A

Chapter 26: Bacterial and Viral STDs (Gonorrhea, Syphilis, Herpes, HPV)

Gonorrhea

  • Classification: gram-negative cocci. A major issue is that many infections are asymptomatic.
  • Common symptoms (when present): discharge, painful urination (dysuria), pelvic pain in women, testicular pain in men.
  • Asymptomatic carriage: many individuals do not show symptoms and may unknowingly transmit the infection.
  • Incubation: can be long, particularly in women; the max incubation time is 21 ext{ days}.
  • Transmission to infants: can be passed to infants during vaginal delivery.
  • Public health concern in NH: rising number of cases and increasing antibiotic resistance.
  • Treatment context: historically penicillin was effective; resistance is increasing, leading to use of different medications or alternatives.
  • Key takeaways: asymptomatic transmission makes control difficult; antibiotic resistance is a growing challenge for management and treatment.

Syphilis

  • Nature: a bacterial STD that presents in stages with varying symptoms across stages.
  • Incubation timeline: incubation can range from 10 \leq t \leq 90 \text{ days} before symptoms appear.
  • Primary stage: canker sores (chancre) at the inoculation site; these sores last for about 3-6 \text{ weeks} and are not very painful; they often heal spontaneously.
  • Diagnostic/behavioral note: some individuals delay seeking care after lesions resolve, which can allow progression to later stages.
  • Secondary stage: typically develops about 3 \text{ weeks} after the primary sores resolve; presents as a rash, often involving the palms of the hands and the soles of the feet; rash is usually non-itchy and may resolve without treatment.
  • Progression risk: if untreated, the disease can enter a tertiary stage years later, becoming systemic and potentially fatal due to damage to internal organs.
  • Treatment: penicillin is most effective in the early stages; treatment becomes more difficult in the late, systemic stages.
  • Epidemiology: rising cases in New Hampshire, similar to other NH trends here.
  • Overall significance: early detection and treatment are crucial to prevent long-term organ damage from tertiary syphilis.

Herpes

  • Nature: lifelong viral infection; genital herpes manifests as cold sores in the genital area.
  • Demographic note: the most common group affected is teenagers.
  • Onset and course: symptoms usually arise soon after infection and can last 2-3 \text{ weeks} per episode.
  • Treatment: antiviral therapy (e.g., acyclovir) can manage outbreaks but cannot cure the infection.
  • Transmission risk: the virus can be transmitted even when an individual is asymptomatic, increasing the risk of unknowingly passing the infection to partners.
  • Pregnancy/infant risk: genital herpes can infect the infant during vaginal birth, potentially affecting the eyes and CNS and, in severe cases, causing death or severe mental impairment.
  • Risk mitigation around birth: options include a C-section or suppressive antiviral therapy to reduce viral load prior to birth.
  • Treatment details: acyclovir is a commonly used antiviral; other antivirals are available.
  • Recurrence: some individuals have recurring outbreaks; others may have a single episode.

Papillomavirus (HPV)

  • Prevalence: about 2.0 \times 10^{7} people in the US are affected.
  • Affects both men and women; symptoms are more readily observed in women when the cervix is involved, but men can be asymptomatic as well.
  • Transmission: highly transmissible from person to person, particularly when warts are present or viral shedding occurs at the skin surface.
  • Genital warts and cancer risk: HPV strains differ in risk profiles.
    • Strains 6 and 11: generally cause genital warts and are not thought to cause cervical cancer.
    • Strains 16 and 18: strongly associated with cervical cancer.
    • Other strains may cause cancer, cause warts, or do both.
  • Vaccine information: a vaccine exists to prevent infection with certain high-risk strains primarily to reduce cervical cancer risk.
    • The vaccine currently discussed targets strains 16 and 18, with additional coverage that may include other strains; education and public health messaging emphasize vaccination to protect against cervical cancer.
    • The transcript notes the vaccine is available for females and discusses the debate on male vaccination as a strategy to reduce transmission and protect males against potential cancer risk.
    • Age recommendation mentioned: females aged roughly 13 \leq \text{age} \leq 26 years.
  • Cervical and penile cancer: HPV is linked to cervical cancer in women and can be associated with penile cancer in men.
  • Genital warts treatment: treatment for genital warts mirrors that for non-genital warts (topical therapies and other wart treatments).
  • Infection dynamics: individuals can have HPV infections repeatedly; outbreaks depend on the specific strain and immune response.
  • Practical implications: vaccination, screening, and education are central to reducing HPV-related cancers and transmission.

Chapter 26: Summary and Implications

  • Across STDs covered, asymptomatic infections are common and pose a major challenge for transmission control.
  • Antibiotic resistance is a recurring theme (gonorrhea), underscoring the need for surveillance and updated treatment strategies.
  • Syphilis demonstrates how diseases can progress through stages, with early detection preventing severe late-stage consequences.
  • Viral STDs (herpes and HPV) require ongoing management, prevention (including vaccination for HPV), and careful considerations for mother-to-child transmission during birth.
  • Public health relevance: vaccination strategies (HPV), pregnancy management (herpes risk), and communication about asymptomatic transmission are critical for reducing disease burden.
  • Numerical summaries to remember:
    • Gonorrhea incubation max: 21 \text{ days}
    • Syphilis incubation: 10-90 \text{ days}
    • Primary chancre duration: 3-6 \text{ weeks}
    • Secondary rash onset after primary lesions: about 3 \text{ weeks}
    • HPV affected individuals in the US: 2.0 \times 10^{7}
    • HPV vaccination window discussed: females 13 \leq \text{age} \leq 26
    • Herpes episode duration: 2-3 \text{ weeks}
  • Real-world relevance: highlights importance of screening, vaccination, safe birth practices, and ongoing management for long-term health outcomes.