# Sexually Transmitted Infections
## November 4th, 2020
- We now continue with our regularly scheduled sexual educational program
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- So, our agenda!
- Discuss epidemiology of STIs
- Explain STI risk factors and prevention measures
- Describes signs/symptoms/treatments of common STIs
- Discuss HIV and AIDS
- "Again, there'll be medical photographs of genital body parts and diseases, so please be aware of that if you're sensitive"
- Most diseases transmitted by vaginal sex can also be transmitted via oral sex, so we won't draw a distinction between them here
- Some diseases can be transmitted in multiple ways; Zika, for instance, is primarily transmitted via mosquitos, but it can also be transmitted via semen
- In young adults, Chlamydia and Gonorrhea are quite common, and over half of cases are in young people; HIV is more evenly spread in age
- STIs are particularly severe for women, making 24,000 U.S. women infertile each year (often without their knowledge)
- Often ~50% of people have no symptoms of STIs, but can still transmit it
- There's a HUGE link between alcohol and illicit sex; 70% of college students report sexual activity primarily happening when drinking, 90% of college rape cases involve alcohol in some way, and 20% of college students stop using protection when drunk
- 60% of college women who contract STIs report being under the influence when they're infected
- Sexual infection CAN happen with non-coital (i.e. intercourse) activity; people who only do oral sex or anal sex consider themselves virgins, but it can DEFINITELY lead to diseases
- HIV is easily transmitted via oral sex, genital infections like HSV or herpes can be transmitted this way, and ~10% of syphilis cases are transmitted orally
- Let's talk about common diseases, shall we?
- HPV (the HUMAN PAILLOMAVIRUS) infects 15% of the nation and 43% of sexually active college females (especially those with 3+ partners)
- This causes a number of issues; the most common and least worrisome is GENITAL WARTS (infecting ~20 million people), affecting most sexually active adults
- These look kinda yucky, and affect both men and women, but aren't generally harmful; in rare cases it can cause cervical cancer in women
- In young adults, 70% of cases will go away within 2 years; those that don't go away can result in cancer (especially HPV type 16 and 18, which cause 72% of cervical cancer cases)
- HPV types 6 and 11 cause 90% of genital warts
- "There are hundreds of different strains of HPV, which can infect the vocal cords, mouth, anal tract, genitals - you name it"
- The older you are when you start having sex, the less likely you are to contract this; younger people are more likely to have multiple partners, and have less mature cervixes that are more susceptible
- If you DO start having sex in your late teens, within 5 years you have a 50% chance of contracting HPV (and indeed, infection cases peak in the early 20s, while cervical cancer doesn't occur until 20+ years later)
- Cervical cancer is tested for using a "pap smear," and pre-cancer can be diagnosed quite easily
- How do you prevent HPV? Vaccines! Gardasil treats the most common strains, and is especially effective administered before sex
- This vaccine is actually created by genetically modifying yeast to look like HPV viruses that are harmless, and is quite effective since being introduced
- A condom, too, helps significantly
- CHLAMYDIA doesn't present symptoms in 75% of women and 50% of men, and infects 1.5 million annually, but can still be transmitted; it's especially prevalent in the southeast ("we're not beating Alabama yet, but we're gaining")
- It's caused by intracellular bacteria and transmitted by "genital secretions;" the symptoms include irregular discharges, pelvic pain, or burning during urination
- Fortunately, Chlamydia can be treated with over-the-counter medicines (unlike gonorrhea); if not treated promptly, it can lead to infertility
- HERPES SIMPLEX VIRUS (HSV) looks like red blisters or "cold sores" on the genitals, and is transmitted by skin-to-skin contact with the blisters; the first time having it usually gives quite painful blisters and results in fever, chills, aching, etc., for ~10 days; after that, the virus'll stay in you, and recurrent cases cause mild itching and tingling and occasionally small blisters
- Symptoms CAN be quite mild (especially in recurrent cases), and ~20% of adults have herpes - 2/3rds of whom haven't been diagnosed (and might not have symptoms)
- Herpes is generally non-fatal and mild, but neonatal herpes can be fatal in pregnant women
- These recurrences are typically brought on by stress, which weakens the immune system
- Condoms help prevent this, but don't cover all of the genital skin
- Other ways to prevent this:
- Don't kiss or have sex with people who have visible sores
- Ask your partner if they've ever had sores (since herpes can last for YEARS inside people)
- Don't touch your eyes or genitals if you do have HSV, and don't touch your sores
- Don't share personal items with people
- Use condoms, even if the sores have gone away
- Don't have many sexual partners in the first place, to decrease your risk
- Use lubricants during sex to prevent microscopic abrasions (which can let the virus in)
- GONORRHEA gives ~600,000 infections annually, is transmitted via sexual contact or fluids, and can be transmitted to the throat or eyes (as well as to children during birth)
- Again, most cases appear in young adults <25, and more cases *appear* in females (men are tested less frequently) - again, it's most common in the southeast
- Symptoms include genital or rectal discharges, abdominal pain, burning while urinating, sore throat, etc.; 75% of women don't display symptoms
- In women, severe cases can spread to the uterus/fallopian tubes and cause pelvic inflammation or adhesions (cause ovaries/etc. to stick to the bowels), increasing the chance of infertility or a tubal pregnancy and causing pain; in men, it can cause infertility by spreading to the penis
- Biblical references to "unclean discharges from the body" are likely to gonorrhea
- Gonorrhea USED to be easily treated via penicillin, but modern strains are highly resistant to it; Ceftriaxone is used, but we're starting to see resistance there as well
- SYPHILIS has been around for some time, and is a rare but growing problem (with 83% of cases in active homosexual men, although straight men and women get it, too); it's passed by direct contact and does NOT have to present sores to be contagious
- Primary syphilis occurs within 3 weeks of exposure, eventually progresses to secondary syphilis (though it may take years and go through a laten phase without sores), with rashes visible on the palms and feet; tertiary syphilis then enters the heart/brain and leads to death
- These sores are called "chancre," and while they look painful, it actually isn't - because it destroys the nerves
- These sores occur on the penis in men and the vulva/cervix in women; it CAN be transmitted by women to their children (with symptoms including "Hutchinson's teeth" shape, flattened noses, bent shins, sores, etc.)
- Tertiary syphilis starts affecting the brain and giving you seizures, reduced mental capacity, hearing loss, etc. - nasty stuff
- Syphilis is highly concentrated in the U.S. right now, in a small number of urban (primarily southern) counties
- HIV/AIDS; the HUMAN IMMUNODEFICIENCY VIRUS attacks and destroys the immune system, leading to AIDS (ACQUIRED IMMUNE DEFICIENCY SYNDROME) that has severe symptoms due to it destroying the body's immune system (destroying the body's CD4 cells) and making mild illnesses MUCH more severe
- This is transmitted through bodily secretions (like semen or breast milk) or blood; needle sharing is a common transition route
- Half of all U.S. cases occur in the southeast
- What's the risk factor for HIV?
- Fellatio (i.e. a blowjob) has a low but non-zero risk, vaginal sex has a 10x higher risk, and anal sex has an even HIGHER risk (due to higher chances of abrasion, since that epithelium wasn't designed for sex - plus your large intestine is designed to absorb fluids)
- The "recipient" of the sex has the highest risk of contracting this
- Most HIV cases are in Africa (where unlike the West, it's most common in women)
- HIV cases occur mostly under the age of 35, but with a higher chance of contracting it in old age than other sexual diseases
- 60% of people who have HIV don't know they have it, which is why screenings for it are regular (since it is a fatal disease)
- Again, the main risk factors are exchanging sex for money, having sex with men, being a drug user, etc.
- This is treated using ART (Antiretroviral therapy); this treatment is expensive, but fairly effective
- Pre-exposure prophylaxis and using these drugs BEFORE getting HIV can reduce your risk of contracting HIV dramatically
- Higher numbers of sexual partners, not using condoms, etc. increase the risk, as you'd expect
- MOLLUSCUM isn't as serious, and has a volcano-like leision; it usually gets better on its own after 2 weeks to 6 months (although surgical treatments work), and is commonly transmitted by shaving razors
- PUBIC LICE aren't specifically sexually diseases, but are transmitted via close contact; over the counter permethrins work, but prescription lindane shampoo is highly effective (but can be toxic to the nervous system if incorrectly used)
- So, how do you prevent all of these diseases?
- Abstinence, of course, reduces your risk for these DRAMATICALLY, and ~28% of 24 year olds have not had sex
- Long-term monogamous relationships where you've talked about your sexual history of diseases help in a huge way, too (although as we mentioned, it's possible to have a disease and never have symptoms, so get screened regularly)
- Condoms help reduce skin contact in a big way, but they're not foolproof - they are HIGHLY effective if used correctly
- STD screening should be done annually for sexually active adults, especially for chlamydia and gonorrhea
- Homosexual men should especially be screened for HIV, syphilis, urethral infections, and rectal infections, as well as hepatitis A/B
- Nucleic acid amplification can be used to help with this screening process
- Now, for some rather tragic history of researching STDs in the U.S...
- In 1932, the U.S. Public Health Service promised over 400 poor African Americans with syphilis free meals and burial stipends to study the effects of the disease on them - however, when a cure for syphilis was discovered in 1943, we DIDN'T give this to them!
- In 1946-48, U.S. scientists intentionally infected ~700 Guatemalan prisoners with syphilis and gonorrhea to test if penicillin prevented new infections; none of the prisoners were asked for their consent (and it ended up not working)
- So, be careful out there! Bye!