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Chapter 8

CHAPTER 8- Sexually Transmitted Infections

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Psychology 2075
William Fisher

Sexually Transmitted Infections 12/3/2012 1:50:00 PM - STD refer to infections that cause symptoms - increase STIs in Canada - ages 15-24 most common: human papillomavirus, trichomoniasis and chlamydia ; ½ people HIV get at these ages Information in chapter from public health agency of Canada - only some STIs must be reported - cause bacteria vs. virus vs. other organisms chlamydia: an organism causing a sexually transmitted infection; the symptoms in men are a thin clear discharge and mild pain on urination; women are frequently/75% asymptomatic (no symptoms) - bacterium - most common bacterial sti in Canada symptoms - men appear 7 – 21 days after infect - vs. gonorrhea - test by urine sample or cervix cells sample - 50% no symptoms in men treatment - curable : azithromycin or one of tetracycline not penicillin - untreated: urethral damage, infection of epididymis (a highly convoluted/folded duct behind the testis, along which sperm passes to the vas deferens.), reiter’s syndrome (a medical condition typically affecting young men, characterized by arthritis, conjunctivitis, and urethritis, and caused by an unknown pathogen, possibly a chlamydia.), proctitis /inflammation of rectum is anal sex in men in women: pelvic inflammatory disease: [an infection and inflammation of the pelvic organs such as the fallopian tubes and the uterus in women] , infertility because scar fallopian tubes, baby can be born with pneumonia or eye infection prevention: - working on vaccine - prevent by screening, in screening asymptomatic carriers identified, treated, cured - examples: nova scotia high school girls given self test screen kit, Ontario 2 bath houses urine drop off testing kit HPV: human papillomavirus the organism that causes genital warts - more than 40 different types - some cause genital warts, some cause cervical cancer, majority no symptom - not reportable so no national data - women under 25 - condoms do not eliminate transmission of infection - skin to skin contact of genital area genital warts: infection causing warts on the genitals and cervical cancer, cauliflower like, men: around urethral opening, shaft, scrotum & women: vulva, walls vagina, cervix & anus , appear 3-8 months after sex - HPV 16 & 18 = cervical cancer - cancer penis and anus (both gender) - oral sex transmission ; oral cancer risk diagnosis - distinctive warts - abnormal cells on a pap test treatment - chemical podophyllin or trichloroacetic acid for treat genital warts - aldara also and it is self applied - warts fall off - cryotherapy use liquid nitrogen warts frozen off - many cases go away on own - risks increase with longer infections vaccine - Gardasil: protect against 4 types HPV which collectively cause 70% of cervical cancer, prevent warts and must be administered in 3 shots over 6 months. ; girls 9-13 age recommend. Protect against 16 & 18 : 95% effective, how long immunization last Is unknown at least 5 years - cervarix: protect against 2 types that cause 70% cancer - federal fund vaccine, school based programs, vaccine not free for boys genital herpes : a sexually transmitted infection, the symptoms of which are small, painful bumps or blisters of the genitals caused by HSV: herpes simplex virus - sexual intercourse, oral spread - 2 strain HSV1 & 2 - HSV 2 = genital herpes, HSV 1= cold sores ; can cross over, either can cause genital herpes - rate increase with age - test positive for HSV 2 in blood 14% report diagnosed with herpes, HSV1 in blood and not 2; 2% report being diagnosed : greater majority asymptomatic symptoms HSV2: - small, painful bumps or blisters on genitals, appear within 2-3 weeks Women: found on vaginal lips; men: on the penis & around anus (both) - blisters burst painful - fever, painful urination, headaches - heal on own in 3 weeks in first episode infection , virus keeps living in body sometimes dormant - symptoms may reoccur unpredictably, 7-14 days of sores HSV1:less severe - herpes most infectious during outbreak, but still infectious treatment - no kill virus drug - acyclovir/zovirax prevent or reduce the recurring symptoms - valacyclovir/ Valtrex and famciclovir/ famvir newer drugs even more effective at shortening outbreaks and suppressing recurrences; they plus acyclovir reduce rate transmission long term consequences - recurrent herpes: meningitis or narrowing of the urethra due to scarring leading to difficulty urination - increase risk of HIV infection because open blisters during outbreak easier enter body - transfer mother to baby some cases lead to serious illness or death in baby , highest risk in women recent infected and having first outbreak ; should do a c section if outbreak psychological aspects: coping with herpes - feel stigmatized, think should abstain from sex so not spread it - psychologists exploring therapies herpes patients: relaxation training, instruction stress management, instruction imagery technique in which patient imagines that the genitals are free of lesions and that he or she is highly resistant to the virus HIV & AIDS AIDS/acquired immune deficiency syndrome: a sexually transmitted disease that destroys the body’s natural immunity to infection so that the person is susceptible to and may die from a disease such as pneumonia or cancer HIV: human immune deficiency virus, the virus that caused AIDS - reported disease 1981, Canada 1982, virus identified 1984 HIV - HIV2 another strain virus found almost exclusively in Africa - destroys body’s natural system of immunity to diseases an epidemic? - 33 million persons world wide infected HIV, majority yet to show symptoms/know - 2008: 2 million deaths worldwide - highest rates: sub Saharan Africa, - number of new infections a year decreasing transmission - body fluids 4 ways spread: intercourse, blood contamination, hypodermic needles, from infected mother at birth - 56% diagnosed with HIV/AIDS in Canada: gays - 70% cases result heterosexual transmissions world wide - most likely spread through anal - penile vaginal or anal intercourse is riskier if it is with a person who is infected with HIV (seropositive) has engaged in high risk behaviors (unprotected anal or vaginal sex, injection drug use), is hemophiliac, is from a country where there is a high rate of HIV infection or if condoms are not used. - 415 Ugandan heterosexual couples one partner infected other not, 22% became infected in 2 years ; equal male to female or vise versa transmission rate - higher viral count in infected person greater chance transmission - WHO: circumcision reduce risk transmission by 60% - condoms 80-95% effective in protecting against transmission in heterosexuals | Sexually transmitted infection risk chart when condoms are not used: Anal high risk: warts, gonorrhea, hep B, herpes, HIV/AIDS, lice, syphilis Giving Oral sex high risk: gonorrhea, hep B, herpes, syphilis Getting oral sex high risk: hep B, herpes, | The virus - retrovirus reproduce only in living cells of the host species; invade host cell, each time host cell divides copies of the virus are produced along with more host cells each containing genetic code of virus - subgroups of HIV1 differ genetically - HIV invade group of white blood cells / lymphocytes called CD4+ T- lymphocytes or Tcells ; critical to body’s immune response fighting infections; when HIV reproduces it destroys the infected T cell, eventually T cells so reduced that cannot fight off infections - 2 coreceptors for HIV: CCR5 & CXCR4 which allow HIV to enter T cells ; ccr5 important in early stages and cxcr4 in later stages the disease the health Canada laboratory center for disease control expert working group on Canadian guidelines for sexually transmitted disease established the following 4 broad classes of manifestations of HIV infection: 1. primary infection ; 2-8 weeks after infect, antibodies develop to it, no immediate symptom, maybe fever or sore throat, stage lasts as long as person feel well or so long as t cell count stay around 1,000 cells per cubic millimeter of blood, which is a normal level, people can infect others in this stage 2. asymptomatic infection; show no symptoms, lymphadenopathy frequently present, swollen lymph glands, night sweats, can infect others 3. progressive infection; conditions that indicate immune system is sufficiently suppressed that it is not able to fight off infections, fever, chronic diarrhea, weight loss, fatigue, chronic yeast infections in throat or vagina, shingle or abnormal or cancerous cells in the cervix. T4 cell count drops by half to around 500. Immune system silently failing. Treatment with AZT, DDI and other drugs may begin at this time. 4. aids defining opportunistic infection: diagnosis of aids applied when person is affected by life threatening opportunistic infections (infections that occur only with severely reduced immunity) such as pneumocystit carinni pneumonia and kaposi’s sarcoma, a rare form of skin cancer. Diagnosis also used when other opportunistic infections or cancers of the lymph tissue are present and the person shows a positive test for HIV antibodies. Neurological problems can occur in AIDS patients because virus can infect cells of brain; symptoms may include seizures and mental problems. T cell count below 200 is indication of AIDS diagnosis the blood test that detects the presence of antibodies to HIV uses the ELISA (for enzyme linked immunosorbent assay) technique. Easy and cheap. Can be used in 2 important ways: 1. to screen donated blood. All donated blood in Canada is screened, tiny risk remains 2. to help people determine whether they are infected (HIV positive) but are asymptomatic carriers. - elisa highly accurate detect HIV antibodies ; does give false positives sometimes - other major test using the western blot or immunoblot method ; more expensive and difficult, more accurate - neither test predict whether person will develop symptoms or will progress to AIDS classification - elisa: long waiting period - rapid test developed in Canada only takes 60 seconds decect HIV1 antibodies - Aids society say should do tests in sexual health center - home test kit in U.S. treatment - AZT (azidothymidine/ zidovudine or ZDV) has been ; stop from multiply , cannot repair already damaged immune system, many side effects some people cannot use it/ or can only use limited time. - DDI (dideoxyinosine or didanosine) and DDC (dideoxycytidine) ; slow progression by prevent replication - D4T ; all ART drugs - protease inhibitors attack viral enzyme protease which is necessary for HIV to make copies of itself/multiply. - darunavir: acts on viruses that are resistant to the protease inhibitors - combine: AZT and protease inhibitor and one other anti HIV drug : combo called HAART / highly active antiretroviral therapy : 1996 - HIV mutated to drug resistant forms, HIV not detectable in blood of person taking drug cocktail because it was hiding out in t cells and the lymph nodes and in organs such as the brain, eyes and testes - person diagnosed with HIV who receives treatment can expect live 20-30 years - long term HAART treatment: diabetes like problems, brittle bones, heart disease: must stop or switch treatment; some people stop responding to treatment - drug pentamidine in aerosol form standard treatment to prevent PCP women, children, ethnic minorities and AIDS - women AIDS in Canada increase, heterosexual partners, need training so demand condom use, should be included in clinical trial drug tests, specific needs as women should
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