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Chapter 8

Psychology 2075 Chapter 8: Sexually Transmitted Infections

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Psychology 2075
William Fisher

Chapter 8: Sexually Transmitted Infections Friday, January 6, 2017 6:40 PM • STD refers to infections that caused symptoms • STI encompasses infections that have and don’t have symptoms • STIs disproportionately affects teens and young adults o 2009: 64% of new chlamydia cases were 15-24 o Majority of cases are HPV, trichomoniasis and chlamydia o HIV population: half become infected at 15-24 • Bacterial: chlamydia, gonorrhea, syphilis • Viral: herpes, HIV/AIDS, HPV, Hep B Chlamydia (bacterial) • Most commonly reported STI in Canada o 700/100000 people o Adolescent girls have 5x the national rate • Symptoms o Thin, clear discharge o Mild pain on urination o Symptoms appear 7-21 days after infected o Difference between chlamydia and gonorrhea (men) • Peeing with gonorrhea with more painful and more profuse, puslike discharge • Must diagnose correctly cause the drugs are different o 50% of male cases are asymptomatic o 75% of female cases are asymptomatic Treatment • o Azithromycin or doxyclycline o Untreated men: urethral damage, infection of epididymis, Reiter's syndrome, proctitis in men who have anal o Untreated women: pelvic inflammatory disease, fallopian tube scarring (possible infertility) o Baby born to infected mother may develop pneumonia or eye infection • Prevention o Vaccine being developed, will be available in the next decade o Most effective tool is screening because so many people who have it are asymptomatic and spread disease without knowing o Recommend routine testing to all sexually active women under 25 o Rn, physicians don’t really suggest chlamydia testing, especially not men o Most common reason why people don’t get screened is because no symptoms o Anonymous self testing is a good method, and use condoms!! HPV (viral) • Human Papillomavirus o More than 40 types; some low risk (genital warts but not cancer), some high risk (cervical cancer) o Most asymptomatic but will still transmit virus o Not reportable: estimated between 20-33% of women have HPV, 11-25% cancerous types • Highest rate among women under 25 • Lower in men o Transmitted through skin to skin contact (penis/scrotum/vagina/vulva/anus) o Genital warts • Cauliflower-like warts that appear around genitals • Usually around urethral opening, shaft of penis, or scrotum in the male • Usually on vulva, walls of vagina, or cervix in the female • Appear 3-8 months after intercourse with infected person • Negative impact on quality of life ▪ Difficulty completing usual activities ▪ Experiencing pain and discomfort ▪ Experiencing anxiety and depression ▪ Poor self-image ▪ Reduced sexual activity o HPV can be transmitted through oral sex, and increase rate of oral cancers o HPV 16 and 18 account for 70 percent of the cases of cervical cancer • Also associated with cancer of the penis and anus • Diagnosis o Diagnosis can sometimes be made by looking at the warts, but could be hard to tell o Women can check for abnormal cells during pap test • Treatment o Podophyllin (podofilm) or bichoroacetic acid (BCA) can be applied • Typically applied a few times and then warts fall off o Cryotherapy (with liquid nitrogen) to freeze off warts o Podofilox cream can be applied o Most of the time, symptoms go away on their own, but some persist for a long time • Vaccine o Gardasil and Cervari o 3 shots over 6 months at ages 11-12, or before sexual activity or women younger than 25 if they do not have HPV o Protects against types 16 and 18 o Lasts at least 5 years o Free in all Canadian provinces and Yukon, but some say that it encourages young girls to engage in sexual activity Genital Herpes • Sexually transmitted infection, the symptoms of which are small, painful bumps or blisters on the genitals • HSV: the herpes simplex virus o HSV-1 = cold sores and genital herpes o HSV-2= genital herpes • 16% of women and 11% of men infected, rate increased with age o Only 6% infected were aware o Majority are asymptomatic • Symptoms o HSV-2 genital herpes are small, painful bumps or blisters on the genitals o Typically appear 2-3 weeks of infection o Women: vaginal lips, men: penis, could be found around anus o Blisters can burst and be painful • Heal on their own after 3 weeks o Fever, painful urination, headaches o HSV-1 is less severe • Treatment o No cure o Zovirax: prevents and reduces recurring symptoms o Valtrex and Famvir: more effective at shortening outbreaks and suppressing recurrences o Reduce transmission rate from infected partner to uninfected partner • Long-Term Consequences o Men or women with recurrent herpes may develop complications like meningitis or narrowing of the urethra caused by scarring, leading to difficulties with urination (does not affect majority) o Increases risk of HIV infection (open blisters during an outbreak can make HIV easy to enter body) o Transfer from mother to infant during childbirth • Leads to serious illness or death • Risk is less with women who have had the disease longer, low if woman is not having outbreak • C-section performed on women with outbreak • Psychological Aspects: Coping with Herpes o Many feel stigmatized because of their disease; believe that they should abstain from sexual activity o Information on herpes, relaxation training, instruction in stress management, and instruction in an imagery technique in which the patient imagines that genitals are free of lesion and that he or she is highly resistant to the virus HIV Infection and Aids • AIDS= acquired immune deficiency syndrome (1982) o Sexually transmitted disease that destroys body's natural immunity to infection so that the person is susceptible to and may die from another disease, such as pneumonia or cancer • HIV= human immunodeficiency virus (1984) An Epidemic? • o Estimated 33 million people are infected with HIV, most with no symptoms and are unaware of infection o 2011- 2.5 million people newly infected, 1.7 million died from AIDS o 72% of new HIV infections are from sub-Saharan Africa o # of people with HIV is increasing, but number of new infections each year is decreasing • Transmission o Exchange of body fluids 1. Sexual intercourse (penis in vagina or penis in anus) 2. Contaminated blood 3. Contaminated hypodermic needles 4. Infected woman pregnant of breastfeeding o Canadian exposure 2011 • 47% men who have sex w men • 14% needles • 3% men w men AND needles • 37% heterosexuals who have sexual contact with infected person o 70% of HIV worldwide is from heterosexual transmission o Sexual behaviour most likely to spread HIV is anal (receiving partner) o Cumulative risk: likelihood of contracting STI after repeated unprotected exposure • People tend to underestimate o Male circumcision reduces risk of HIV transmission by as much as 60 percent • The Virus o Retrovirus: reproduce in living cells of host species (human) o Invades a group of white blood cells (lymphocytes) called CDA 1 T-lymphocytes • Critical to the body's immune response in fighting off infections • HIV reproduces and destroys infected T-cell • T-cell numbers reduced and infections will be harder to fight off • 2 coreceptors for HIV ▪ CCR5 (early stages) ▪ CXCR4 (later stages) • The Disease Primary/Acute Infection • Initial infection to development of antibodies to it over next 2-4 weeks • Mild symptoms (fever, headache, sore throat) • Highly infectious Chronic Asymptomatic Infection • Virus is replicating but person should no symptoms • Swollen lymph glands and night sweats, not immediately life threatening Chronic Symptomatic HIV Infection • T4 cell count is greatly reduced • Fever, chronic diarrhea, unexplained weight loss, fatigue, chronic yeast infections in throat/vagina, shingles, abnormal or cancerous cells in cervix • AZT, DDI and other drugs may begin AIDS-defining conditions • Diagnosed with AIDS when person is affected by life-threatening opportunistic infections such as Pneumocystis carinii pneumonia and Kaposi's sarcoma, or when other opportunistic cancers or infections of lymph tissue and shows positive for HIV Diagnosis • Blood test detects antibodies using ELISA (enzyme-linked immunosorbent assay) technique • Screen donated blood, help people determine if they are positive • Very accurate, but also produces false positives (must always be confirmed twice) • 1 week+ for results Western blot or immunoblot method • Expensive and difficult but very accurate 60 second test to detect HIV-1 antibodies Home test kit (mail-in) Ora Quick (cotton swab, 20 minutes) Some at-home tests are unreliable, no counselling and support, and should not have to pay for testing • Treatment No cure, but drugs to control disease AZT (azidothymidine, also called zidovudine or ZDV) used widely • Stopped virus from multiplying, but cannot repair damaged immune system • May side effects and cannot be sued by some people or can only be used for limited periods Antiretroviral therapy (ART): DDI (dideoxyinosine or didanosine) and DDC (dideoxycyti
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