FEMALE SEXUALITY

SEXUALLY TRANSMITTED DISEASES (STD’s)

SUZANNA ROSE

I. Basics of Communicable Diseases

A. Pathogens:

• CD’s are caused by infectious agents, called Pathogens (i.e.; bacteria, fungi, yeast, protozoa, viruses, etc)

B. Transmission:

• Pathogens from STD’s almost exclusively transmitted via direct contact, such as oral, anal, vaginal sex.

C. Incubation Period

• Time between exposure & appearance of symptoms. Pathogens increase in number & begin to produce disease. Maybe contagious even without presence of symptoms.

II. Current Incidence

• WHO estimates 125 million new cases of STD’s per year (356,000 per day)

  1. AIDS ­ 58,000 in 1997

  2. Clamydia ­ 4 million new cases/annually

  3. Gonorrhea ­ Over 300,000 new cases per year

  4. Genital Herpes ­ 40 to 50 million Americans infected

  5. HPV (genital warts) ­ 750,000 per year

  6. Syphilis ­ 8,000 cases reported in 1997

• Under reported because of failure to seek treatment; Private MD’s fail to report to public health services

III. Categories of STD’s

a. Viral Infections

b. Bacterial Infections

c. Other

IV. Viral Infections - HIV/AIDS

A. Historical perspective

• 1981; reports of new disease affecting gays/I.V. drug users

B. Virus Types

• HIV-1 (primary strain in U.S.)
• HIV-2 (2nd strain of virus was identified in 1985)

C. Current Perspective

• WHO estimated that 22 to 26 million people infected in world with HIV by 2000
• HIV in the U.S.

• AIDS is leading cause of death among men (25-44 yrs)
• 3rd leading cause of death among women (25-44 yrs)
• Since 1981, female cases risen from 8% to 18% by 1995
• AIDS is 6 times as prevalent among African Americans & 3 times among Hispanics than white, Caucasian Americans
• Gay males continue to be largest proportion of cases, but shifting towards I.V. users & heterosexuals

D. Transmission of HIV

1. Sources

a. blood

b. vaginal or cervical secretions

c. breast milk

d. semen

2. Types of sexual behaviors

a. anal intercourse

b. vaginal intercourse

c. oral sex

3. Other transmittance

a. blood donation (less a problem)

b. breast feeding

c. Across placenta during pregnancy

E. Development of HIV Disease

1. Important time periods

a. weeks 1-3: virus enters body, circulates, and makes infected person contagious

b. weeks 1-8: acute viral syndrome

• short term
• mild or severe flu-like symptoms
• fever, fatigue, rash, aching muscle and joints, sore throat, enlarged lymph noes

c. 6 weeks - 6 months +: positive HIV antibody test - Helper T cells decrease early in infection

• seronegative: negative test
• seropositive: positive test for HIV

d. 2 yrs: onset of longer-lasting symptoms

e. 6 months-15 yrs: development of AIDS

F. HIV and Women

a. Mean age at diagnosis is 35 yrs

b. Incidence are 16 X higher among African-American women and 7 X times among Hispanic-American women than among European-American Women

c. Primarily associated with drugs or heterosexual contact

d. Lesbian women have low incidence of HIV

e. Bisexual women have higher HIV incidence than lesbians or heterosexual women

G. HIV & Prevention

1. Sexual abstinence, reducing # of partner, careful selection of partners, move slowly in relationships, safe sex practices, not engaging in sex with prostitutes

2. Latex condoms for vaginal, anal & oral sex. Never reuse condom. Apply before contact made. Water-based lubricants

3. Avoid sexual contact when impaired (ETOH/drugs)

4. Avoid sharing I.V. drug equipment (i.e.; needles) and if shared, clean with bleach water cocktail to reduce risk

V. Viral Infections - Genital Herpes

• HSV-1: 85% oral infections (fever blisters, cold sores)
• HSV-2: 85% genital infections (lesions)
• Pregnancy:

  1. Virus can cross placenta & infect fetus. May result in spontaneous abortion, mental retardation, or defective sight/hearing.

  2. 2/3 infants infected at birth. Often result in C-Section.

• Dormancy: Between attacks, the virus stays in nervous system. The virus travels up sacral ganglia nerve bundles & @ lower back outside of spinal cord. Immune system is unable to reach this site.

VI. Viral Infections - Viral Hepatitis

• Description

  1. Hepatitis A: Most common, Transmitted via contaminated food and analingus

  2. Hepatitis B: Seriously affects liver. Leads to high incidence of liver cancer. Transmitted like HIV, mostly sexually among gay males

  3. Hepatitis C: Not as contagious as "B".

  4. Vaccines for A & B, but not C.

  • Signs & Symptoms
  • Treatment

VI. Viral Infections - Human Papilloma Virus (HPV)

• Description:

  1. Most common viral STD in U.S.

  2. Linked to high rate of cervical cancer (HPV is present in 90% of cervical cancer cases)

  3. Women with multiple sex partners & early age of 1st intercourse are at higher risk for cervical cancer

  4. Can cause genital & anal warts. Lesions shed particles & transmit sexually even when not visible

  5. Removal of warts does not remove virus from body.

  • Signs & Symptoms
  • Treatment

VII. Bacterial Infections

a. Chlamydia

• Most common STD in U.S.
• Infection lives an intracellular parasite
• Infects genitals & eye
• Transmitted via vaginal/anal intercourse
• Untreated can cause Pelvic Inflammatory Disease

b. Gonorrhea

• Caused by bacterium Neisseria Gonorrhoeae, which requires warm, moist body surface
• Transmitted via heterosexual & homosexual contact (genital, oral-genital, anal-genital)
• Infects mucous membrane of genital, throat, eye, rectum
• Can infect child during pregnancy

c. Syphilis

• Life-threatening systemic infection
• Caused by the spirochete Treponema Pallidum
• Phases (primary, secondary, late or tertiary)
• In pregnancy, bacteria can cross placenta & infect fetus. Most extreme outcome is congenital stillbirth

d. Cystitis

• Inflammation of urinary bladder caused by E. Coli pathogen

e. Vaginitis

• Inflammation of vagina caused by an abundance of particular organisms

  1. Candida: yeast infection

  2. Trichomonas

  3. Gardnerella

IV. Other

• Scabies
• Pubic Lice

V. Social Issues

a. Confidentiality

b. Parental Consent

c. Informing partners of positive results

d. Payment & Costs of testing/treatment

e. Get informed & educated!

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