adults have antibodies to HSV-1  HSV 2 (Type 2) ○ Almost always sexually transmitted ○ Usually occurs during adolescence and early adulthood ○ Approximately 22% of adults have antibodies to HSV 2  Remains in the body for life © 2010 McGraw-Hill Companies. All Rights Reserved. 24
  • 25. Genital Herpes  Symptoms  90% of infected people have no symptoms  First episode causes flulike symptoms and genital lesions  Virus remains alive in an inactive state and an outbreak can occur at any time  Diagnosis  Diagnosed through examination of sores and culturing of fluid taken from sores  Treatment  No cure  Antiviral drugs taken at the beginning of an outbreak can shorten the severity and duration of symptoms © 2010 McGraw-Hill Companies. All Rights Reserved. 25
  • 26. Hepatitis B  Inflammation of the liver which can cause serious and permanent damage to the liver  Highly contagious but preventable with vaccine  Transmitted through the exchange of bodily fluids  Symptoms  Flulike symptoms, nausea, vomiting, dark-colored urine, abdominal pain, and jaundice  Diagnosis and treatment  Diagnosed through a blood test  No cure  Prevention © 2010 McGraw-Hill Companies. All Rights Reserved. 26
  • 27. Syphilis  Can be effectively treated with antibiotics  Symptoms  Primary phase: 10-90 days after exposure ○ Characterized by painless ulcers, called chancres  Secondary phase: 3-6 weeks after exposure ○ Characterized by flulike symptoms and highly contagious skin rash  Late, or tertiary, phase ○ Damage to organs, dementia, cardiovascular damage, blindness, and death  Diagnosis and treatment  Diagnosed by examination of infected tissues and with blood tests  Treated by antibiotics but damage from late stages of infection can be permanent © 2010 McGraw-Hill Companies. All Rights Reserved. 27
  • 28. Other STDs  Trichomoniasis  Most common curable STD among young women  Single-celled organism  Bacterial vaginosis (BV)  Abnormal vaginal discharge caused by unhealthy species of normal vaginal bacteria  Pubic lice and scabies  Contagious parasitic infections © 2010 McGraw-Hill Companies. All Rights Reserved. 28
  • 29. What You Can Do  Education  Diagnosis and treatment  Get vaccinated  Be alert for symptoms  Get tested  Inform your partners  Get treated  Prevention  Talk openly about your concerns  Know your potential partner © 2010 McGraw-Hill Companies. All Rights Reserved. 29
  • 30. Chapter 18 © 2010 McGraw-Hill Companies. All Rights Reserved.

Notes de l'éditeur

  1. Table 18-1 Annual New Cases of STDs in the United States
  2. Table 18-2 Sexually Transmitted Pathogens and Associated Disease
  3. Figure 18-1 The general pattern of untreated HIV infection
  4. Figure 18-2 Routes of HIV transmission among adults
  5. Figure 18-3 The life cycle of HIV: How antiviral drugs work
  6. Figure 18-4 What’s risky and what’s not: The approximate relative risk of HIV transmission of various sexual activities.
  7. Symptoms appear in 7-21 days