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Sexually Transmitted Infections Ch 8.docx

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Western University
Psychology 2075
Corey Isaacs

Sexually Transmitted Infections 1/9/2013 11:14:00 AM Chapter 8 Stigma and Shame  STI-related stigma – awareness that people are judged negatively for contracting an STI  STI-related shame – the negative feelings people have about themselves as a result of receiving an STI diagnosis  People with higher stigma and shame are less likely to be tested  People with better sexual health education in school reported less stigma and shame  Some STIs are caused by bacteria and some by viruses o Bacterial infections can be cured using antibiotics o Viruses can’t be cured but can be treated to reduce symptoms Chlamydia  Bacterium that is spread by sexual contact and infects the genital organs  The most prevalent bacterial sexually transmitted infection in Canada  Symptoms o Men – thin, clear discharge and mild discomfort on urination appearing 7-21 days after infection  Similar to symptoms of gonorrhea o Women are frequently asymptomatic – have no symptoms  Treatment o It is curable o Treated with azithromycin, not responsive to penicillin o Poorly treated or undiagnosed cases may lead to urethral damage, epididymitis and proctitis in men who have had anal intercourse o Women can experience pelvic inflammatory disease (PID) and possibly infertility due to scarring of the fallopian tubes  A baby born to an infected mother may develop an pneumonia or an eye infection  Prevention o An effective vaccine for humans should be available within the next decade o One of the most effective tools for prevention, in addition to safer sex, is screening  Asymptomatic carriers can be identified, treated and cured so they don’t spread the disease unknowingly  Far fewer men than women are screened o Self screening tests were available to high school girls in Nova Scotia  Two of the tests were positive which would’ve gone untreated if not tested  Most girls used it for the reassurance of a negative test HPV  Human papillomavirus  More than 40 types of HPV that are sexually transmitted  Low risk types – only cause genital warts and don’t cause cancer o Genital warts – cauliflower-like warts that typically appear three to eight months after contact with a infected person  High risk types – can cause cervical cancer o Can also cause cancer of the penis, anus and oral cancers  Symptoms o Most people are asymptomatic but can still transmit the virus o Transmitted through skin to skin contact  Diagnosis o Can be made by inspecting the warts o Abnormal cells on a pap test for women  Treatment o There are drugs to make the warts fall off  Vaccine o There are now two vaccines available in Canada  Gardasil – protects against HPV 16 and 18, the ones associated with cervical cancer, as well as two others that cause most cases of genital warts  Shown to be highly effective  Not known how long immunity lasts, but it is at least 5 years  Cervarix – a newer vaccine that protects against two HPV types that cause 70 percent of cervical cancers o The vaccine is funded by the government and free Genital Herpes  A disease of the genital organs caused by the herpes simplex virus (HSV)  Transmitted by sexual intercourse and oral sex  In the past – HSV-1 only used to cause cold sores and HSV-2 caused genital herpes o Today – both strains can cause genital herpes  Symptoms o The majority of those infected are asymptomatic and don’t know they are infected, they transmit the disease unknowingly o HSV-2 – small, painful bumps or blisters on the genitals that typically appear within 2-3 weeks of infection  Fever, painful urination and headaches may occur  The virus continues to live in the body after the blisters are healed and may stay for the rest of the person’s life  Symptoms may reoccur unpredictably for 7-14 days o HSV-1 – tends to be less severe o People are most infectious during an outbreak, but are also infectious even when there is no outbreak  Treatment o There is no known drug that cures the virus o Researchers are currently creating drugs to treat symptoms in those already infected, and working on a vaccine  Long-term consequences o Men or women the recurrent herpes may develop meningitis or narrowing of the urethra from scarring leading to difficult urination o Herpes increases the risk of becoming infected with HIV o The potential transfer of the virus from mother to infant during childbirth  C-sections are typically performed on women during an outbreak  Vaginal birth is possible if there is not an outbreak HIV and AIDS  AIDS – acquired immune deficiency syndrome o 1981 – first discovered in Los Angeles identified in several gay men o 1982 – first case found in Canada, number of cases began to rise soon after o 1894 – the discovery that the HIV virus is what causes AIDS  HIV – human immune deficiency  HIV-1 – accounts for most infections in North America  HIV-2 – found almost exclusively in Africa o 2008 – in this year alone, HIV infection caused approximately 2 million deaths worldwide  Sub-Saharan Africa accounts for about 71 percent of all new infections – approximately 22.4 million in total infected  1.5 million infected in Eastern Europe and Central Asia, 310,000 in the Middle East and North Africa, 2.2 million in Latin America and the Caribbean, 4.7 million in Asia and the North Pacific and 2.3 million in Europe and NA o The number of new infections each year has been decreasing  Transmission o Four ways:  Sexual intercourse (vaginal or anal)  Contaminated blood  Contaminated hypodermic needles  From an infected woman to her baby during pregnancy/childbirth o Most commonly from men having sex with men o Cumulative risk – the likelihood of contracting an STI after repeated unprotected exposure  The virus o Retrovirus – reproduce only in living cells of the host  The virus is copied when the host cells divide o Invades a group of white blood cells (lymphocytes) called CD4+ T-lymphocytes (T cells)  These cells are critical to the body's immune response in fighting off infections  When HIV reproduces, in destroy s the infected T cell eventually reducing the number of T cells so much that infections cannot be fought off  The disease o Primary infection  Begins with the initial infection with the virus and development of antibodies to it over 8 weeks  Symptoms occur that are not specific to HIV like a fever or sore throat  This stage lasts as long as the person keeps feeling well and the T4 cell count stays around 1,000 cells per cubic mL of blood (normal level) o Asymptomatic infection  The person is infected with the virus but shows no symptoms, except swollen lymph glands and night sweats are possible but not life-threatening o Progressive infection  The person has conditions that indicate that their immune system is sufficiently suppressed that it can’t fight infections  Not immediately life threatening symptoms may occur – fever, chronic diarrhea, unexplained weight loss, fatigue, shingles or abnormal or cancerous cells in the cervix  The T4 cell count drops by half o AIDS – defining opportunistic infection  The diagnosis of AIDS is applied when the person is affected by life-threatening opportunistic infections (infections that occur only with severely reduced immunity) like pneumonia and Kaposi’s sarcoma (a rare skin cancer)  A T cell count below 200 is alone an indication of AIDS  Diagnosis o The blood test that detects the presence od antibodies to HIV uses the ELISA (enzyme-linked immunosorbent assay) technique  Easy and cheap to perform and can be used in two different ways:  To screen donated blood  To help people determine whether they are HIV positive but are asymptomatic carriers  Long waiting period of more than a week for results  The test is highly accurate and has a low rate of false negatives however there are a large number of false positives – which is why a second test is recommended:  Western blot/immunoblot test is more accurate, difficult and more expensive, not ideal for mass blood sample testing, but ideal for testing ELISA positives o Both tests test for HIV antibodies but do not predict whether the person will develop symptoms or progress to AIDS  Treatment o There is not yet a cure for AIDS o Progress is being made to treatments to control the disease o ART – antiretroviral therapy  AZT has been used widely – stops the virus from multiplying  Has many side effects and can only be used for a limited time  DDI and DDC are also used o 1996 – protease inhibitors attack the viral enzyme protease which is necessary for HIV to make copies and multiply o 2006 – darunavir, a drug that acts on viruses that are resistant to the protease inhibitors o HAART – hig
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