MIDTERM
CN-MP
LECTURE \ SECOND SEMESTER
CHAPTER 3: SEXUALLY TRANSMITTED INFECTION (STI)
STI Key Facts
 More than 1 million sexually transmitted
infections (STIs) are acquired every day
worldwide, the majority of which are
asymptomatic.
 Each year there are an estimated 374 million
new infections with 1 of 4 STIs: chlamydia,
gonorrhea, syphilis and trichomoniasis.
 More than 500 million people aged 15 to 49
years are estimated to have a genital infection
with herpes simplex virus (HSV) (1).
 HPV infection is associated with 570 000 cases
of cervical cancer in 2018, and over 311 000
cervical cancer deaths each year (2).
 Almost 1 million pregnant women were
estimated to be infected with syphilis in 2016,
resulting in over 350 000 adverse birth
outcomes including 200 000 stillbirths and
newborn deaths (3).
 STIs have direct impact on sexual and
reproductive health through stigmatization,
infertility, cancers and pregnancy complications
and can increase the risk of HIV.
 Drug resistance, especially for gonorrhea, is a
major threat to reducing the burden of STIs
worldwide.
 Sexually Transmitted Infection (STI)
 Most STIs have no symptoms
 A person can have an STI and not know it
 Why would you be at greater risk of getting an
STI that doesn't cause any symptoms?
 How can someone get an STI?
o Vaginal sex
o Anal sex
o Oral sex
o Transmission from mother to baby during
childbirth
o Skin to Skin contact
o Sharing equipment
o Exchange of bodily fluids
 There are 3 types of STIs
 Bacterial
 Parasitic
 Viral
 Bacterial STIs
 Chlamydia
 Gonorrhea
 Syphilis
BSN
S2
 Chlamydia
o Among the most common bacterial STIs in
the world
o Passed by having unprotected oral, anal or
vaginal sex
o Condoms can help prevent the spread of
chlamydia during vaginal/anal sex
o Condoms or dental dams can be used for
protection during oral sex
o Most people have no symptoms
o The infection can be cured with a single
dose of antibiotics
o A person can get the infection again, so
their partners should also be tested
o Remember chlamydia is CURABLE!
 Gonorrhea
o Sexually transmitted bacterial infection
o Passed along by having unprotected oral,
anal or vaginal sex
o Condoms can help prevent the spread of
gonorrhea during vaginal or anal sex
o Condoms or dental dams can be used for
protection during oral sex
o Most people have no symptoms
o The infection can be cured with antibiotics
o A person can get the infection again, so
their partners should also be tested
o Remember gonorrhea is CURABLE!
 Syphilis
o Rare sexually transmitted bacterial infection
o Can cause serious damage to the body if not
cured, including death
 CHAPTER 3: SEXUALLY TRANSMITTED INFECTION (STI)
o Passed along by having unprotected oral,
anal or vaginal sex
o Condoms can help prevent the spread of
syphilis during vaginal or anal sex
o Condoms or dental dams can be used for
protection during oral sex
o Syphilis produces a wide range of
symptoms that are often confused with other
illnesses
o Some people have no symptoms at all
o The infection can be cured antibiotics
o A person can get the infection again, so
their partners should also be tested
o Remember syphilis is CURABLE!
 Parasitic STIs
 Pubic lice
 Scabies
 Trichomoniasis
 Pubic lice
 The lice attach their eggs to the pubic hair
and feed on human blood
 Trichomoniasis
 Caused by a parasite that is usually sexually
transmitted, but it can survive 24 hours on
wet towels and bathing suits
 Scabies
 Caused by the itch mite. It burrows just
under the skin and lays eggs. The scabies
mite can live for 2-4 days away from the
human body; it can be transmitted without
sexual contact.
 How to prevent parasitic STIs
 Trichomoniasis
o Condoms will help prevent the spread
 Pubic lice and Scabies
o Avoid sharing towels and clothing that
have not been washed
o When trying on bathing suits or
underwear in the store always wear
something underneath
 Signs and symptoms of a parasitic STI
 Intense itchiness
 Reddish rash
 Pain during sex or urination
 Vaginal discharge
 How are parasitic STIs treated?
o Shampoo – special shampoo to kill lice or
scabies
o Lotion - special shampoo to kill lice or
scabies
o Ointment- special shampoo to kill lice or
scabies
o Antibiotic – used to treat trich
 Viral STIs
o Human Papilloma Virus (HPV)
o Herpes
o Hepatitis
o HIV / AIDS
 Human Papillomavirus (HPV)
 Very contagious virus
 Some people never get symptoms
 HPV is spread through skin to skin contact ,
oral, anal and vaginal sex with an infected
partner
 Some types cause genital warts and other
types can cause cancer of the cervix
 Treatment
 Treatments remove the warts but does not
remove the virus from the blood
 Most warts will clear over time
 There is no cure for HPV
 There is a vaccine to prevent HPV available
for students in grade 7
Course Code: Microbiology & Parasitology CN-MP
 Genital Herpes
 Caused by the Herpes Simplex Virus (HSV)
 Spread through skin to skin contact and oral,
anal and vaginal sex
 Some people with herpes never develop
sores, but are still contagious and may
spread it to others without knowing
 People who have an initial outbreak can
have more outbreaks throughout the rest of
their life
 Remember herpes is not CURABLE. It is
TREATABLE!
 Hepatitis
 Hepatitis is a virus that affects your liver
 It can cause permanent liver disease and
cancer of the liver
 Hepatitis A & B can be prevented by
vaccines
 There is no vaccine for Hepatitis C
 Remember hepatitis is not CURABLE!
 How is Hepatitis transmitted
 Hepatitis A is transmitted through fecal oral
route
 Hep B is transmitted through blood and
bodily fluids
 Hep C is transmitted mostly through blood
but also through bodily fluids
 How can someone lower their chances of
getting Hepatitis B and C?
 Get vaccinated against Hepatitis B
(available for students in grade 7)
 Practice safer sex
 Do not share instruments used in body-
piercing, tattooing or hair removal
 Do not share personal items such as
toothbrushes, razors and needles
 Human Immunodeficiency Virus (HIV) and
Acquired Immunodeficiency Syndrome
(AIDS)
 HIV and AIDS
o HIV is the initial infection
o AIDS is the advanced stage of the disease
o Over a period of time, the virus attacks and
damages the body’s immune and nervous
system
 How is HIV/AIDS spread?
o The virus is spread through bodily fluids
o Decrease risk with condom use
o There is no cure for HIV infection
o Once infected, you have HIV for life
 STI Testing
Chlamydia and Gonorrhea
o Urine test for males and females
o If symptoms present, swabs may be
done
Trichomoniasis
o Diagnosed by taking a sample of vaginal
discharge
Genital warts (HPV)
o Diagnosed by visual examination
Herpes
o Usually diagnosed by sight, and by
history
o A swab of the lesion can be taken to
confirm virus
Hepatitis B, C, Syphilis and HIV
o Diagnosed by blood tests
 Where can someone go for STI testing and
treatment?
o Family Doctor/Nurse Practitioner
o Walk-In Clinic
o Health Unit – STI and Birth Control
clinic
 What is the only 100 % effective way of
preventing STIs and pregnancy?
ABSTINENCE
 What does abstinence mean?
 Abstinence means to not do something
 Sexual abstinence means to abstain from
different levels of sexual activity
 Possible choices for sexual abstinence
between two people could be:
o Avoiding vaginal and anal intercourse
 CHAPTER 3: SEXUALLY TRANSMITTED INFECTION (STI)

o Avoiding oral-genital contact of an HIV infected person

o Avoiding genital contact  Window Period
 Preventing STIs and pregnancy  When a person gets infected it may take 6
 Delay sexual activity until you are older weeks or up to 3 months before antibodies
 If you choose to be sexually active, use to HIV are detected in the blood
protective barriers (condoms, dental dams)  The HIV test looks for antibodies. When
and birth control these antibodies are detected the person is
 Sexual health and decision making diagnosed HIV positive
 Concept of consent  A person can be positive and the test shows
 Communication in a relationship negative because the test was done during
 Keep informed about STIs and how to the window period
protect yourself  Why HIV rates not going down?
 Talk to a parent, teacher, or a trusted adult  Sex at an early age
 Little life-skills and sex education
What is HIV?
 Little condom use
 H-uman  Multiple partners
o Found only in humans  Stigma and Discrimination
o Transmitted among humans  Sex for money or sex for.things
o Preventable by humans  Substance abuse: Ganja, cocaine, alcohol
 I-mmunodefiency  Men having sex with men & homophobia
o Body lacks ability to fight off infections  Gender inequity and gender roles
 STI and HIV – The Link
 V-irus
o Type of germ  Persons with a history of STIs are more likely
to get HIV because:
o Lives and reproduces in body cells
o persons with STIs are more likely to have
 AIDS
sores and small breaks in the skin and lining
 A-cquired; received, not inherited (does not
of their genitals.
run in families)
o HIV can more easily enter the body through
 I-mmuno; protected from (in this case the
these breaks.
system protects the body from disease)
o You can get an STI by having sex without a
 D-eficiency, - a lack of
condom, with an infected person.
 S-yndrome; – a group of symptoms or diseases
o At the same time, you could be getting HIV
 HIV IS FOUND IN BODY FLUIDS
which is also contracted by having
o Semen
unprotected sex.
o Breast milk  ALL STIs are Preventable: Most STI’s are
o Blood treatable But HIV/AIDS CANNOT BE CURED
o Vaginal fluid  Prevention
 How HIV is passed on?  Talk with partner about HIV
 During unprotected (skin to skin) sex (anal,  Use a condom with your regular and non-
vaginal or oral) regular clients, and partners every time you
 Contact with HIV infected blood or blood have sex
products  Reduce the number of main partners
 Sharing IV drug needles of HIV positive  Get tested. Know your status
people  Who is most at risk for HIV?
 From HIV positive mother to child  Anybody having sex without a condom.
 During breast feeding  People with more than 1 partner who don’t
 You CANNOT get HIV from… use a condom during sex
o Tears  People whose sex partner have sex with
o Saliva other partners without using a condom
o Sweat  How You DON’T Get HIV
o Urine
Course Code: Microbiology & Parasitology CN-MP
 You CANNOT get HIV by hugging,  Lesions may be bathed in mild soap and
touching, living with or caring for someone water
with HIV, shaking hands or kissing.  Sitz baths may provide some relief
 You CANNOT get HIV from eating out of  Sex partners may benefit from evaluation
the same plate or cup or utensils that an HIV and counseling
positive person uses. o Transmission is possible when lesions
 Early Signs & Symptoms of HIV not present due to viral shedding
o Fever
o Fatigue  Syphilis
o Night Sweats  Syphilis: Clinical Presentation
o Loss of Appetite  Primary / Infectious / Early Syphilis Stage:
o Diarrhea  Primary Phase
o Swollen Lymph Glands  Primary chancre
Remember these are symptoms of many other o Begins as papule and erodes into painless
illnesses. ulcer with a hard edge and clean base
 REMEMBER o Usually in the genital area
 You CANNOT tell by looking if someone o Appears 9-90 days after exposure
has HIV. o Can be solitary or multiple (eg. kissing
 An individual can look and feel well for lesions)
many years and be HIV positive. o Heals with scarring in 3-6 weeks and 75%
 The HIV positive person can pass the virus of patients show no further symptoms
on to someone else.  Secondary Phase
Common STIs in HIV-Infected Women  Occurs 6 weeks – 6 months after chancre
1. Herpes Simplex Virus (HSV)  Lasts several weeks
2. Syphilis  Accompanied with fever, malaise,
3. Chlamydia generalized lymphadenopathy, and patchy
4. Gonorrhea alopecia
5. Trichomoniasis  Maculo-papular rash usually on palms and
 Herpes Simplex Virus (HSV) soles
 HSV: Clinical Presentation  Secondary / Latent Stage:
 Primary Infection  Positive serology
o Prodrome phase: Tingling/itching of skin o Rapid Plasma Reagin (RPR)
o Appearance of painful vesicles in clusters o Venereal Disease Research Lab (VDRL)
on an erythematous base  Patients are asymptomatic and not
o Vesicles ulcerate then crust over and heal infectious after first year, but may relapse
within 7-14 days o One-third will convert to sero-negative
o Viral shedding continues for up to 2-3 status
weeks o One-third will stay sero-positive but
 Recurrent Disease asymptomatic
o After primary infection, virus migrates to o One-third will develop tertiary syphilis
sacral ganglion and lies dormant  Tertiary Stage:
o Reactivation occurs due to various triggers  Cardiovascular: Aortic valve disease,
o Reoccurrence is usually milder and shorter aneurysms
in duration  Neurological: Meningitis, encephalitis,
 HSV: Diagnosis tabes dorsalis, dementia
 Clinical presentation  Gumma formation: Deep cutaneous
 Viral culture granulomatous pockets
 Tzanck smear/Giemsa smear  Orthopedic: Charcot’s joints, osteomyelitis
 Skin biopsy  Renal: Membranous Glomerulonephritis
 HSV: Treatment Considerations  Syphilis: Diagnosis
 Antivirals  Requires demonstration of:
 CHAPTER 3: SEXUALLY TRANSMITTED INFECTION (STI)

o Organisms on microscopy using dark field o Pharynx

o Positive serology on blood or cerebrospinal o Rectum
fluid (CSF)  Signs and Symptoms
 Non-Specific Treponemal Tests:  Frequently asymptomatic
1. Venereal Disease Research Laboratory  Vaginal discharge
(VDRL)  Abnormal uterine bleeding
2. Rapid Plasma Reagin (RPR)  Dysuria
 Positive serology on blood or CSF  Mucopurulent cervicitis
o Specific Treponemal Test:  Lower abdominal pain
1. Fluorescent Treponemal Antibody  Gonorrhea: Diagnosis
Absorption (FTA-ABS)  Clinical exam
2. Microhemagglutination-Treponema  Cervical culture
pallidum (MHA-TP)  Polymerase chain reaction (PCR) or ligase
 Organism may not be cultured but diagnosis chain reaction (LCR)
cannot be determined by clinical findings only  Gram stain–polymorphonucleocytes with
 Syphilis: Treatment Considerations gram negative intracellular diplococci
 Primary/ secondary/ latent stage: Benzathine  Gonococcal Isolate Surveillance Project (GISP)
penicillin - Percent of Neisseria gonorrhoeae isolates with
 Neurosyphilis: Penicillin G resistance or intermediate resistance to
 Ask about penicillin allergy before ciprofloxacin, 1990–2005
treatment  Gonorrhea: Treatment Considerations
 Jarisch-Herxheimer reaction may occur  Intramuscular Ceftriaxone
 Chlamydia  For pregnant women only:
 Chlamydia: Clinical Presentation o Ceftriaxone single dose but
o Mucopurulent cervicitis/vaginal discharge substitute Quinolones with
o Dysuria Erythromycin
o Lower abdominal pain o Do not treat with Quinolones or
o Urethritis, salpingitis, and proctitis Tetracyclines
o Post coital bleeding – friable cervix  Evaluate and treat all sexual partners
 Trichomoniasis
 Key Considerations:
 50% of females are asymptomatic  Trichomoniasis: Clinical Presentation
 Sterile pyuria with urinary tract symptoms  Signs and symptoms:
should trigger you to think chlamydia  Vulvar irritation
 Chlamydia: Diagnosis  Dysuria
 Dyspareunia
 Chlamydia culture
 Pale yellow, malodorous - gray/green frothy
 New tests include:
discharge
1. Direct immunofluorescence assays (DFA)
 Strawberry cervix, inflamed and friable
2. Enzyme immunoassay (EIA)
 Trichomoniasis: Diagnosis
 Chlamydia: Treatment Considerations
o Flagellated, motile trichomonads on wet
 Antibiotics
mount
o Azithromycin
o Vaginal pH > 4.5
 Evaluate and treat sexual partners
o Diagnosis confirmed by microscopy
 Avoid sex for seven days after completion
of treatment o Other FDA approved tests:
 Gonorrhea 1. OSOM Trichomonas Rapid Test
 Gonorrhea: Clinical Presentation 2. Affirm VP III
 Areas of Infection  Trichomoniasis: Treatment Considerations
o Urethra o For HIV-infected women: same treatment as
o Endocervix non-HIV infected women
o Metronidazole or Tinidazole
o Upper genital tract
Course Code: Microbiology & Parasitology CN-MP
o Sex partners have to be treated
 Providing Culturally Competent Care
 The following factors can influence a woman’s
understanding of STDs and need for screening:
 Language and literacy level
 Cultural and social background and its
impact on her
 understanding of health, illness, and the
female anatomy
 Comfort with discussing sexual health
issues
 Comfort and previous experience with STD
screening or testing
 History of sexual abuse and/or domestic
violence may cause anxiety and exam
refusal
 Pearls of Wisdom
o Get comfortable with obtaining a thorough
sexual history
o Check oral cavity if genital STD suspected
o Minimum of annual screening for STDs is
recommended, with more frequent
screening if high risk behaviors are reported
o Partner notification and risk reduction
counseling for both patient and partner is an
important part of treatment and follow-up.
 Conclusion
 STD screening and treatment should be a
primary intervention and a standard of care
in all health care settings.
 Women infected with STDs have increased
chances of contracting HIV.
 Studies show STD and HIV co-infection
increases HIV virus shedding in the
patients’ genital secretions.
 If co-infection is present, proper diagnosis
and treatment of STDs will decrease the
chances of transmitting HIV.