Women’s Health ?? Women’s Health & STIs Discussion Topic Infection rates for many STIs continue to be highest among young people (typically defined as around 15-24 years old). What are some rea
Women's Health
Women's Health & STIs
Discussion Topic
Infection rates for many STIs continue to be highest among young people (typically defined as
around 15–24 years old). What are some reasons for this? What would you recommend to increase
prevention or encourage testing or treatment among this group?
Discussion Requirements:
At least 250 words
External Resource: STDs during Pregnancy
Explore CDC website to learn more on how STDs can impact pregnant women
Course Materials• Required Text or E-Book: Alexander, L., LaRosa, J., Bader, H., & Garfield, S., Alexander,W. (2007). New Dimensions in Women’s Health, 7th ed. Sudbury, MA: Jones and Bartlett.ISBN# 978-1284088434
APA Format
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Chapter 7
Sexually Transmitted Infections
Pap Tests, Vaccination, and HPV Testing
Pap test
- Strengths: a national screening program is already in place; Pap tests find most cases of abnormal cell growth before they become cancerous.
- Limitations: very inefficient—many false positive and false negative results.
A variety of screening methods and prevention methods are in place for cervical cancer. Together, they have the potential to eliminate deaths from cervical cancer.
The Pap test is an examination that looks for signs of abnormal cell growth in the cervix. In the five decades they have been in use, Pap smears have helped to dramatically reduce deaths from cervical cancer.
HPV testing: Instead of looking for cervical dysplasia, an early sign of disease, the HPV test looks for the DNA of the actual virus.
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Pap Tests, Vaccination, and HPV Testing
HPV testing
- Strengths: HPV tests outperform Pap testing; a combined program of HPV testing and Pap tests is nearly 100% effective at identifying women at risk.
- Limitations: the current screening infrastructure in the U.S. is based on Pap testing; presence of high-risk HPV does not guarantee that cancer will develop.
Pap Tests, Vaccination, and HPV Testing
HPV Vaccines
- Strengths: Cervarix and Gardasil vaccine protect against strains responsible for most cervical cancer.
- Safe and effective.
- Limitations: screening programs are still needed to find the cervical cancers caused by non-covered HPV strains.
- Expensive (~$130 per dose)
- Needs to be given BEFORE a person becomes sexually active to be effective.
Vaccination: The Gardasil and Cervarix vaccines provides protection against most, but not all, high-risk strains of HPV. The vaccines are given as a series of three injections over a 6-month period.
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Herpes Simplex Virus (HSV)
- Two types: HSV-1 and HSV-2
- Can infect genital area or mouth (cold sores)
- Incurable, but not life-threatening
- Related to viruses that cause chicken pox and mono
A cold sore caused by an oral HSV-1 infection
Magnified view of herpes simplex virus. About one in four young people in the United States will be affected by a viral STI.
© Image Point Fr/Shutterstock
Courtesy of CDC
Herpes genital infections are recurrent and incurable STIs. There are two types of herpes simplex virus (HSV) that are transmitted sexually: HSV-1 and HSV-2. The viruses that cause chicken pox and mononucleosis are also part of the herpes family. At one time, it was believed that HSV-1 was geographically localized above the waist, and HSV-2 was localized below the waist. It is now known that both HSV-1 and HSV-2 are capable of infecting either the mouth or the genital area. HSV-1 causes infections of the mouth area, which are commonly known as cold sores or fever blisters. HSV-2 has traditionally been known as genital herpes.
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Genital Herpes
Very common virus: nearly 50 million people have it (often without knowing about it).
Figure 7-6: Genital herpes—Initial visits to physicians’ offices,
United States, 1966–2010.
Data from IMS Health, Integrated Promotional Services. IMS Health Report, 1966-2010.
An estimated 45 million Americans are infected with HSV, although most of these infections are asymptomatic. Most cases of herpes are spread by people who do not know they have it. As the graph on this slide shows, the number of physician visits due to herpes has grown dramatically over the past 50 years. Some of this trend may be due to increased reporting, but the general trend is at least somewhat genuine.
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Herpes: Course of Infection
- Outbreaks last a few days to 3 weeks
- Outbreaks get less severe over time
- Treatment: Medications, comfort measures
- Can be asymptomatic
- Symptoms (if present): Small, painful blisters; fever; enlarged lymph nodes; recurrent episodes; first infection most severe
- Emotional adjustment, prevention of transmission to future partners
Herpes outbreaks appear, last for anywhere from a few days to a few weeks, and then return. Generally, the outbreaks get less frequent and severe over time, as the immune system gets better at fighting the virus. Medications and comfort measures can also help. Although no one wants to get genital herpes, in most cases the stigma of the disease vastly outweighs its physiological effects. Although there is no way to guarantee prevention of sexual transmission, there are many ways to reduce risk, from avoiding sex or wearing condoms between outbreaks to taking suppressive therapy to reduce outbreaks and asymptomatic shedding.
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Hepatitis
- Inflammation of liver
- Several viruses: Types A, B, C, D, E, F, or G
- Hepatitis B: considered an STI
- Prevention: vaccination for types A and B
- Thanks to vaccination, new cases of hepatitis B have fallen by 95% over the past 20 years!
Hepatitis, an inflammation of the liver, is caused by infection with one of several viruses—type A, B, C, D, E, F, or G. Although hepatitis A, B, and C may be transmitted via sexual intimacy, hepatitis B is the only infection transmitted primarily through sexual contact. Hepatitis B has the distinction of being entirely preventable; a three-shot series can provide lifetime immunity to hepatitis B. Fortunately, mandatory vaccinations have greatly reduced the new cases of hepatitis B over the past 20 years.
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Vaginitis
Trichomoniasis: protozoan organism
- Symptoms: frothy, thin, greenish discharge; vaginal itching; odor; urinary frequency; painful intercourse
- Treatment: metronidazole
Yeast infections: overgrowth of naturally occurring yeast organisms
- Symptoms: thick, white discharge; redness; swelling; itching
- Treatment: antibiotic vaginal cream, prescription drugs
Several kinds of vaginal infections can be transmitted through sexual interaction. Because they may be frequently transmitted through nonsexual means, however, they are not generally referred to as STIs. Vaginitis is a broad umbrella term for these infections. Trichomonas infection, yeast infections, and bacterial vaginosis are fairly common reproductive tract infections. Although they are responsible for physical and emotional discomfort, they do not pose long-term health problems among otherwise healthy women.
Trichomonas infection is caused by a one-celled protozoan and is usually transmitted between individuals via sexual contact. Yeast organisms (also known as Candida albicans, fungus infection, monilia, and candidiasis) normally exist in the microscopic ecosystem of a woman’s body. “Yeast infections” occur when something causes these organisms to grow out of control.
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Vaginitis
Bacterial vaginosis (BV): bacterial organism
- Symptoms: thick or watery discharge, odor, painful urination, burning during intercourse, redness, itching; 50% are asymptomatic
- Treatment: antibiotics (oral or vaginal delivery)
Bacterial vaginosis (BV) is a condition caused by an overgrowth of several species of vaginal organisms and may be transmitted by sexual activity.
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HIV/AIDS
- AIDS (acquired immunodeficiency syndrome) is a disease caused by HIV (human immunodeficiency virus). It is characterized by the destruction of the immune system.
- HIV is a retrovirus—a virus that incorporates its genetic material into the genome of the cell it attacks.
- HIV is spread through sexual intercourse, shared intravenous needle use, or contaminated blood or blood products.
HIV is a virus that, if left untreated, eventually causes the disease AIDS. HIV is spread when blood or sexual fluid from an infected person gets into a noninfected person’s body, almost always from unprotected vaginal or anal intercourse or from sharing needles to inject drugs.
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HIV/AIDS
- Incubation time ranges from a few months to several years.
- Without treatment, people with HIV may be diagnosed with AIDS when they have one of 26 opportunistic infections.
HIV/AIDS
Historical overview
- First diagnosed in the United States in 1981
- 40,000/year become infected with HIV.
- 1 of 4 people with HIV in the United States are women
- Women infected: 75% through heterosexual sex; 25% through intravenous drug use
The HIV outbreak was first observed almost exclusively among gay men. However, since then the number and proportion of women infected with HIV has risen dramatically, to 1 in 4 people infected.
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Global Perspective
HIV: The most serious disease of this generation
- More than 35 million people worldwide are living with HIV
- Half of all people living with HIV are women
- Each year, 1.5 million deaths, 2.1 million new cases
- A massive public health campaign has greatly slowed the spread of HIV, increased the number of people on treatment, and saved many lives. But, there is lots of work to be done.
Figure 7-7: Global Prevalence of HIV
Reproduced from UNAIDS. (2010). UNAIDS Global Report.
More than 33 million people—95% of whom live in developing countries—are living with HIV infection. Half of all people currently living with HIV are women. In 2013, 2.1 million people were infected, and 2 million people died of HIV-related causes. This worldwide epidemic has hit sub-Saharan Africa the hardest. Even though sub-Saharan Africa contains only 10% of the world’s population, most of the people living with HIV/AIDS, and most AIDS-related deaths, occur here.
The global community has launched a massive, coordinated response to this epidemic. This work has shown promising results, particularly in expanding access to treatment and improving estimations of infections. Since 2007, the number of AIDS-related deaths per year has fallen by more than 25%. Despite this progress; however, much work remains to be done.
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In the United States, HIV is a maturing epidemic.
Epidemiological Trends
Figure 7-9: Number of people living with HIV/AIDS and new infections of HIV, United States.
Centers for Disease Control and Prevention. (2013). HIV Surveillance Report, 2011; vol. 23.
http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.
In the United States, HIV is a maturing epidemic. The number of new cases has fallen from its height in the 1980s. However, because there are still some new cases, and because HIV-positive people are living much longer, the total number of people with HIV/AIDS is continuing to grow.
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Social Issues
- Disproportionately affects African American women
- Lower socioeconomic status
- Lack of health insurance, access to treatment
- Other high-risk groups
- Homosexual and bisexual men
- Intravenous drug users
- Prostitutes
- Inmates
African American women have been disproportionately hit by the AIDS epidemic. African American women are 12 times more likely to have HIV than White women in the United States.
African American women who have HIV infection are less likely to receive treatment than other ethnic groups and are more likely to die early. Half the people who died of AIDS in 2003 were African American. Class undoubtedly plays a large role in this disparity. Women who are economically deprived often have inadequate access to healthcare facilities and are more likely to be unhealthy in general. Many do not have health insurance or are chronically uninsured, or lack information on how to access and use scarce public healthcare facilities.
Homosexual and bisexual men, intravenous drug users, prostitutes, and prison inmates are also at increased risk for acquiring HIV infection.
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HIV Transmission
- Sexual intercourse with exchange of bodily fluids
- Injection with HIV-contaminated needles, syringes, etc.
- HIV-positive woman infecting her fetus during pregnancy or childbirth
- HIV-positive woman infecting her infant during breastfeeding
Today, HIV is spread mainly through unprotected vaginal or anal intercourse and, to a lesser extent, sharing needles with someone who has HIV. Medications can greatly reduce mother-to-child transmission before, during, and after birth.
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Clinical Dimensions and Treatment Issues of HIV/AIDS
Testing for HIV
- Anonymous vs. confidential
- Waiting period
Possible symptoms of HIV
- Temporary flu-like illness 1 to 2 months after exposure
Anonymous testing involves not giving a healthcare provider your name; a confidential test involves giving your name to a healthcare provider, but your information will still be protected. Testing for HIV is difficult because the most common tests look for antibodies, part of the body’s response to the virus, not the virus itself. This means that the longer you wait after a risk, the more you can trust a negative result (conversely, a negative result just after a risk is not very reliable). The CDC currently advises people to wait 3 months after a risk to get a test to know for sure; however, the average person develops antibodies about 1 month after exposure to HIV.
It is very difficult to tell if you have HIV based on symptoms, because the only symptoms that appear are very vague; in fact, the body reacts to HIV just as it does to many other viral infections. Furthermore, the symptoms go away, but HIV does not.
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Living with HIV
- Continuous treatment can now prevent the progression to AIDS in HIV-positive people.
- HAART uses three medicines to keep HIV in check.
- Treatment is still very intensive (often many pills a day, side effects, high costs for medications).
Treatment for HIV can now prevent the development of AIDS. New types of drugs are now used together as part of the “AIDS cocktail,” or HAART (highly active antiretroviral therapy). HAART therapy usually consists of three medications that attack HIV in distinct ways and that are taken at the same time; this simultaneous “triple attack” helps prevent HIV, which mutates rapidly, from developing resistance to any one type of medication. These drugs still have significant limitations and side effects, however, and the search continues for more effective and more affordable treatment regimens.
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Sexual Activities and Relative Risk
Informed Decision Making
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Sexual Activities and Relative Risk
Informed Decision Making
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Prevention
- Anyone who is sexually active can get an STI.
- Many people who have STIs don’t know about it.
- If you are sexually active, take steps to lower your risk for STI infection (and if you have been at risk, get tested)
Courtesy of CDC.
STIs can cause enormous physical and emotional suffering.
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Risk Reduction Strategies
Unprotected oral, vaginal, and anal sex are the highest risk activities.
Ways to reduce risk
- Latex or polyurethane condoms (or female condoms, dental dams)
- Mutual monogamy
- Lower-risk activities (kissing, mutual masturbation)
- Abstinence
- Get tested (local health department, Planned Parenthood)
Latex condoms, although not a guarantee against infection, are a key component of risk reduction for STIs
Courtesy of CDC.
Unprotected oral, anal, or vaginal intercourse can all spread STIs. There are, however, many ways to lower risk. Mutual monogamy, with a person who has been tested for STIs, is one method—provided both partners are actually monogamous. Using latex condoms, or activities such as mutual masturbation, are other methods. Abstaining from all sexual contact may be an option for some. Finally, for people who wish to get tested, local health departments or Planned Parenthood facilities offer low-cost, confidential testing.
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