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Chapter 15

Chapter 15 - Sexually Transmitted Diseases

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University of Ottawa
Peggy Kleinplatz

Chapter 15 – Sexually Transmitted Diseases Sexually Transmitted Diseases: diseases that are transmitted by sexual contact - Half those diagnosed in the U.S are among those under the age of 25 BACTERIAL INFECTIONS Chlamydia (chlamydia trachomatis bacterium): most prevalent and damaging of all STD’s - Transmission: o Passed through sexual contact o Can spread via fingers, genitals to the eyes - 2 types affect females o Infection of the mucosa of the lower reproductive tract – commonly takes the form of an inflammation of the urethral tube or an infection of the cervix  Symptoms:  Mild irritation or itching of the genital tissues  Burning sensation during urination  Slight vaginal discharge o Invasive infection of the upper reproductive tract – pelvic inflammatory disease (PID)  Occurs when bacteria that cause chlamydia or gonorrhea spread from the cervix upward, infecting the lining of the uterus, the fallopian tubes, and possibly the ovaries and other adjacent abdominal structures  Chlamydia accounts for 1.5 million cases of PID in the U.S annually  Symptoms:  Disrupted menstrual periods  Chronic pelvic pain  Lower back pain  Fever  Nausea  Vomiting  Headache  Salpingitis: primary preventable cause of female infertility and ectopic pregnancy  Can stop the work of IUD as contraception - In men: o Epididymitis: infection of the epididymis  Symptoms:  Sensation of heaviness in the affected testis  Inflammation of the scrotal skin  Formation of a small area of hard painful swelling at the bottom of the testis o Nongonococcal urethritis (NGU): infection of the urethral tube not caused by gonorrhea  Symptoms:  Discharge from the penis  Burning sensation during urination - Trachoma: a chronic, contagious form of conjunctivitis caused by chlamydia infections – world’s leading cause of preventable blindness o Congunctivitis: inflammation of the mucous membrane that lines the inner surface of the eyelid and the exposed surface of the eyeball - Treatment: doxycycline for 7 days or one dose of azithromycin Gonorrhea (neisseria gonorrhoease bacterium): initially cause inflammation of mucous membranes - Transmission: passed through penile-vaginal, oral-genital, oral-anal, or genital-anal contact - Symptoms: more evident in men than women o Men:  Early symptoms:  Bad-smelling, cloudy discharge from the penis  Burning sensation during urination  Swollen and tender lymph glands in the groin  Complications:  Can spread up the genitourinary tract  Fever  Painful bowel movement  Difficulty urinating  Painful swelling at bottom of affected testis and inflammation of scrotum o Women:  Early symptoms:  Cervix can become inflamed without producing symptoms  Painful or burning sensation when urinating and/or increased vaginal discharge  Green or yellowish discharge  Complications:  Spread of disease to the upper reproductive tract – can cause PID o Sterility and ectopic pregnancy o Development of tough bands of scar-tissue adhesions o Both sexes:  Chills, fever, loss of appetite, skin lesions, arthritic joint pain - Treatment: Dual therapy of one does of ceftriaxone, cefixime, ciprofloxacin, levofloxacin, or ofloxacin, plus one dose of azithromycin (or doxycycline for 7 days) Nongonococcal urethritis (NGU): an inflammation of the urethral tube caused by organisms other than gonococcus - Primary causes: chlamydia trachomatis and mycoplasma genitalium - Can also result from: invasion by infectious agents, allergic reactions to vaginal secretions, irritation from soaps, vaginal contraceptives, deodorant sprays - Symptoms and complications: o Men:  Discharge from the penis  Mild burning sensation during urination o Women: usually show no symptoms  Itching  Burning sensation during urination  Mild discharge of pus from vagina o Rare cases can produce a form of arthritis - Treatment: One dose of azithromycin, or doxycycline for 7 days Syphilis (treponema pallidum bacterium): caused by a thin corckscrewlike bacterium - Transmission: Passed from open lesions during penile-vaginal, oral-genital, oral-anal or genital- anal contact th - If treated before the 4 month of pregnancy fetus will not be affected - Symptoms and complications: 4 phases o Primary Stage: painless sore (chancre) at site where bacterium entered body  In women: inner vaginal walls or cervix  In men: glans of the penis or on the penile shaft or on the scrotum  Can occur in the mouth, rectum, anus or breast  Painless so goes undiscovered when it occurs internally  Moves on to second stage 50% of the time when untreated o Secondary Stage: chancre disappears and generalized skin rash appears, often on the palms of the hands and soles of the feet  Flu-like symptoms, such as fever, swollen lymph glands, fatigue, weight loss, and joint or bone pain  Symptoms cant subside within week - Latent Stage: there may be no visible symptoms, can last several years o Infecting organisms continue to multiply, preparing for final stage of syphilitic infection o After 1 year of latent stage individual is no longer contagious, but pregnant women can pass the infection to their fetus - Tertiary Stage: heart failure, blindness, mental disturbance and more; death may result o 30% of people enter this stage if they do not obtain effective treatment during first 3 stages o Treatment can still be beneficial depending on the extent of the damage - Treatment: o Primary, secondary and latent phases at less than 1 years duration can be treated with intramuscular injections of benzathine penicillin G, doxycline, erythromycin or ceftriaxone o More than 1 years duration: treated with intramuscular injections of benzathine penicillin G once a week for 3 weeks VIRAL INFECTIONS - Virus: an organism that invades, reproduces, and lives within a cell, thereby disrupting normal cellular activity Herpes (HSV – herpes simplex): characterized by blisters on the skin in the regions of the genitals or mouth - 8 different viruses: most common – varicella-zoster virus that causes chicken pox and followed by HSV-1 and HSV-2 - HSV-1: typically manifests itself as lesions or sores – cold sores or fever blisters (in the mouth or on the lips, oral herpes) - HSV-2: generally causes lesions on and around the genital areas (genital herpes) - Transmission: o More common in women, concluding that male-female transmission is more likely o Passed primarily through penile-vaginal, oral-genital, oral-anal, or genital-anal contact – oral herpes also passed through kissing - Symptoms and complications o HSV-2 symptoms:  One or more painful red bumps called papules that usually appear in the genital regions  In women- most affected: labia, mons veneris, clitoris, vaginal opening, inner vaginal walls, cervix  In men – most affected: glans or shaft of penis  Anal intercourse: eruptions around the anus  Bumps become painful blisters and eventually rupture to form wet, open sores  Crust forms and healing begins  Other symptoms: swollen lymph nodes in the groin, fever, muscle aches, headaches, urination with a burning sensation, increased vaginal discharge o HSV-1 symptoms:  Characterized by the formation of papules on the lips and sometimes inside the mouth, on the tongue and on the throat  Blisters tend to crust over and heal in 10-16 days  Other symptoms: fever, general muscle aches, swollen lymph nodes in the neck, flulike symptoms, increased salivation, bleeding in the mouth o Recurrence:  Virus never leaves, just hides and becomes dormant throughout life and then reoccurs at a later time  Recurrence rates for genital herpes caused by HSV-1 are lower than the rates for genital HSV-2 infections  Prodromal symptoms: symptoms that warn of an impending herpes eruption  Itching  Burning  Throbbing  Pins and needles at the site infected by herpes blisters  Pain in legs, thighs, groin or butt  Shedding occurs when these symptoms are present o Other complications:  Men: not likely to experience major physical complications  Women:  Cancer of the cervix – cofactor, not direct link  Infection of a newborn – severe damage or death, viral shedding plays primary role  Ocular herpes – very bad, can be treated, if treated right away o Treatment:  No cure, just strategies to prevent outbreaks, reduce discomfort and speed healing  Acyclovir – Zvirax: topical ointment, oral and injectable  Suppressive therapy: medication is taken daily to prevent recurrent outbreaks – better and preferred by patients  Episodic treatment: involves treating herpes outbreaks when they occur with an antiviral agent – reduced duration and severity of lesion pain and time needed for total healing Genital Warts (HPV – Human Papillomavirus): viral warts that appear on the genitals and are primarily transmitted sexually - Transmission and incidence: Passed primarily through penile-vaginal, oral-genital, oral-anal, or genital-anal contact, most common STD’s in N. America - Symptoms: o Visible symptoms take 3-8 months to appear o In women: most common on bottom part of the vaginal opening, perineum, labia, inner walls of vagina, cervix, anus o In men: most common on the glans, foreskin or shaft of the penis, anus o On moist areas: pink or red and soft and cauliflowerlike growths on moist areas o On dry skin: hard and yellowish-gray growths - Complications: o Can invade the urethra causing urinary obstruction and bleeding o Can cause cancer off the cervix, vagina, vulva, urethra, penis and anus o HPV 6 and 11 – linked to cancers of the genitals and anus o HPV 16 and 18 – most often associated with the development of cervical cancer o Respiratory papillomatosis: results from HPV infection of the upper respiratory tracts in newborns - Treatment: o Cryotherapy (freezing), application of topical agents, cauterization, surgical removal, or vaporization by carbon dioxide laser o Gardasil: Viral Hepatitis: a disease in which liver function is impaired by a viral infection - Incidence: o Hepatitis A – most common form in the U.S, then B then C - Transmission: o Hepatitis A and B more likely to be transmitted sexually o Hepatitis B virus can be passed through blood, semen, vaginal secretions and saliva – manual, oral, or penile stimulation of anus o Hepatitis A is spread by means of oral-anal contact, especially when the mouth encounters fecal matter o Hepatitis C is spread through intravenous drug use and less frequently through contaminated blood products, sexual contact, or mother-to-fetus or mother-to-infant contact - Symptoms and C
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