STDs / STIs

Althea K. Moser M.A., CHES

What are STDs?

 STDs refer to more than 25 infectious organisms that are transmitted primarily
through sexual activity

 Despite their burdens, costs, and complications, and the fact that they are largely
preventable, STDs remain a significant public health problem in the United States

 STD prevention is an essential primary care strategy for improving reproductive

health.1

Source:
Office of Disease Prevention and Health Promotion on the website Healthy [Link]., and is found on the page “Sexually Transmitted Diseases”

 .
What are STDs?

 STDs cause many harmful, often irreversible, and costly clinical

complications, such as:

 Reproductive health problems

 Fetal and perinatal health problems
 Cancer
 Facilitation of the sexual transmission of HIV infection 2

Source:
Office of Disease Prevention and Health Promotion on the website Healthy [Link]., and is found on the page “ Sexually Transmitted Diseases”
How are STDs Transmitted?

 Ejaculation does not have to occur for an STD/STI to be passed from

person to person

 Sharing contaminated needles used to inject drugs or using

contaminated body piercing and tattooing equipment also can
transmit some infections, such as HIV or hepatitis B and C

 Source:
Office of Disease Prevention and Health Promotion on the website Healthy [Link]., and is found on the page “ Sexually Transmitted Diseases”
How are STDs Transmitted?

 Anyone who has had or is having sexual intercourse or oral sex, or

who has participated or is participating in sex play, is at risk for
acquiring an STD/STI

 It is possible for a person to decrease his or her risk by having

protected sex and knowing his or her STD/STI status and that of his or
her partner.

 Source: National Institutes of Health (NIH) on the page “

How many people are affected by or at risk for a sexually transmitted disease or sexually transmitted infection (STD/STI)? ”
How are STDs Transmitted?

 The Centers for Disease Control and Prevention (CDC) estimates nearly 20 million
new cases of these reportable STDs/STIs (gonorrhea, chlamydia, syphilis) occur
each year in the United States—almost half of them among young people 15 to 24
years of age.1

 While not the most common STD/STI, HIV/AIDS is one of the most devastating and
most well known. Recent data from the CDC indicate that 1.1 million Americans
have HIV2

 One in five is unaware that they have the virus.

 Approximately 50,000 Americans become infected with HIV each year.
 15,529 people with AIDS died in 2010

Source: National Institutes of Health (NIH) on the page “

How many people are affected by or at risk for a sexually transmitted disease or sexually transmitted infection (STD/STI)? ”
What are the Most Common Types of STIs?
Chlamydia

 Chlamydia
 Chlamydia1 (pronounced kla-MID-ee-uh) is a common
STD/STI caused by the bacterium Chlamydia trachomatis
 Chlamydia can be transmitted during vaginal, oral, or
anal sexual contact with an infected partner. While many
individuals will not experience symptoms, chlamydia can
cause:
 Fever
 abdominal pain, and
 unusual discharge of the penis or vagina

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Chlamydia
 In women, whether or not they are having symptoms and know about
their infection, chlamydia can cause pelvic inflammatory disease (PID)
 In PID, the untreated STD/STI progresses and involves other
parts of the woman's reproductive system, including the
uterus and fallopian tubes
 This progression can lead to permanent damage to the
woman's reproductive organs
 Chlamydia can be passed on during pregnancy or delivery
and could lead to eye infections or pneumonia in the infant

 If chlamydia is detected early, it can be treated easily with an

antibiotic taken by mouth

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)? ”
Gonorrhea
 Gonorrhea2 (pronounced gon-uh-REE-uh) is caused by the bacterium Neisseria
gonorrhoeae

 The most common symptoms of gonorrheal infection are:

 a discharge from the vagina or penis, and
 painful or difficult urination

 The most common and serious complications of gonorrhea occur in women and
include:
 pelvic inflammatory disease (PID)
 ectopic pregnancy
 infertility, and
 the potential spread to the developing fetus if acquired during pregnancy

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Gonorrhea

 Gonorrhea can infect the mouth, throat, eyes, and rectum and can
spread to the blood and joints, where it can become a life-threatening
illness

 People with gonorrhea can more easily contract HIV, the virus that
causes AIDS. HIV-infected people with gonorrhea are also more likely
to transmit the virus to someone else.3

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)? ”
Genital Herpes

 Genital herpes4 is a contagious infection caused by the herpes simplex

virus (HSV)
 There are two different strains, or types, of HSV:
 herpes simplex virus type 1 (HSV-1), and
 type 2 (HSV-2)

 Both can cause genital herpes, although most cases of genital herpes
are caused by HSV-2.5

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)? ”
Genital Herpes

 When symptomatic, HSV-1 usually appears as fever blisters or cold

sores on the lips, but it can also infect the genital region through oral-
genital or genital-genital contact

 Symptomatic HSV-2 typically causes painful, watery skin blisters on

or around the genitals or anus

 Substantial numbers of people who carry these viruses have no or

only minimal signs or symptoms

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Genital Herpes

 Neither HSV-1 nor HSV-2 can be cured

 Even during times when an infected person has no symptoms, the virus can
be found in the body's nerve cells
 Periodically, some people will experience outbreaks in which new blisters
form on the skin in the genital area; at those times, the virus is more likely
to be passed on to other people.
 Pregnant women, especially those who acquire genital herpes for the first
time during pregnancy, may pass the infection to their newborns, causing
life-threatening neonatal HSV, an infection affecting the infant's skin, brain,
and other organs.6

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)? ”
HIV/AIDS
 HIV, or the human immunodeficiency virus,7 is the virus that causes AIDS
(acquired immunodeficiency syndrome)

 HIV destroys the body's immune system by killing the blood cells that fight
infection

 Once HIV destroys a substantial proportion of these cells, the body's ability to
fight off and recover from infections is compromised

 This advanced stage of HIV infection is known as AIDS

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
HIV/AIDS

 People whose HIV has progressed to AIDS are very susceptible to opportunistic
infections that do not normally make people sick and to certain forms of cancer
 AIDS can be prevented by early initiation of antiretroviral therapy in those with
HIV infection

 Transmission of the virus primarily occurs during:

 unprotected sexual activity
 sharing needles used to inject intravenous drugs
 from mother to infant during pregnancy, delivery, and breastfeeding

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)? ”
Human Papillomavirus (HPV)
 HPV8 is the most common STD/STI

 More than 40 HPV types exist, and all of them can infect both men and
women

 The types of HPVs vary in their ability to cause genital warts; infect other
regions of the body, including the mouth and throat; and cause cancers
of the cervix, vulva, penis, and mouth

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Human Papillomavirus (HPV)

 No cure exists for HPV infection

 Regular screening with a Pap smear test can prevent or detect at an

early stage most cases of HPV-caused cervical cancer

 A newly available vaccine protects against most (but not all) HPV
types that cause cervical cancer. The American Academy of Pediatrics
recommends this vaccine for school-aged boys and girls.9

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Syphilis
 Syphilis10 infections are caused by the bacterium Treponema pallidum

 It is passed from person to person during:

 vaginal
 anal, or
 oral sex through direct contact with sores

 Those people at highest risk for syphilis include men having sex with both men
and women and people residing in the south. 10

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Syphilis
 The first sign of syphilis is a chancre, a painless genital sore that most
often appears on the penis or in and around the vagina
 Beyond being the first sign of a syphilis infection, chancres make a
person two to five times more likely to contract an HIV infection
 If the person is already infected with HIV, chancres also increase the
likelihood that the virus will be passed on to a sexual partner. 3
 These sores typically resolve on their own, even without treatment
 However, the body does not clear the infection on its own, and, over
time, syphilis may involve other organs, including the skin, heart,
blood vessels, liver, bones, and joints in secondary syphilis
 If the illness is still not treated, tertiary syphilis can develop over a
period of years and involve the nerves, eyes, and brain and can
potentially cause death

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Bacterial Vaginosis
 Bacterial vaginosis11 is a common, possibly sexually transmitted, vaginal infection
in women of reproductive age

 While it is healthy and normal for a vagina to have bacteria, just like the skin,
mouth, or gastrointestinal (GI) tract, sometimes changes in the balance of different
types of bacteria can cause problems

 Bacterial vaginosis occurs when problematic bacteria that are normally present
only in small amounts increase in number, replace normal vaginal lactobacilli
bacteria, and upset the usual balance

 This situation becomes more likely if a woman douches frequently or has new or
multiple sexual partners

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Bacterial Vaginosis

 The most common sign of a bacterial vaginosis infection is a thin,

milky discharge that is often described as having a "fishy" odor

 Some women will have no symptoms at all

 Having bacterial vaginosis increases the risk of getting other

STDs/STIs and is also associated with pelvic inflammatory disease
(PID)

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Trichomoniasis
 Trichomoniasis12 (pronounced trik-uh-muh-NAHY-uh-sis) infection is caused
by the single-celled protozoan parasite Trichomonas vaginalis

 It is common in young, sexually active women

 The parasite also infects men, though less frequently

 The parasite can be transmitted between men and women as well as

between women whenever physical contact occurs between the genital
areas

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Trichomoniasis

 Although Trichomonas infections do not always cause symptoms, they can

cause:
 frequent, painful, or burning urination in men and women
 vaginal discharge, genital soreness, redness, or itching in women

 A person may be unaware that he or she is infected and continue to re-

infect a sexual partner who is having recurrent signs of infection

 As with bacterial STDs/STIs, all sexual partners should be treated at the

same time to avoid re-infection

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Viral Hepatitis

 Viral hepatitis is a serious liver disease that can be caused by several

different viruses, which can be transmitted through sexual contact

 Hepatitis A virus (HAV) causes a short-term or self-limited liver infection

that can be quite serious, although it does not result in chronic infection
 While there are other ways the virus can be transmitted, HAV can be
spread from person to person during sexual activity through oral-rectal
contact.
 Vaccination can prevent HAV infection.13

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
Viral Hepatitis

 Hepatitis B virus (HBV) causes a serious liver disease that can

result in both immediate illness and lifelong infection leading to
permanent liver scarring (cirrhosis), cancer, liver failure, and death
 HBV spreads through both heterosexual and homosexual contact as
well as through contact with other bodily fluids, such as blood,
through shared contaminated needles used for injecting intravenous
(IV) drugs, tattooing, and piercing
 Pregnant women with HBV can transmit the virus to their infants
during delivery
 HBV infection is preventable through vaccination.1

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)? ”
Viral Hepatitis
 Hepatitis C virus (HCV) can cause an immediate illness affecting the
liver, but it more commonly becomes a silent, chronic infection that leads
to liver scarring (cirrhosis), cancer, liver failure, and death

 HCV is most commonly transmitted through sharing needles or exposure

to infected blood

 However, it can spread through sexual contact or from mother to fetus

during pregnancy and delivery

 There is no vaccine for HCV, and treatments are not always effective.15

Source: Department of Health and Human Services and found on the NIH’s website on the page “
What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?”
What is the Incidence, Prevalence, and
Cost of STIs?

 [Link]
Prevention Techniques for
STIs/STDs

 [Link]
STI Treatment Options:

 STDs/STIs caused by bacteria, yeast, or parasites can be treated with

antibiotics
 These antibiotics are most often given by mouth (orally)
 Sometimes they are injected or applied directly to the affected area
 Whatever the infection, and regardless of how quickly the symptoms
resolve after beginning treatment, the infected person must take all
of the medicine prescribed by the health care provider to ensure that
the STD/STI is completely treated

Source: US Department of Health and Human Services and found on the NIH’s website on the page “
What are the treatments for sexually transmitted diseases and sexually transmitted infections (STDs/STIs)?”
STI Treatment Options:

 Although treatments, complications, and outcomes vary among viral

STDs/STIs depending on the particular virus (e.g., HIV, genital herpes,
human papillomavirus, hepatitis) health care providers can provide
treatments to reduce the symptoms and the progression of most of
these illnesses

 For example, medications are available to limit the frequency and

severity of genital herpes outbreaks while reducing the risk that the
virus will be passed on to other people

Source: US Department of Health and Human Services and found on the NIH’s website on the page “
What are the treatments for sexually transmitted diseases and sexually transmitted infections (STDs/STIs)?”
STI Treatment Options:
 Individuals with HIV need to take special antiretroviral drugs that control
the amount of virus they carry

 These drugs, called highly active antiretroviral therapy, or HAART,1 can

help people live longer, healthier lives

 If a woman with HIV becomes pregnant, these medicines also can reduce
the chance that her fetus or infant will get the infection

Source: US Department of Health and Human Services and found on the NIH’s website on the page “
What are the treatments for sexually transmitted diseases and sexually transmitted infections (STDs/STIs)?”
Sources:
 References by Section:
 Sexually Transmitted Diseases
 United Nations. Report of the International Conference on Population and Development, Cairo, Egypt, September 5–13, 1994. New York: United Nations; 1995.
 St. Louis ME, Wasserheit JN, Gayle HD, editors. Janus considers the HIV pandemic: Harnessing recent advances to enhance AIDS prevention. Am J Public Health. 1997;87:10-12.
 How many people are affected by or at risk for a sexually transmitted disease or sexually transmitted infection (STD/STI)?
 Centers for Disease Control and Prevention. (2012). Sexually transmitted disease surveillance 2011. Atlanta, GA: U.S. Department of Health and Human Services. Retrieved March 19,
2013, from [Link] (PDF - 4.91 MB)
 Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Division of HIV/AIDS Prevention. (2012, July). HIV in the United States: At
a glance. Retrieved March 19, 2013, from [Link] (PDF - 512 KB)
 What are the Most Common Types of STIs?
 Centers for Disease Control and Prevention. (2012, February 8). Chlamydia-CDC Fact Sheet. Retrieved July 11, 2012, from [Link]
 Centers for Disease Control and Prevention. (2012, June 4). Gonorrhea-CDC Fact Sheet. Retrieved July 11, 2012, from [Link]
 Centers for Disease Control and Prevention. (2012, April 11). Basic Information about HIV and AIDS. Retrieved July 11, 2012, from [Link]
 Centers for Disease Control and Prevention. (2012, January 31). Genital Herpes-CDC Fact Sheet. Retrieved July 11, 2012, from [Link]
 Xu, F., Sternberg, M. R., Kottiri, B. J., McQuillan, G. M., Lee, F. K., Nahmias, A. J., Berman, S. M., & Markowitz, L. E. (2006). Trends in herpes simplex virus type 1 and type 2 seroprevalence in
the United States. Journal of the American Medical Association, 296(8):964-973
 Marquez, L., Levy, M. L., Munoz, F. M., & Palazzi, D. L. (2011). A report of three cases and review of intrauterine herpes simplex virus infection. The Pediatric Infectious Disease Journal, 30,
153-157. PMID 20811312
 Centers for Disease Control and Prevention. National Prevention Information Network. (n.d.). HIV/AIDS Introduction. Retrieved June 3, 2012, from [Link]
 Centers for Disease Control and Prevention. (2012, March 22). Sexually transmitted diseases (STDs): Human papilloma virus (HPV). Retrieved June 3, 2012, from
[Link]
 Committee on Infectious Diseases. (2012). HPV vaccine recommendations. Pediatrics, 129, 602-605.
 Centers for Disease Control and Prevention. (2011, November 17). 2010 Sexually Transmitted Diseases Surveillance: Syphilis. Retrieved June 7, 2012, from
[Link]
 Centers for Disease Control and Prevention. (2010, September 1). Bacterial Vaginosis-CDC Fact Sheet. Retrieved July 11, 2012, from
[Link]
 Centers for Disease Control and Prevention. (2011, November 30). Trichomoniasis-CDC Fact Sheet. Retrieved July 11, 2012, from
[Link]
 Klebanoff, M. A., Carey, J. C., Hauth, J. C., Hillier, S. L., Nugent, R. P., Thom, E. A., et al.; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units.
(2001). Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. New England Journal of Medicine, 345, 487-493.
 Centers for Disease Control and Prevention. (2011, January 28). Sexually transmitted diseases (STDs). Sexually transmitted diseases treatment guidelines, 2010. Vaccine-preventable
STDs. Retrieved June 3, 2012, from [Link]
 Centers for Disease Control and Prevention. (2011, January 28). Sexually transmitted diseases (STDs). Sexually transmitted diseases treatment guidelines, 2010. Hepatitis C. Retrieved
June 3, 2012, from [Link]
 STI Treatment Options

 Panel on Antiretroviral Guidelines for Adults and Adolescents. (2012). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington, DC: Department
of Health and Human Services. Retrieved June 3, 2012, from [Link]