HTH Chapter 15 & 16 COMPLETE

STIs on the rise

• in 2015, after years of declining STI rates, reported cases began to increase, and by 2017, the CDC reported the highest number of cases of STIs ever.

• three diseases in particular were up dramatically between 2015 and 2016: chlamydia, gonorrhea, and syphilis

STIs dramatically increased by 2015 to 2016

• chlamydia (1.59m reported cases, 4.7% increase)

• gonorrhea (0.469m reported cases, 18.5% increase)

• syphilis (27,800 reported cases, 18.5% increase)

STI disproportionately affects

• STI affect people of all background but disproportionately affect women, minorities, and infants.

• increased rates among racial and ethnic minorities are correlated with poverty, unemployment, low educational attainment, mistrust of the health care system.

STI affects younger people

• people ages 15 to 24 account for half of the 20m new STI dx each year. 

• 2 out of 5 sexually active young women ages 15 to 24 have already had an STI that can cause infertility and death.

• young males account for more than 80% of HIV dx among 13 to 19 year olds. 

routes of transmission

• STIs are generally spread through intimate sexual contact such as vaginal intercourse, oral-genital contact, hand-genital contact, and anal intercourse.

• less likely modes of transmission include mouth-to-mouth contact or contact with fluids from body sores.

STI pathogen locations 

• STI pathogens prefer dark, moist places, especially the mucous membranes lining reproductive organs.

• Most are susceptible to light, extreme temperature, and dryness, and many die quickly on exposure to air.  

• STIs have pathogen-specific incubation periods and periods of communicability. 

chlamydia

• most commonly reported STI in the US.

• in 2017, over 1.7m chlamydia infections were reported.

• experts believe the actual number may be closer to 3 million cases.

• soaring numbers among adults ages 15 to 24, make up two-thirds of all new cases. 

chlamydia signs and symptoms

• men: painful urination, urge to urinate frequently, or difficult urination. watery, pus-like discharge from the penis.

• women: yellowish discharge, spotting between periods, and occasional spotting after intercourse. 

women UTI risk

women are at a greater risk for UTIs since their urethra is much shorter than a man’s and closer to her anus than a man, allowing bacteria to spread into her urethra more easily.

chlamydia dx

• a sample of urine or fluid from the vagina or penis can be collected and tested to identify the presence of the bacteria. however, chlamydia tests are not a routine part of many health clinic’s procedures. 

chlamydia treatment

• if detected early, chlamydia is easily treatable with antibiotics such as tetracycline, doxycycline, or efrotomycin.

• refrain from sex while being treated and have your partner get treated and cured before having sex.

• you do not develop immunity to chlamydia. 

gonorrhea signs and symptoms

• men: white, milky discharge from the penis accompanied by painful, burning urination 2 to 9 days after contact, as well as testicular pain.

• women: most women do not experience any symptoms; others have vaginal discharge or a burning sensation on urinating. 

gonorrhea complications

• men: gonorrhea may spread to the prostate, testicles, urinary tract, kidneys, and bladder, and scar tissues may cause sterility. 

• women: undetected infection can spread to the fallopian tubes and ovaries, causing sterility or severe inflammation and PID. 

• left untreated, gonorrhea can spread through the blood and cause disseminated gonococcal infection, leading to arthritis, cardiovascular, and brain issues. 

gonorrhea for babies

• if a gonorrhea infected woman becomes pregnant, the infection can be transmitted to her baby during delivery, potentially causing blindness, joint infection, or a life-threatening blood infection. 

gonorrhea dx and treatment

• dx requires a sample of either urine or fluid from the vagina or penis to detect the presence of the bacteria.

• In the early stages, gonorrhea is treatable with antibiotics, but it is becoming increasingly resistant to current treatment regimens.

syphilis demographics

• the incidence of syphilis is highest in adults ages 20 to 39, and its particularly high among African Americans and men who have sex with men.

• the incidence of syphilis in newborns has continued to increase in the US as well. 

syphilis stages

primary syphilis, secondary syphilis, latent syphilis, tertiary/late syphilis.

syphilis complications on pregnancy

• pregnant women with syphilis can experience premature births, miscarriages, and stillbirths, or transmit the infection to their unborn child. 

• because in most cases the fetus does not become infected until after the first trimester, treatment of the mother during this time will usually prevent infection of the fetus. 

syphilis dx and treatment

• syphilis can be diagnosed with a blood test or by collecting a sample from the chancre.

• it is easily treated with antibiotics, penicillin specifically, for all stages except the late stage. 

herpes symptoms

• precursor phase: burning sensation and redness at the site of infection.

• second phase: a blister filled with clear fluid teeming with the virus forms. 

herpes treatment

• there is no cure for herpes at the present, however, antiviral medications can prevent or shorten outbreaks. 

• prescription drugs like acyclovir and OTC meds like Abreva can be used to treat symptoms. 

• Drugs such as famciclovir may reduce viral shedding between outbreaks, potentially reducing risks to your sexual partners. 

herpes becomes reactivated

• when the victim becomes overly stressed, diet and sleep are inadequate, or the immune system is overworked, the virus becomes reactivated at the same site and begin the blistering cycle all over again.

HPV affects

• affecting more than 79 million people, most of whom are in their late teens or 20s, one of the most common STIs in the US. 

• over 100 related viruses. 

• HPV infections are so common that most sexually active men and women will have at least one form of HPV during their lives.

• More than 40 types of HPV can infect the genital or anal areas of humans via skin-to-skin contact.

HPV signs and symptoms

• the typical incubation period is 6 to 8 weeks after contact.

• people with low-risk types of HPV may develop genital warts. 

HPV complications

• cervical cancers often result from HPV infections, particularly HPV-16, and HPV-18.

• HPV may also pose a threat to a fetus that is exposed to the virus during birth. 

• HPV can also cause oropharyngeal cancers around the tonsils or the base of the tongue, 9,000 people dx each year, men four times more likely.

HPV dx and treatment

• dx by presence of genital warts or microscopic analysis of cells from a Pap smear. 

• treatment is only available for the low-risk forms of HPV that cause genital warts. 

• treated with topical medication or be frozen with liquid nitrogen and then removed. 

• vaccines are available for several types of HPV. 

candidiasis symptoms and treatment

• itching and burning of the vagina and vulva and a white, cheesy vaginal discharge. 

• when candidiasis infects the mouth, whiteish patches form, and is referred to as trush. 

• antifungal drugs applied on the surface or by suppository usually cure candidiasis in just a few days. 

trichomoniasis symptoms

• men: most do not experience symptoms, but some face irritation inside the penis, mild discharge, and a slight burning after urinating.

• women: foamy, yellowish, unpleasant-smelling discharge accompanied by a burning sensation, itching, and painful urination. 

trichomoniasis dx and treatment

• dx by collecting fluid samples from the vagina or penis. 

• treatment includes oral metronidazole, usually give to both sexual partners to avoid cross-infection. 

AID recognition

• recognition of AIDS began in 1981 report from the CDC.

• since its discovery, approx 78m people world-wide have becomes infected with HIV, the virus that causes aids, and over 35m have died. 

people living with AIDS

• today, 37 million people world-wide are living with HIV, with 1.8 million new infections and 1 million deaths in 2016. 

• more than half of the blobal population w/HIV are recieiving antiretroviral treatment. 

• majority of HIV-infected are in sub-Saharan Africa, making up nearly 70 percent of all new cases in the world.

• rates are increasing in Eastern Europe and Central Asia, up 57% in the past 5 years, especially among drug users. 

HIV in the US

• since HIV was first discovered, almost 700,000 people in the US have died of AIDS, with just over 12,000 deaths each year. 

• 1 in 7 people with HIV in the US do not know they are infected. nearly 1.25m people in the US are living with HIV. 

HIV transmitted

• HIV enters the body when another person’s infected body fluid gain entry through a breach in body defenses.

• a break in mucous membranes of the genital or anus, particularly in anal intercourse, allows the virus to enter and begin to multiply. 

• progressively destroys helper T cells, weakening the body’s resistance to disease. 

• HIV CANNOT be transmitted through causal contact. 

HIV at risk population

• men who have sex with men (MSM), particularly young black/African MSM are most seriously affected by HIV. 

• people of color have poorer HIV/AIDS outcomes than whites due to a number of social and economic barriers and challenges, such as lack of access to early treatment, stigma, homophobia, and poverty. 

HIV infection causes

• exchange of body fluids vaginal area is more susceptible to microtears, and a woman is exposed to more semen that a man is to vaginal fluid.

  • 80% of HIV infection in women is through heterosexual contact. 

• contaminated needles: sharing needles and engaging in high-risk sexual activities dramatically increase infection risk. Tattooing and body piercing can also be risky.

mother to child HIV transmission

• can occur during pregnancy, labor and delivery, or through breastfeeding. 

• approximately 15 to 45 percent of HIV-positive women will transmit the virus to their infant. 

• with appropriate interventions transmission rates can be lowered to 5 percent. 

HIV/AIDS symptoms and dx

• a diagnosis of AIDS, the final stage of HIV infection is made when the infected person has a dangerously low CD4 (helper T) cell count. 

• or has contracted one or more opportunistic infections such as Kaposi’s sarcoma. tuberculosis, recurrent pneumonia, or invasive cervical cancer. 

testing for HIV

• everyone between ages 13 and 64 should get tested for HIV at least once. 

• three categories of tests exist for HIV, antibody tests, combination antigen/antibody tests, and nucleic acid tests (NAT).

antibody HIV tests

• if infected, the body produces antibodies 18 to 84 days after infection.

• this is known as the window period, and is the general timeframe it may take for sufficient antibodies to be detectable. 

• may not be detectable until day 84 so false negatives in earlier days are possible.

combination antigen/antibody HIV tests

• tests for HIV antibodies and antigens produced when the body reacts to foreign invaders. 

• window for detection is shorter (usually 2 to 4 weeks or 13 to 42 days) for antigens and antibodies to be detected. 

nucleic acid tests (NAT) and HIV p24 Antigen Test

• newer, quicker, more costly tests look for the virus and antigens for the virus HIV p24 and are available to the public.

HIV treatment

• current treatments combine selected drugs, especially protease inhibitors and reverse transcriptase inhibitors. 

• protease inhibitors prevent the production of the virus in chronically infected cells that HIV has already invaded. 

• essentially, they change the cell in such a way to inhibit HIV reproduction in infected cells as well as making the spread to other cells more difficult. 

sexually transmitted infections (STIs)

infections transmitted through some form of intimate, usually sexual, contact.

chlaymdia

a sexually transmitted infection of the urogenital tract caused by the bacterium chlamydia trachomatis.

epididymitis

inflammation of the sperm-carrying tube behind the testicles.

pelvic inflammatory disease (PID)

an infection and inflammation of the uterus, ovaries, and other female reproductive organs.

urinary tract infection (UTI)

an infection of the urinary tract caused by untreated STIs, more common among woman then men. 

nongonococcal urethritis

an inflammation of the urethra not caused by gonorrhea, often due to other bacterial infections.

conjunctivitis

an eye infection that affects adults who do not wash their hands after intimacy and touch their eyes.

gonorrhea

a sexually transmitted infection caused by the bacterial pathogen neisseria gonorrhoeae infecting the linings of the urethra, genital tract, pharynx, and rectum.

a sexually transmitted infection of the urogenital tract caused by the bacterium chlamydia trachomatis, most common bacterial STI in the US.

disseminated gonococcal infection (DGI)

a severe complication of gonorrhea where the infection spreads throughout the body, resulting in arthritis as well as cardiovascular and brain issues.

syphilis

a sexually transmitted infection caused by the bacterium treponema pallidum, generally transferred only through direct sexual contact or from mother to fetus. 

primary syphilis

the first stage of syphilis characterized by the development of chancre, a bacteria-oozing sore located at the infection site that appears about a month after initial infection. 

secondary syphilis

when syphilis infection is left untreated secondary symptoms may appear such as a rash or white patches on the skin and mucous membranes. 

latent syphilis

following the secondary stage if the infection is left untreated, the syphilis bacteria begin to invade body organs causing lesions called gummas. 

tertiary syphilis

years after syphilis has entered the body, leading to heart and central nervous system damage, blindness, deafness, paralysis, dementia, and possible death. 

herpes

a general term for a family of infections characterized by sores or eruptions on the skin caused by the herpes simplex virus, including genital herpes (HSV-2) or oral herpes (HSV-1).

genital herpes (HSV-2)

a sexually transmitted infection caused by the herpes simplex virus, primarily resulting in painful sores and blisters in the genital area.

oral herpes (HSV-1)

a common infection acquired in childhood, caused by the herpes simplex virus, leading to cold sores or fever blisters around the mouth and lips.

human papillomavirus (HPV)

a group of viruses, many of which are transmitted sexually, some types can cause genital warts of cervical cancer. 

genital warts

warts that appear in the genital area or anus, caused by the human papillomavirus (HPV).

candidiasis (yeast infection)

yeast-like fungal infection caused by the chemical imbalance of the vagina in which the candida albicans fungus in the vagina multiple.

bacterial vaginosis (BV)

a condition resulting from an imbalance of normal bacterial flora in the vagina, leading to symptoms like discharge and odor.

trichomoniasis

sexually transmitted disease caused by the protozoan trichomonas vaginalis that spreads by sexual contact with items that have discharged fluids on them. 

pubic lice

small parasitic insects that are usually transmitted during sexual contact, more annoying than dangerous, often called crabs. 

acquired immune deficiency syndrome (AIDS)

a disease caused by a retrovirus, the human immunodeficiency virus (HIV), that attacks the immune system, reducing the number of help T cells and leaving the victim vulnerable to infections, malignancies, and neurological disorders. 

human immunodeficiency virus (HIV)

the virus that causes AIDS by infecting helper T cells.

protease inhibitors

a class of antiviral drugs that inhibit the enzyme protease, preventing viral replication in HIV treatment.

preexposure prophylaxis for HIV (PrEP)

a daily pill, taken by those having sex with someone with HIV or otherwise at high risk, to help prevent HIV infection.

AHA reported death from CVD decreased

• In 2016–17, the American Heart Association (AHA) reported that deaths from cardiovascular disease (CVD) had declined in the United States by over 33 percent in the past decade.

• Still over 92 million American adults, more than 1 in every 3 adults, suffer from one or more types of CVD or the aftereffects of stroke.

improvement in CVD deaths

• due to better dx, early intervention, and steadily improving treatments.

• improved understanding of diet, activity, stress, and other behaviors.

costs of CVD

• the measurable direct and indirect costs of CVD, including health care costs and lost pro-ductivity, total nearly $1 billion per day.

• 2,300 people in the US die from CVD each day. 

CVD disparities

• 50% african american adults suffer from CVD

• 64% of sudden female  deaths from coronary heart disease occur without previous symptoms. 

• more men suffer from CVD at every age until 80, when women surpass men in prevalence rates. 

• women have a higher lifetime prevalence of stroke. 

• nearly half of all men have no previous symptoms prior to their heart attack.

heart disease is a killer

• leading killer of African American and white women in the US.

• heart disease causes as many death as cancer in hispanic women

• for indian/native women, heart disease is the second most common cause of death

• heart disease is the number one killer for men in most racial and ethnic groups

  • except Asian men in which it is the second

CVD is global

• CVD accounts for over 31 percent of all deaths globally.

• Over 75 percent of the world’s CVD deaths occur in low-and middle-income countries, places where people have more risks and fewer options for prevention and treatment.

• People with CVD in these countries die at younger ages, often during their most pro-ductive years

ideal cardiovascular health has declined

• the number of people with ideal cardiovascular health dropped from 8.5 percent to 5.9 percent.

• largely due to poorer BMI, BP, blood sugar, and cholesterol measures.

ICH simple 7

ideal cardiovascular health simple 7 metrics.

• behaviors: not smoking, sufficient physical activity, a healthy diet, an appropriate energy balance/normal weight.

• health: optimal levels of cholesterol, blood pressure, and fasting blood glucose without medication. 

blood flow within the heart

1. deoxygenated blood flows into the right atrium from the superior and inferior venae cavae.

2. blood moves from the right atrium into the right ventricle; from there it is pumped through the pulmonary arteries into the lungs.

3. blood picks up oxygen and discards carbon dioxide in the lungs; it then goes through the pulmonary veins into the left atrium.

4. oxygenated blood is forced from the left atrium into the left ventricle; from there it is pumped through the aorta into the rest of the body’s blood vessels. 

the heart: a mighty machine

• The heart is a muscular pump, roughly the size of your fist. It is a highly efficient, extremely flexible organ that contracts 100,000 times each day and pumps the equivalent of 2,000 gallons of blood through the body.

• In a 70-year lifetime, an average human heart beats 2.5 billion times.

• two upper chambes (atria) recieve the blood

• two lower chambers (ventricles) pump to blood out again

blood

• human body contains 6 quarts of blood, transports nutrients, oxygen, waste products, hormones, and enzymes throughout the body

• regulate body temp, cellular water levels, and acidity levels of body components, helps defend against toxins and microorganisms. 

hypertension rates

• 50 percent of adults in the United States are likely to be labeled as hypertensive.

• There are large disparities in self-reported hypertension by race/ethnicity, age, sex, level of education, and state.

  • Cur-rently, African Americans have the highest rate of high blood pressure in the United States and globally at approximately 45 percent

• Rates are also much higher among older adults, men, and people who have less than a high school education.

men and women hypertension

• men under age 45 are nearly twice the risk of becoming hypertensive as women. 

• same rates of high blood pressure between ages 45 and 64, women higher rates after age 65. 

18-39 worst treated for hypertension

• Young adults ages 18 to 39 are the worst of all age groups when it comes to following recommendations to control hypertension.

• Variable blood pressure readings, costs of treat-ment, denial of the seriousness of the problem, and resistance to drug side effects appear to be among reasons for poor con-trol.

• Not surprisingly, acute ischemic stroke hospitalization rates have doubled for men ages 18 to 34 in the past 20 years, consistent with increases in risk factors such as hypertension, lipid disorders, diabetes, sedentary lifestyle, and obesity

peripheral artery disease (PAD) in the US

• In the United States, 6.5 to 12 million people are believed to have PAD, particularly those who smoke, have diabetes, have high cholesterol, have high blood pressure, are over 65, are non-Hispanic black, and/or are male.

• leading cause of diability in people over age 50, and men develop it more frequently than women do. 

coronary heart disease impacts

• Globally, CHD is responsible for over one-third of all deaths in people over the age of 35.

• Nearly one-half of all middle-aged men and one-third of middle-aged women in the United States will eventually develop health problems related to CHD.

• Of all the major cardiovascular-diseases, CHD is the greatest killer, accounting for nearly 1 in 7 deaths (nearly 367,000 people) in the United States each year.

• 45 In addition, there are over 720,000 new coronary events and 335,000 reoccurrences each year

angina treatment

• Over 10 million people in the United States suffer from angina symptoms, ranging from heartburn-like symptoms to palpitations and crushing chest pain.

• Drugs such as nitro-glycerin can dilate veins and provide pain relief. Other medica-tions such as calcium channel blockers can relieve cardiac spasms and arrhythmias, lower blood pressure, and slow heart rate.

• Beta-blockers can control potential overactivity of the heart muscle.

congestive heart failure in US

• Nearly 5.1 million adults have heart failure in the United States, and the number of cases is expected to increase dramatically by 2030.Untreated, heart failure can be fatal.

congestive heart failure treatment

• most cases respond well to treatment that includes diuretics to relieve fluid. 

• drugs such as digitalis to increase pumping of the heart

• drugs called vasodilators which expand blood vessels and decrease resistance, allowing blood to flow more freely. 

congenital cardiovascular defect

• 40,000 infants born in the US each year with some form of congenital cardiovascular defect.

• about 25 percent have severe forms and must undergo invasive procedures to correct problems within the first year of life. 

• caused by chromosome abnormalities, environmental exposures, heredity, maternal rubella, maternal drug us. 

FAST test for stroke

• facial droop or numbness

• arm weakness or numbness

• speech difficulty

• time to act and 911

stroke death rates

• decreased by 29% since 2004

• still nearly 800,000 people experience a new or recurrent stroke each year

• 133,000 people die, making fifth leading cause of death in the US. 

factors that lead to CVD

• According to the U.S. Burden ofDisease Collaborators, the greatest contributor to CVD is suboptimal diet, followed by tobacco smoking, high body mass index, high blood pressure, high fast-ing plasma glucose, and physical inactivity.

• Newer research indicates that for people ages 12 to 39, hypertension, smoking, high body fat, and high blood glucose increase the chances of dying from CVD-related complications before age 60.

metabolic syndrome impacts

• increases the risk for heart disease by as much as three times the normal rates.

• more than one-third of US adults meet the criteria for MetS, with women being more likely than men to have metabolic syndrome overall.

• rates increase with age, and disparities by race. 

dx metabolic syndrome (3 or more)

• elevated blood triglycerides (150+ mg/dl)

• reduced blood HDL cholesterol (less than 40m, 50wm)

• elevated fasting blood glucose (100+ mg/dl)

• elevated blood pressure

  • systolic greater than 130mm hg

  • diastolic greater than 85mm hg

• elevated waist circumference (40in m, 35in wm)

smoking cessation

• avoid tobacco 

• smokers are two to four times more likely to develop CHD 

• cigarette smoking doubles a person’s stroke risk

• smokers are over 10 more likely than nonsmoker to develop peripheral vascular disease

• chemicals in smoke damage and inflame arteries, increasing bp and allow plaque to accumlate more easily.

fat, cholesterol, and diet

• if level of HDL (good cholesterol) is lower than 35 mg/dl, cardiovascular risk increases dramatically.

• DASH: dietary approaches to stop hypertension

  • reduce sodium intake

  • consume 5 to 10ml per day of soluble fiber

  • consume 2g per day of plant sterols

maintain a healthy weight

• obesity strains the heart, forcing it to push blood through the many miles of capillaries that supply each pound of fat.

• a heart that to continuously move blood through an over abuandance of vessels may become damaged.