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HCET Home > On-line Training > Family Planning – The Basics > 5. Sexually Transmitted Infections/Diseases - STIs or STDs

Chlamydia & Gonorrhea	Symptoms
What are they? Both are curable, bacterial infections spread sexually, diagnosed by culture during a pelvic exam (used less often today), or by a urine sample.	Male Discharge Painful urination Pain and swelling in the testicles
	Female Vaginal discharge Bleeding after sex Painful urination Abdominal pain, painful intercourse Fever
Many women and some men have no recognizable symptoms at all

Complications of Chlamydia and Gonorrhea

• Pelvic inflammatory disease (PID)
• Infertility
• Ectopic pregnancy
• Chronic pelvic pain
• GC (gonorrhea) can lead to joint, skin and heart problems

Common Treatments

• Chlamydia - Doxycycline #14 100mg PO (by mouth) twice a day for 7 days or Zithromax 1 gram PO immediately
• Gonorrhea - Suprax 400mg PO immediately or Rocephin 125 mg or 250mg IM (injected into muscle) immediately plus Doxycycline/Zithromax as above

Important Messages to Patients

• Condoms help prevent transmission
• You must finish all of the medication even if symptoms go away
• All your partners must be tested and treated
• You must abstain (not have sex at all) until both have completed treatment for 7 day meds for one week after a single dose medication
• Follow up is needed if symptoms persist or unable to finish the medications
• Any patient being tested for an STD that is reportable in Wisconsin, should be informed about the reporting & partner notification requirements

  To Clinics
  

• Report confirmed and suspected cases of STDs including chlamydia and GC to the Local Public Health Department (Wisconsin Law)
• Encourage the patient to have syphilis and HIV screening

Other STIs

Syphilis - 1 | 2

• Bacterial Infection spread sexually
• Can also be transmitted by a pregnant woman to her fetus
• Can be treated at any time during the disease
• Can cause miscarriage, stillbirth and birth defects
• Infant can be born with the disease with or without symptoms
• Late stages of the disease can cause irreversible damage
• Testing for syphilis is done by a blood test
• If test is positive, report to local health department
• Patients should be referred for treatment

Symptoms of Syphilis - 4 stages

1. Primary: chancre (painless, open sore) appears on the genitals or mouth 1-12 weeks after exposure. It will resolve without treatment
2. Secondary: 0-10 weeks after the sore resolves, secondary symptoms may appear
   • Most common – fever and rash on palms of hands and soles of feet
   • Other secondary symptoms can include body rash, mucous membrane patches, temporary alopecia (hair loss) wart-like growths, facial rash
3. Latent: no symptoms
4. Tertiary: organ and central nervous system involvement/damage

Trichomoniasis - 1 | 2 | 3 | 4 | 5 | 6 | 7

• The STD called Trichomoniasis is caused by the protozoan Trichomonas vaginalis, also called T. vaginalis
• The STD Trichomoniasis is often called Trichomonas or “trich” for short
• Trich is the most common curable STD in the U.S. and worldwide
• Infection caused by a protozoan, primarily sexually transmitted

Symptoms of Trichomoniasis

• Many are asymptomatic (especially men), discharge, itching and burning
• Diagnosed by a wet prep
• Treatable with oral medication Metronidazole
• The patient must avoid alcohol while on this medication
• Treat partner too (but infection will clear up on its own within 3 weeks in 30-60% of untreated men)

Lice (Crabs)

• Lice are parasites that infect the pubic area
• Spread by close body contact, use of another’s bedding, clothing or towels
• Symptoms include itching and visualizing the lice which often look like moving freckles
• Patients should not be encouraged to come to the clinic – instead recommend over-the-counter medications RID or NIX
• Partner and other close household members should be treated too
• Itching may persist for 1-2 weeks after treatment
• All towels, linens, clothing and hair accessories must be washed in very hot water and dried in a clothes dryer

Genital Herpes or Herpes Simplex Virus–2 (HSV-2)

• A viral infection spread by skin to skin contact usually through sexual contact
• According to the CDC, herpes is the most common STD in the U.S.
• Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital HSV infection. ^[I]
• Not curable, but can be controlled with antiviral medications such as Valtrex
• Diagnosed by culture during an exam
• Most people who have herpes have no symptoms and are not aware they have it

Symptoms of HSV-2

• First outbreak (and sometimes subsequent outbreaks) may be accompanied with flu-like symptoms such as fever, chills, headache, body aches and fatigue
• Tingling or burning prior to an outbreak
• Blister-like sore which opens to a painful, open, ulcerated sore, can last from a few days to 2 weeks
• Some patients have recurrent outbreaks
• Generally over time outbreaks will become less frequent and less severe

Complications of HSV-2

• Vaginal delivery may be substituted with C-section if outbreak is present just prior to delivery or during labor
• Antiviral meds beginning at 36-38 weeks can prevent an outbreak from occurring
• Nerve pain

Treatment & Important Messages Regarding HSV-2

• Antiviral medications such as Valtrex and Acyclovir
• Medications can be used during an outbreak to lessen severity
• Medications can also be used daily as suppressive therapy (to decrease likelihood of an outbreak)
• Suppressive therapy will also decrease risk of transmission by decreasing the viral load
• Always use a latex condom
• The virus can be shed (you can give it to your partner) even at times when there is no outbreak
• Condom use does not totally eliminate the risk of transmission
• Avoid sex during outbreaks
• Healthy lifestyle is very important and improves immunity
• Stress management
• Healthy diet
• Adequate rest and sleep (6-10 hours per night)
• Take a multi-vitamin for women 15-44 years of age
• Adequate exercise
• Quit smoking
• Avoid sunburns if you have oral lesions
• Avoid alcohol or other drugs (street drugs)

HPV: Human Papilloma Virus

• Human Papilloma Virus (HPV) is a viral infection that sometimes causes genital warts, but in many people is asymptomatic
• HPV causes genital warts
• There are 30 distinct types of HPV that can infect the genital area
• Sub-clinical HPV infection is more common
• HPV may cause pre-cancerous cervical changes, lead to cervical, penile, anal cancer
• The virus is not treatable, but 90% infected will clear themselves of the virus within 2 years
• The warts and the precancerous cervical changes caused by the virus are treatable
• The genital warts are diagnosed by visualization
• Pap smear screens for precancerous changes
• No blood test for HPV available yet
• Culture is available but not widely used yet due to high cost and imperfections in the test

Contracting HPV

• HPV is spread by skin-to-skin contact
• Highly contagious: It is thought that roughly 65% of sexually active people will carry this virus at some point in their lives
• 65% will transmit HPV to their partner if no condom is used
• Condom use recommended
• Condoms decrease transmission by 35%
• 1 to 3% chance of oral transmission

HPV Symptoms

• Most people are asymptomatic, yet able to transmit the virus
• Cauliflower like growths on the genitals
• Itching and pain
• Abnormal pap smears

HPV Complications

• Persistent cervical infection with certain types of HPV is the single most important risk factor for cervical cancer
• Cervical cancer can be detected early by getting regular pap smears
• More frequent pap smears may be advised if patient has had an abnormal pap smear

HPV Treatment

• The virus itself is not treatable, warts are
• A healthy lifestyle is important to boost immunity to suppress the virus
• Quit smoking
• Healthy diet
• Vitamins – multivitamin for women 15-44
• Adequate sleep (6-10 hours per night)
• Adequate exercise
• Stress management
• Avoid alcohol and other drugs (street drugs)
• Treatment for the warts
• TCA acid applied to the warts burns the wart - Condylox or Aldara cream applied by the patient at home, which causes irritation

HPV Testing

• Is done, but not routinely
• Only done if the thin prep pap test comes back with a ASCUS result
• Not done on every patient
• Not done by patient request

Molluscum Contagiosum

• A viral infection caused by skin contact, primarily spread sexually
• Symptoms: very small, smooth, flesh toned, raised, waxy bumps on the abdomen, pubic area and thighs
• Curable with use of TCA acid or sterile needle removal. Can resolve on their own in 6-12 months
• Partner should be screened

Other Problems and Infections

Bacterial Vaginosis

• A vaginal infection caused by an overgrowth of certain bacteria that are normally in the vagina
• Diagnosed by wet prep

Contracting Bacterial Vaginosis 

• Not considered an STI
• Associated with the act of sexual intercourse which introduces more bacteria into the vagina and changes the normal flora
• Condom use lowers incidence
• Improper wiping
• Anal intercourse followed by vaginal intercourse without washing or using condoms
• Douching frequently washes away the protective bacteria
• Use of panty liners, feminine sprays, bubble baths and have also been implicated

Symptoms of Bacterial Vaginosis 

• Excessive, watery, thin, milky, white discharge
• Strong fishy odor
• Vulvar irritation
• Itching
• Less frequently may have abdominal discomfort

Risks of Bacterial Vaginosis

• Many women are bothered by recurrent infections, it is unclear why
• May lead to Pelvic Inflammatory Disease (PID)
• Premature rupture of membranes

Treatment of Bacterial Vaginosis 

• Metronidazole 500mg by mouth twice a day for 7 days is the 1st choice
• This medication can also be given immediately in a one time dose or as a cream vaginally (Metrogel)

For more information

• CBSNews.com - 'Abstaining' Teens Still Get STDs
• CDC's Sexually Transmitted Diseases Facts & Information
• iwannaknow.org
• ASHA - Facts & Answers about STDs: Introduction
• Sexually Transmitted Diseases STDs
• NIAID Fact Sheets - Chlamydia | Gonorrhea | Syphilis | Genital Herpes | HPV & Genital Warts
• Gonorrhea - Symptoms - Treatments - Prevention
• CDC's Division of Parasitic Diseases - Trichomonas Infection | Pubic Lice/Crabs
• American Academy of Dermatology - Molluscum Contagiosum

Endnotes:
[I] Genital Herpes - CDC Fact Sheet http://www.cdc.gov/std/Herpes/STDFact-Herpes.htm

Self-test Questions

Chlamydia and Gonorrhea are both bacterial infections spread sexually.

True
False

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URL: http://65.163.14.21/training/FPbasics/5STISTD.htm
 Last update: 03/05/08