Adama science and

technology university
ASOHS
Sexually Transmitted Infections

By Dr. Kassim R. MD,MSc

Nov. 2013 GC
 STI’s
• Infections that can be transmitted through sexual activity
• May be caused by a bacteria, virus, fungus, or other
organism
• Some are curable, some are not
• Left untreated, STIs can cause pain, sickness, infertility,
birth defects, and sometimes death
• STIs are very common (see next slide)
• You can have more than one STI at a time, and you can
get the same STI more than once.
 Incidence of STIs
• Starting statistics
– ~1/2 of the STIs diagnosed annually in the USA occur
among people under 25
– ~19,000,000 new cases each year in USA
– Approximately 3 million teenagers are infected with
STIs each year
– 25% of U.S.A population > 1(one) STI by age 35
– Largest proportion of AIDS cases infected in
teenagers or 20s
 Factors contributing to high rates of STIs

• Main reason:
• multiple sexual partners
• unprotected sex--especially prevalent behavior in
adolescence and early adulthood
• Use of oral contraceptive
• Limited access to health care
• Neglactions:- Practitioners do not ask questions about
patients’ sexual behaviors
• Absence of symptoms:-Some diseases have no obvious
symptoms
• Difficulty talking to partner
 RISK FACTORS FOR STI
• Risk factors are:
• 1. Age: 15 years and older
• 2. Marital status: unmarried people who often change
their sexual partners are more frequently exposed.
• 3. Occupation: soldiers, policemen, students,
seasonal laborers, and other people who are
temporarily away from home tend to expose
themselves more easily.
• 4. Residence: Due to industrialization and
consequent urbanization there is usually a large
group of single young men in towns and Women in
towns may have more difficulty.
 Things to be know For each STI:
STI
• Causative agent:-Know what causes it (bacteria,
virus, other organism, etc.)
• Mode of transmision:-Know how it can be
transmitted, and how to avoid transmission
• Clinical S/S:-Know what the symptoms are
• Intervention methods:-Know how it is treated, if
treatment is available
 The public health importance of STIs

• The occurrence of STI in an individual is an indicator of unprotected

sexual activity that increases the chance of acquiring another STI
including HIV.
• There fore the epidemiological determinants of STI and HIV infection
are similar b/c both infections result from risky sexual behaviour.
• STI promote the spread of HIV in the community; for instance men
with gonococcal urethritis have eight times higher concentration of the
virus in their semen than men without it.
• This increases the probability of infection in their partners. Similarly,
women with vaginosis have large number of CD4 cells in the vagina
resulting in high chance of acquiring HIV infection. ---STIs are also
important causes of
• cervical and penile cancer.
• Infertility
• other obstetric complications like ectopic pregnancy occur following
inadequately treated STIs.
Syndromic approach to the management of STI

• The control of STI, is based on three principles

• Education on the mode and means of reducing
the transmission of STI
• Provision of effective Management for
symptomatic patients with STIs
• Detection of infection in asymptomatic
individuals by screening patients attending
routine services like family planning or antenatal
clinics.
• Advantages of syndromic case management over
etiologic
• Solves the problem of scarce human resources and
lab facilities where these are significant limitations
for management based on the identification of the
etiologic agent of a specific STI.
• Saves the time spent to isolate the specific pathogen
and the inaccessibility of such facilities
• Saves financial expenditure to get lab services
• N.B. The syndromic case mgt requires
identification of distinct syndromes that are
known to be associated with STI rather than
identifying specific diseases
• * One of the means of controlling AIDS is
effective control of STI. Because: Both
infections, share similar epidemiologic
determinants
• STIs increase the susceptibility to infections as
well as the spread of HIV.
 Examination of a pt with STI
• Like any other disease, the diagnosis of STIs relies on
paper history taking and physical exam. This entails
privacy and confidentiality in order to promote health
seeking behaviour and avoid stigmatization.
• The demographic characteristics of the pt that include age,
sex, and marital status are important components of the
history.
• The occupation of the pt is also important because long
truck drivers and solders are at increased risk for STIs.
Multiple sexual partnership and history of STIs in the pt or
his/her partner are also important risk factors for STIs.
• Urethral discharge or burning on micturation in men
• - Onset, unprotected casual sex, the amount of discharge
should be inquired.
• * Vaginal discharge in women
• - Vaginal discharge is abnormal when the women notice
change in colour, amount and odour.
• History of STI in her partner, multiple sexual partners and
change in Partner is important risk factor to consider in the
history.
• * Genital ulcer in men and women.
• The onset, history of recurrence, presence of pain, location
and whether the ulcer is single or multiple should be
described in the history.
• Lower abdominal pain in women.
• The onset, quality of pain radiation, severity,and presence
of vaginal discharge, last menstrual period, and systemic
symptoms like fever, nausea and vomiting are essential
components of the history.
• * Scrotal swelling
• The health worker should ask the onset, presence of pain,
history of trauma and for concomitant urethral discharge
• * Inguinal bubo.
• Presence of pain, ulceration, discharges and the locations
of the swelling are essential components of the history
Size comparison of STI pathogens

Protozoa, lice, scabies mites:

Easily visible under light microscope

Yeast: clearly visible under

light microscope

Bacteria: barely visible under

light microscope

Viruses: not visible under light

microscope
 (global)

(from C Wilson Biology of Sexuality lecture)

 Bacterial infections

• Chlamydia
• Gonorrhea
• Nongonococcal urethritis (NGU)
• Syphilis
• Bacterial vaginosis
 1. Chlamydia
• Caused by: bacterium Chlamydia trachomatis that
infects the urogenital system
• Prevalence: The most common bacterial STI in the USA
(3-4 million new cases a yr. in USA)
• Transmission: primarily penile-vaginal, oral-genital,
oral-anal, or genital-anal contact; can also be spread by
fingers from one body site to another.
• Symptoms:
– In majority of cases, none! (No symptoms)
– if present:
• Women: mild irritation or itching, burning on urination, slight
vaginal discharge
• Men: urethral discharge, burning on urination
 Chlamydia (cont.)
• Consequences if left untreated:
• Women: pelvic inflammatory disease (PID)
– Bacterial infection spreads from cervix up into uterine lining, fallopian
tubes, and possibly ovaries.
– Symptoms of PID include disrupted menstruation, chronic pelvic pain,
lower back pain, fever, nausea, vomiting, and headache.
– Even after treatment, scar tissue from PID can block fallopian tubes
and cause infertility or ectopic pregnancy (very dangerous)
• Men: epididymitis (infection of the epididymis) or urethritis
(infection of the urethral tube)
– Symptoms of epididymitis: heaviness in testis; small, hard, painful
swelling in testis; inflamed scrotum
– Symptoms of urethritis: penile discharge, burning on urination
 Chlamydia (cont.)
• Consequences if left untreated, cont.:
• Trachoma:
– a chronic, contagious form of conjunctivitis
caused by chlamydia infection. World’s leading
cause of preventable blindness.
Common cause of eye infections
in newborns, who can become
infected as they pass through
birth canal.
• Consequences for babies born to infected mothers:
– Babies of infected mothers can also develop pneumonia caused
by chlamydia infection
– Chlamydia infection can lead to premature delivery
 Chlamydia (cont.)
• Treatment:
• 7-day treatment of doxycycline, or one dose of
azithromycin
• All exposed sexual partners should be treated
 2. Gonorrhea
• Caused by: bacterium Neisseria gonorrhoeae
• Prevalence: ~700,000 new cases a yr. in USA
• Transmission: penile-vaginal, oral-genital, oral-anal, or
genital-anal contact
• Symptoms:
– Male early symptoms:
• foul-smelling, cloudy penile discharge,
• Burning on urination
• symptoms may clear up, but does not necessarily
mean bacteria are gone
– Female early symptoms:
• usually go undetected
• inflamed cervix, mild discharge
• Burning on urination
 Gonorrhea (cont.)
• Consequences if left untreated:
• Men: prostate abcesses, painful BMs, difficult on
urination, possible sterility due to scar tissue in epididymis
after epididymitis
• Women: PID (often more severe than with chlamydia infection),
ectopic pregnancy, severe pelvic pain due to scar-tissue
adhesions across pelvis
• Both sexes: can enter bloodstream and spread throughout
body in ~2% of cases, causing fever, loss of appetite,
arthritic pain, can invade heart, liver, CNS
– Can cause blindness in infants (due to conjunctivitis)
Gonorrhea (cont.)
• Treatment:
• Dual therapy of two antibiotic regimens
• Often, chlamydia infections accompany gonorrhea
infection--dual therapy will treat both infections
• Resistant bacteria require special treatment
• All exposed sexual partners should be treated
 3. Nongonococcal Urethritis
• Any urethral inflammation not caused by gonorrhea
– Main infecting organisms: Chlamydia trachomatis and
Mycoplasma genitalium
– Can also result from other infectious agents, allergic reactions to
vaginal secretions, or irritation from soaps, contraceptives, or
deodorant sprays
• Prevalence: quite common in men; symptoms in women
are usually undetected
• Transmission: mainly through penile-vaginal coitus
• Symptoms:
– Men: penile discharge, burning on urination
– Women: frequently, no symptoms; may have mild itching,
burning on urination, vaginal discharge of pus
 Nongonococcal Urethritis (cont.)
• Consequences if left untreated:
• Men: can spread to prostate, epididymis, or both
• Women: cervial inflammation, PID

• Treatment:
• 7-day treatment of doxycycline, or one dose of
azithromycin
• All exposed sexual partners should be treated
 4. Syphilis
• Caused by: bacterium Treponema pallidium
• Prevalence: ~700,000 new cases a yr. in USA
• Transmission: penile-vaginal, oral-genital, oral-anal, or
genital-anal contact
• Symptoms:
– Primary syphilis: Single, painless sore (chancre)
– Women: on inner vaginal walls or cervix, sometimes on labia
– Men: glans of penis, penile shaft, or scrotum
– Can also occur on lips or tongue (infected orally) or in rectum/anus
(infected through anal intercourse)

Glans of penis labia anus

 Syphilis (cont.)
• Symptoms:
– Secondary syphilis: skin rash,
– often on palms, soles of feet
• Severity can vary from barely
• noticeable to severe
• Does not hurt or itch
• Person may feel flu-like symptoms
• If not treated, symptoms will subside, but disease is
not eliminated
– Latent syphilis: no symptoms; no longer contagious after 1 year
of latent stage (except pregnant woman to fetus--at all stages)
– Tertiary syphilis: severe symptoms anywhere--such as heart
failure, blindness, paralysis, liver damage, mental disturbance,
death
 Syphilis (cont.)
• Treatment:
• Primary, secondary, or latent syphilis (< 1yr) early
cases treated with benzathine penicillin G or other
antibiotic
• All exposed sexual partners should be treated
• Treated patients need blood tests at 3-month intervals
to make sure they are free of bacterium

• To prevent birth defects, death to fetus, it is

recommended that all pregnant women are tested for
syphilis at first prenatal visit
Viral infections

• Herpes Simplex Virus (HSV)

• Human papillomavirus (HPV)
– a.k.a. genital warts
• Hepatitis
– 3 types (HAV, HBV, HCV)
• Human immunodeficiency virus (HIV)
 Herpes
• Caused by: Herpes simplex virus (HSV)
– Two sexually transmitted types: HSV-1 and HSV-2
– HSV-1 is usually oral herpes (cold sores), but can infect genitals;
HSV-2 usually causes genital lesions, but can also infect the
mouth
• Prevalence: >100 million Americans have oral herpes; >45
million Americans (20-25%) have genital herpes
• Transmission:
– Genital herpes: penile-vaginal, oral-genital, oral-anal, or genital-
anal contact
– Oral herpes: through kissing, or oral-genital contact
– Herpes sores are highly contagious--need to avoid contact
between lesions and someone else’s body
– Can still transmit herpes even if no lesions are present
 Herpes (cont.)
• How to reduce risk of transmission:
– Herpes virus cannot pass through latex condoms
– During an outbreak (for most people, ~3 times/yr), best to avoid
sexual contact with the lesion area--condoms should not be
relied on when lesions are present
– Between outbreaks--safest strategy is to use condoms, oral
dams, etc. since there can sometimes be asymptomatic viral
shedding
• Condoms aren’t 100% effective at preventing transmission, since
they don’t cover entire genital area, but they reduce risk significantly
– Medications are available that reduce the amount of
asymptomatic viral shedding that occurs between outbreaks--
can significantly reduce risk of transmission
 Herpes (cont.)
• Recurrence:
– After lesions heal, virus retreats up nerve fibers and stays dormant in
nerve cells in the spinal column
– Flare-ups occur when virus moves back down along fibers to genitals
or lips
– Triggered by wide variety of factors, such as: stress, anxiety, depression,
acidic food, UV light, fever, poor nutrition, fatigue
– Symptoms during recurrent attacks tend to be milder than primary
episode, heal more quickly
– Prodromal symptoms: symptoms that warn of an impending
herpes outbreak
• Burning, throbbing, or tingling at sites of infection
• Sometimes includes pain in legs, thighs, groin, or buttocks
• Viral shedding is more common during prodromal symptoms than
beforehand--best to avoid contact w/infected area from first sign of
prodromal symptoms until sores have healed
 Herpes (cont.)
• Other complications:
• Women:
– Increased incidence of cervical cancer--women with herpes
should get Pap smears every 6-12 months
– Newborn baby can be infected by passage through birth
canal--can cause severe damage or death
• C-section recommended for women w/active symptomatic disease
• Both sexes:
– Ocular herpes infection can occur if virus is transferred from a
sore to the eye
• Must be treated quickly to avoid eye damage
 Herpes (cont.)
• Treatment:
• Reduce frequency of outbreaks
• Treat symptoms of outbreaks and speed healing
• Two types of therapies
– Suppressive therapy: medication taken daily to prevent recurrent
outbreaks; also reduces asymptomatic viral shedding between
outbreaks
– Episodic treatment: medication taken to treat outbreaks when they
occur
• Antiviral drugs-- reduce viral shedding and the duration and
severity of outbreaks
– Acyclovir (trade name Zovirax)
– Valacyclovir (trade name Valtrex)
– Famiclovir (trade name Famvir)
 Genital warts
• Caused by: Human papilloma virus (HPV)
– There are over 100 strains, ~1/2 cause genital infections
• Prevalence: >15% of Americans; >6 million new cases in USA
each year
• Transmission:
– Penile-vaginal, oral-genital, oral-anal, or genital-anal contact
– Condoms do provide some protection, but don’t prevent
transmission of viral infections on vulva, base of penis, scrotum,
and other genital areas not covered by condoms
– HPV is most commonly transmitted by people who are
asymptomatic
 Genital warts (cont.)
• Symptoms:
– Most people don’t develop symptoms and are
unaware that they are infected.
– If visible warts do appear, incubation period is
approximately 3-8 weeks after contact
w/infected person.
• In women, genital warts usually appear on lower
vaginal opening--also,perineum, labia, inner vaginal
walls,cervix
• In men,usually on glans,foreskin,or shaft of penis.
Both sexes: can also occur on anus. In moist areas,
appear pink or red and soft,w/cauliflower-like
appearance; in dry areas, appear hard and yellow-
gray
 Genital warts (cont.)
• Consequences:
• Certain strains of HPV are associated with cancers of the
cervix, vagina, vulva, urethra, penis, & anus
• HPV infections account for 85-90% of risk for
development of cervical cancer
– Risk of HPV-induced cervical cancer is minimal if regular Pap
testing and treatment of precancerous lesions is done
• Pregnant women that are + for HPV can transmit the virus
to their babies during birth
– Can cause respiratory papillomatosis in infants--HPV infection of
upper respiratory tract
 Genital warts (cont.)
• Treatment:
• Visible genital warts are removed by either cryotherapy (freezing)
or chemical treatment; larger warts may require minor surgery to
remove
– Removal doesn’t necessarily prevent recurrence
– Warts may disappear on their own

• New: prevention via vaccine

• Gardisil: vaccine against 4 strains of HPV that together cause 70%
of cervical cancers and 90% of genital warts
• USA Dept. of Health and Human Services committee voted
unanimously that females age 11-26 should be vaccinated
– Most health officials believe vaccination before puberty is best, before teens
become sexually active
 Hepatitis
• Caused by: Hepatitis virus--attacks the liver
– There are three types, each caused by a different hepatitis virus,
hepatitis A (most common), hepatitis B, and hepatitis C
• Prevalence: worldwide, >170 million people (5 million in USA)
have HepC infection (the most health-threatening of the 3 types)
• Transmission:
– All 3 types of hepatitis can be transmitted through sexual contact, but
HepB (and somewhat, HepA)are transmitted more often through sex
– Needle-sharing is also a common mode of transmission (most
common mode of transmission for HepC)
– HepA spread primarily through fecal-oral route
• Oral-anal sexual contact
• Infected food handlers not washing hands after using bathroom
– From infected mother to fetus or infant
 Hepatitis (cont.)
• Symptoms:
– Symptoms vary considerably:
• May have no symptoms
• May have mild flu-like symptoms
• May have high fever, vomiting, severe abdominal pain
• Jaundice can occur--yellowing of whites of the eyes or the skin due to
increased breakdown of RBC.
• Consequences:
• Chronic infection w/HepB or HepC is a major risk factor for liver
cancer
• ~20-25% of HepC+ people manifest progressive disease resulting
in severe liver complications--liver cancer, cirrhosis, liver failure
 Hepatitis (cont.)
• Treatment:
• HepA: bed rest, fluid intake--usually runs its course in a few weeks
to a few months
• HepB: same as HepA, except that some HepB infections can
become chronic and persist for >6 months
– Chronic HepB infections are treated w/several antiviral drugs
• HepC: more serious for the 20-25% of HepC+ people with
progressive chronic HepC infection--antiviral drugs can help
somewhat for some strains of HepC (especially AIDS patients)

• Vaccines
• Available for HepA and HepB
– High risk people (health care workers, injection drug users, sexually active
people w/multiple sex partners, etc.) should be immunized
– CDC recommends that children be immunized for HepB
 Common Vaginal Infections
• Vaginitis: general term applied to variety of vaginal
infections
– May be caused by organisms that are already present in vagina
• Sexual activity may introduce organism, or may throw off balance of
‘good’ microbes in the vagina
– Bacterial vaginosis: caused by anaerobic bacteria,
Mycoplasma bacteria, or Gardnerella vaginalis
– Candidiasis: caused by yeast infection w/Candida albicans
– Trichomoniasis: caused by one-celled protozoan
Trichomonas vaginalis
 Bacterial vaginosis (BV)
• Very common vaginal infection
• Occurs more frequently among sexually active women, though
can occur in women who have not experience sexual intercourse
• Symptoms (in women): foul-smelling pasty discharge, usually
gray, can be white, yellow, or green
– Most men are asymptomatic--some develop urethritis or bladder
infection
• If untreated, can increase risk of PID
• If untreated in pregnant woman, associated w/ premature rupture
of amniotic sac,and preterm labor
• Treatment w/oral or topical Flagyl (metronidazole) or
clindamycin cream
 Candidiasis
• Also very common vaginal infection--3/4 of women will have at
least one genital yeast infection in their lifetime
• Candida albicans yeast are normally present in the vagina of
many women--also present in mouth and intestines of many
people
– Only causes infection/disease when yeast becomes overgrown
– Can occur during pregnancy, from antibiotics Rx, spermicidal creams,
oral contraceptives, high-sugar diet, diabetes
• Symptoms (in women):
– white, clumpy, cottage-cheese discharge
– Intense itching and soreness of vaginal and vulval tissues
• Treatment: topical intravaginal creams, available over the
counter--wise to be diagnosed by a doctor first;
– many women self diagnose incorrectly
Trichomoniasis
• Common in women and men Trichomonas
vaginalis
• 7-8 new cases each year in USA
• Primarily spread through sexual contact
• Symptoms (women):
– White or yellow-green discharge, frothy, w/unpleasant odor
– Irritated vaginal and vulval tissues -- can increase a woman’s
susceptibility to HIV infection
– If untreated, can damage cervical cells, may lead to cervical cancer; in
pregnant women, can lead to premature rupture of amniotic sac and
preterm delivery
• Symptoms (men): usually none, may have frequent or painful
urination or slight urethral discharge
• Treatment: metronidazole (Flagyl)
– All sexual partners should be treated
 Ectoparasitic infections

• Ectoparasites: parasitic organisms that live on the

outer skin surfaces
• 2 common STIs caused by ectoparasites:
1) pubic lice
2) scabies
 Pubic lice (a.k.a. crabs)
• Caused by: biting louse called Phthirius
pubis
• Prevalence: more prevalent among
young (15-25 yr.old) single
people, often associated w/presence of
other STIs. Female pubic louse
• Transmission: during sexual contact when two people
bring their pubic areas together
– Lice can live away from the body for as long as 1 day--can drop
off onto underclothes, bedsheets, etc, and eggs deposited by
female louse can survive for several days
• Therefore, it is possible to get pubic lice by sleeping in someone’s bed or
wearing someone’s clothes
Pubic lice (cont.)
• Symptoms:
– Itching (that’s not relieved by scratching)
– Can also leave bluish-grayish marks on
the thighs and pubic area from bites
– Self-diagnosis is possible by locating a
louse on a pubic hair

• Treatment:
– medicinal lotion (1% permethrin or pyrethrin) applied to all affected
areas + all areas w/body hair (genitals, armpits, scalp, even
eyebrows);
– wash all clothes and bedding that were exposed
Scabies
• Caused by: parasitic mite called Sarcoptes
scabiei
– Female mite burrows beneath skin to lay
eggs--hatched egg grows into adult that on
host’s skin
– Too small to be seen by naked eye
Scabies mite
• Prevalence: not reported to health agencies--worldwide,
estimated at ~300 million cases/yr.
• Transmission:
– by close physical contact, both sexual and nonsexual
– Can be transferred on clothing or bedding (can live away from
host for up to 3 days)
– In addition to sexually active people, school children, nursing
home residents, and indigent people are at risk
 Scabies (cont.)
• Symptoms:
– Small vesicles or pimple-like bumps, red
rash
– Intense itching
– Favorite sites of infestation: webs and
sides of fingers, wrists, abdomen, genitals,
buttocks, and female breasts

• Treatment:
– medicinal lotion (prescription & nonprescription available)
applied at bedtime, then washed off after 8 hrs
– wash all clothes and bedding that were exposed
 Aqcuired immunodeficiency sydrome
(AIDS)
• Caused by:
• Infection w/the human immunodeficiency virus (HIV)
• 2 strains, HIV-1, and HIV-2: HIV-1 is more virulent and causes
most cases in USA; HIV-2 exists along w/HIV-1 in some African
countries
• History
• Research indicates that HIV originated from a subspecies of
chimpanzees that reside in central/SW Africa
– Chimps harbor a simian immunodeficiency virus (SIV) that genetically
converted to HIV
• HIV evolved from SIV sometime around 1931, but likely remained
confined to a small isolated population
– Eventually, migration into large cities and global travel spread the virus
worldwide
 HIV & AIDS
• HIV = a retrovirus that
• targets & destroys helper Tcells
(aka helper T-4 or CD4
cells)
– T cells play a very important role
in the immune system
– Therefore, HIV infection
leaves the body vulnerable
to a variety of opportunistic infections and cancers
• HIV becomes AIDS when:
– HIV is present, and
T-4 cell count is < 200 cells/microliter of
blood (normal T-4 counts are 600 - 1,200
cells/microliter of blood)

T-4 cell under attack by HIV

 HIV/AIDS: prevalence in U.S.A
• >1 million cases reported as of Jan 2006
• > 525,000 people died of AIDS since first diagnosis
• Estimated ~1.2 million people currently HIV+, and ~25 -50% of
these people are unaware of their HIV status
• Overall rate of new HIV infections in USA has slowed, but
number of new infections among teenagers, women, and racial
and ethnic minorities continues to rise
– Teenagers: multiple sexual partners, less likely to have access to or to
use condoms; substance abuse, feel invulnerable
– Ethnic and racial minorities: reduced access to health care,
cultural or language barriers to information about STI prevention,
differences in high-risk behaviors
– Women: fastest-growing HIV-infected population in USA.--HIV more
easily transmitted from men-to-women than vice versa
 Women and HIV/AIDS
• Number of women infected w/HIV is steadily increasing
• Women are more easily infected from heterosexual intercourse
with HIV+ partner than men are
– Semen contains higher concentration of HIV than vaginal fluids
– Female mucosal surface is exposed to HIV in ejaculate longer than a
man’s penis is exposed to HIV in vaginal secretions
– Larger area of mucosal surface is exposed in vagina/on vulva than on the
penis
– Female mucosal surface is exposed to greater potential trauma than the
penis--can cause small tears that allow virus to enter
– Some women have unprotected receptive anal intercourse--the single-
most risky behavior in terms of HIV infection for both men and women
– Adolescent women are more vulnerable to HIV infection b/c their
reproductive tracts are immature--more susceptible to infection
 Global HIV/AIDS
• 5 million new HIV infections occur globally
• By end of 2005, ~40.3 million people infected
• AIDS kills
• >3 million
• people
• each year
 AIDS in Africa
• AIDS has reached epidemic proportions in sub-Saharan
Africa; >15% of all adults are HIV+
– 2/3 (25.8 million) of all people living with AIDS live in sub-Saharan
Africa
– over 80% of AIDS deaths have occurred in Africa, primarily sub-
Saharan Africa
– 75% of HIV infections in African youth are of females
– over 10.5 million AIDS orphans in sub-Saharan Africa
• Factors contributing:
– Widespread poverty
– lack of medical care
– widespread ignorance about HIV prevention
– Cultural factors
– Gender roles
– General feeling of hopelessness
 AIDS: Transmission
• HIV in bodily fluids:
– blood, semen, vaginal secretions, breast milk
– NOTE: saliva, urine, tears--concentration of virus (if any) way too low to
transmit infection.
• Can be transmitted:
– Through vaginal or anal intercourse or oral-genital contact
– Through contaminated blood (needles, blood transfusion)
– From mother to fetus before birth, infant during birth or after
through breastfeeding
• Likelihood of transmission during sexual contact:
– Depends on infected person’s viral load (#virus particles per ml of
blood)
– Is greater when HIV is transmitted directly into blood, (through
small tears in rectal tissues or vaginal walls)
HIV/AIDS: symptoms & complications
• Within few weeks of infection, can cause flu-like
symptoms in some people
• As virus depletes immune system:
– Persistent or periodically repeating fevers, night
sweats, weight loss (“wasting syndrome”)
– Opportunistic infections
• oral candidiasis
• Life-threatening pneumonia caused by Pneumocystis carinii, which
normally inhabits lungs of healthy people
• Others: TB, encephalitis, toxoplasmosis
• Cancers: lymphomas, Kaposi’s sarcoma
• Time from HIV infection to onset of AIDS
typically ranges from 8 - 11 yrs; new treatments can
dramatically slow progression of HIV to AIDS
 HIV: symptoms & complications

• Note: viral load is highest immediately after infection, and

at late stages of HIV progression
 HIV/AIDS: Treatment
• HIV treatment drugs inhibit
two major viral enzymes
(cell proteins that carry out
chemical reactions)
1) Reverse transcriptase
– Enzyme that converts HIV
RNA genome into DNA
so it can insert into our own
DNA
2) Protease
– New HIV proteins are produced in the form of long chains that
need to be cut into smaller pieces to assemble into new HIV
viruses
– Protease enzyme is the “scissors” for this process
Drug therapy to prevent mother-to-
child transmission (MTCT) of HIV
• Zidovudine (an RT inhibitor) can reduce MTCT by 2/3 if
given to both HIV-infected mothers & their newborns
– Drug is given orally to pregnant women during gestation, by IV during
labor, and orally to newborn for first 6 weeks of life
– # of infants infected through MTCT in U.S. has declined dramatically
due to widespread use of this treatment
– Treatment regimen is very costly, and involves multiple treatments,
making it hard to administer in many poorer countries
– Recent studies in S. Africa & Uganda: infants given either a single
dose or a short-course regimen of nevirapine (RT inhibitor)
experienced excellent protection from HIV infection
– Infected mother must still refrain from breastfeeding to avoid infecting
newborn
 The search for a vaccine
• Vaccine: a harmless variant or protein/DNA fragment
from a pathogen (e.g. the HIV virus) that prevents
infection by the pathogen by stimulating the immune
system to develop long-lasting defenses.
• Several attempts have been made to develop a vaccine
against HIV--so far, w/disappointing results
• Many more vaccine candidates (over 30 as of 2005) are
currently being tested
• Many challenges confront vaccine researchers:
– Absence of ideal animal model for research
– HIV is a very complicated virus w/multiple strains
– HIV can change rapidly through genetic mutation
 Preventing STIs
• Only sure-fire way is abstinence, or monogamous
relationship btwn 2 uninfected people
• Get tested for STIs, insist that your partner do too
– May want to wait for results before engaging in sexual activity
that can put you at risk
• Communicate w/partners about safe sex
– Get to know potential sexual partners well enough to
develop trust and communication
– Inform a partner if you have an STI
• Avoid sex w/multiple partners or w/individuals at
high risk for STIs
• Use condoms or oral dams
• If you use injected drugs, do not share needles
 Condoms
• Latex condoms are highly effective in preventing
transmission of HIV, chlamydia, gonorrhea,
NGU, bacterial vaginosis, and
trichomoniasis
– Condoms are less effective in preventing infections transmitted by
skin-to-skin contact, such as syphilis, herpes, HPV, and are ineffective
in preventing pubic lice and scabies
– Condoms from sheep’s membrane contain small pores that may permit
passage of viruses (HIV, HSV, hepatitis)
– Studies on couples where one partner is infected show that with
consistent condom use, HIV infection rates for the uninfected partner
are below 1% per year.
• CDC recommends against using condoms containing
nonoxynol-9 (N-9), which can cause genital lesions that create
an entry point for HIV and other STI pathogens
 Proper use of condoms
Condoms must be used correctly every time!
 Proper use of condoms
• Store condoms in a cool, dry place away from
direct sunlight
• Throw away condoms past expiration date or
condoms in damaged packages
• Put on a condom before any genital contact
occurs
• Be sure that the condom is adequately lubricated--if you add lube,
use only water-based lube (oil-based lubes deteriorate latex)
• Unroll condom directly onto erect penis; if penis is uncircumcised,
pull back foreskin before putting on condom
• After ejaculation, hold base of condom before withdrawal so condom
does not slip off
• Note: rates of condom slippage and breakage are higher during anal
intercourse than vaginal intercourse, so be extra careful during anal
penetration
 THE END

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