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Chapter 8

Psychology 2075 Chapter 8: Chapter 8 Sexually Transmitted Infections

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Psychology 2075
William Fisher

Chapter 8 Sexually Transmitted Infections • STIs affect both physical and mental health • STD refers only to infections that cause symptoms • STI is more encompassing because it includes infections for which people may or may not have symptoms • One of the most disturbing things about the STI epidemic in Canada is that it disproportionately affects teens and young adults o 64% of chlamydia cases in 2009 were to people 15-24 o For people in this age group, HPV, Trichomoniasis and chlamydia account for the majority of cases but chlamydia is the only reportable infection • Canadian youth with low incomes and from ethnocultural minority groups are at a greater risk of contracting STIs • Worldwide, about half of people infected with HIV became infected between ages 15-24 • The distinction between viral and bacterial infections is important because bacterial infections can be cured using antibiotics • Viral infections cannot be cured but can be treated to reduce symptoms o Chlamydia, gonorrhea and syphilis are bacterial o HIV, HPV, herpes, and hepatitis B are viral CHLAMYDIA • Chlamydia trachomatis is a bacterium hat is spread by sexual contact and infects genital organs of both males and females • Chlamydia has become the most prevalent STI in Canada • Rate of 249 cases per 100,000 people • Women affected more than men • The rate of chlamydia has been rising since 1997 • Adolescent girls have a particularly high rate of infection, more than five times the national rate Symptoms • In men: thin, usually clear discharge and mild discomfort on urination appearing 7-21 days after infection o The symptoms are somewhat similar to gonorrhea in men o When a man consults a physician for urethral discharge, his chances of having chlamydia are higher than having gonorrhea o Gonorrhea presents with more painful urination and a more profuse, pus-like discharge • Diagnosis is made from a urine sample in men and from cells from the vagina in women o Used to detect bacteria • 75% of the cases of chlamydia are asymptomatic in women o 50% for men Treatment • Treated with azithromycin or doxyclycline • Does not respond to penicillin • Poorly/untreated chlamydia in men can lead to: urethral damage, epididymitis, Reiter’s syndrome and proctitis in men who have had anal intercourse • In women, it can lead to pelvic inflammatory syndromes and possibly infertility due to scarring of the fallopian tubes • A baby born to an infected mother may develop pneumonia or an eye infection Prevention • Vaccines have been developed that are effective in mice • The next best thing (apart from safer sex) is screening • Recommend routine screening for those under 25 – but only a minority of family physicians do • Far fewer men than women get screened • In an innovative program in rural Nova Scotia, self-test screen kits were made available in a private setting to all high school girls o Did not have to first see a nurse o Took the swabs themselves o Lab tests sent anonymously o Of the girls who used the test, the most common reason for why was for reassurance of a negative test HPV • More than 40 types of HPV that are sexually transmitted • Types 6 and 11 cause genital warts and are called low risk because they do not cause cancer • Other types cause cancer and are called high risk • Some types have no symptoms at all • Majority of people infected with HPV are asymptomatic but can still transmit the virus • HPV is not a reportable disease and thus there are no national Canadian data • Health Canada estimates that between 20-33% of women have HPV o Between 11-25% of women have the cancer-causing types • Study in New Foundland and Ontario found that those under 25 had the highest rates of HPV • Condoms can reduce infection risk but do not eliminate it • Genital warts are cauliflower-like warts appearing on the genitals usually around the urethral opening of the penis, the shaft, or the scrotum, and on the vulva, walls of the vagina or cervix , and can also occur on the anus • Typically appear 3-8 months after intercourse with an infected person • Experiencing genital warts has a negative impact on quality of life including completing usual activities, experiencing pain and discomfort, experiencing anxiety, and depression, creating poor self-image, and reducing sexual activity • New research shows oral sex can transmit HPV – increases risk of oral cancers • HPV 16 and 18 account for 70% of the cases of cervical cancer Diagnosis • Can be made by the presence of warts • HPV is a silent infection, patients showing no obvious signs of infection • Test through Pap test Treatment • Podophyllin (Podofilm) or bichloroacetic acid (BCA) can be applied directly to the warts o May need to be repeated several times and then the warts fall off o Cryotherapy using liquid nitrogen, the warts are froze off Vaccine • Gardasil and Cervari • Administered in 3 shots over 6 months • Administer it to girls around ages 11-12 (as early as 9) and to women up to 25 years old who have not had an HPV infection or an abnormal Pap test • Gardasil protects against types 16 and 18 o 95% effective • How long the immunity will last is unknown, but it is at least 5 years • Federal government has provided funding to the provinces and territories to establish HPV immunization programs o All provinces and the Yukon have publically funded school-based programs to administer the vaccine to girls in grades 6,7 or 8 with parental consent o The vaccine is free • Ontario study showed that parents who were less knowledgeable about the vaccine were less likely to consent to their daughter receiving it GENITAL HERPES • Caused by the herpes simplex virus (HSV) • Transmitted by sexual intercourse and by oral-genital sex • HSV-1 and 2 are circulating • In simpler times, HSV-2 caused genital herpes and HSV-1 caused cold sores • Today, there is more crossing over; Genital herpes can be spread by either HSV-1 or 2 • Study: Rates were higher in women and rates increased with age • The majority of people with HSV are asymptomatic and not aware that they are infected Symptoms • Small, painful bumps or blisters on the genitals • Typically they appear within 2-3 weeks of infection • In women, they are usually found on the vaginal lips, in men they occur on the penis • They may be found on the anus for those who have had anal intercourse • Fever, painful urination, and headaches may occur • The blisters heal on their own in about 3 weeks in the first episode • The virus continues to live in the body and may remain dormant for the rest of their life • HSV-1 infections tend to be less severe • Still infectious even when they are not having a flare-up Treatment • No known drug kills the virus – no cure • acyclovir (Zovirax) prevents or reduces the recurring symptoms but doesn’t cure the disease • Valacyclovir (Valtrex) and famciclovir (Famvir) are newer drugs that are even more effective at shortening outbreaks and suppressing recurrences o Also reduces transmission Long-term Consequences • Can develop complications like meningitis and narrowing of the urethra caused by scarring o But these symptoms are more rare • Having herpes increases the risk of becoming infected with HIV • Can transfer virus to baby in childbirth which can lead to serious illness or death • The risk of transmission to the infant is highest in women who have recently been infected and are having their first outbreak • Vaginal delivery is possible if there is no outbreak at delivery, but mostly do C-section Psychological Aspects: Coping with Herpes • Psychological aspects taken as serious as the medical consequences • Many people feel stigmatized • One highly effective treatment program consists of a combination of information on herpes, relaxation training, instruction in stress management, and instruction in an imagery technique in which the patient imagines that the genitals are free of lesions and that he or she is highly resistant to the virus HIV INFECTION AND AIDS • In 1981, a physician in Los Angeles reported a mysterious and frightening new disease identified in several gay men • First AIDS case in Canada was reported in February 1982 • AIDS = acquired immune deficiency syndrome • A major breakthrough came in 1984 with the identification of HIV o Another strain, HIV-2, has been identified and found almost exclusively in Africa • HIV destroys the body’s natural system of immunity to diseases An Epidemic? • 33 million persons worldwide infected • Hardest hit is sub-Saharan Africa, accounting for 72% of all new HIV infections • Although the number of people with HIV worldwide continues to grow, the number of new infections each year has been decreasing Transmission • Bodily fluids = semen, blood and possibly secretions of the cervix and vagina • Spreads in 4 ways: o Sexual intercourse o Contaminated blood o Contaminated hypodermic needles o Infected woman to her baby (pregnancy, birth, breastfeeding) • Canadians diagnosed are found in these categories o Men who have sex with men (highest) o People who inject drugs o Men who have sex with men and use injection drugs o Heterosexuals who have had sexual contact with an infected person • Worldwide, 70% of the cases result from heterosexual transmission • The sexual behavior most likely to spread HIV is anal intercourse, and the receiving partner is most at risk; This is true for both women and men regardless of sexual orientation • Whether you are gay or straight, statistically the greater your number of sexual partners, the greater your risk of getting infected with HIV • Even if the chance of contracting an STI from one unprotected sexual encounter is low, the chances add up with each additional unprotected sexual encounter = cumulative risk o People tend to underestimate their cumulative risk of contracting an STI, particularly if the partner is appealing to them • In a study of heterosexual transmission of HIV in which one partner was infected and the other was not, 22% of uninfected partners became infected over a 2-year period o Male-female and female-male transmission rates were approximately equal The Virus • HIV is a retrovirus • Retroviruses reproduce only in living cells of the host species – invade the host cell and each time the cell divides, copies of the virus are produced • HIV specifically invades a group of white blood cells called CD4 1 T-lymphocytes (T-cells) • When HIV reproduces, it destroys the infected T cell • Eventually the HIV-positive person's number of T cells is so reduced that infections cannot be fought off • Identified two co-receptors for HIV, CCR5 and CXCR4, which allow HIV to enter T cells • CCR5 seems to be important coreceptor in the early stages of the disease and CXCR4 in the later stages The Disease Four Stages of HIV Infection 1. Primary/acute infection – this is the stage from the initial infection to development of antibodies to it over the next 2-4 weeks o Mild, nonspecific symptoms: Fever, head ache, or sore throat 2. Chronic asymptomatic infection – during this stage, the person is infected with the virus and the virus is replicating, but the person shows no symptoms although lymphadenopathy is frequently present o Symptoms: swollen lymph glands and night sweats (not immediately life threatening) 3. Chronic symptomatic HIV infection – during this stage, the virus has greatly reduced the T4 cell count so that the person’s immune system is not able to fight off infections o Many go on to develop symptoms that are not life-threatening: fever, chronic diarrhea, unexplained weight loss, fatigue, chronic yeast infections in the throat or vagina, shingles, or abnormal or cancerous cells in the cervix o Treatment with AZT, DDI, and other drugs may begin at this time 4. AIDS-defining conditions – the diagnosis of AIDS is applied when the person is affected by life- threatening opportunistic infections o Kaposi’s sarcoma – a rare skin cancer o The diagnosis is also used when other opportunistic infections or cancers of lymph tissue are present and the person shows a positive test for HIV antibodies Diagnosis • The blood test that detects the presence of antibodies to HIV uses the ELISA technique o Easy and cheap to perform 1. To screen donated blood – all donated blood in Canada is now screened with ELISA 2. To help people determine whether they are infected (HIV positive) but are asymptomatic carriers • ELISA is a very sensitive test – highly accurate at detecting HIV antibodies – low rate of false negatives • But does produce a substantial number of false positives • The other major test is the Western blot/immunoblot method – provides confirmation o More expensive and complicated • Both tests detect only the presence of HIV antibodies – they do not predict whether the person will develop symptoms or will progre
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