10.2 Sexually Transmitted Infections and HIV/AIDS

Sexually transmitted infections (STIs) and HIV/AIDS pose significant health risks. This section covers common STIs, their transmission, and prevention strategies. It also delves into HIV/AIDS progression, diagnosis, and treatment options.

Understanding STIs and HIV/AIDS is crucial for sexual health. We'll explore testing, safe sex practices, and social implications. This knowledge empowers individuals to make informed decisions and reduce transmission risks.

Types and Transmission of STIs

Common Sexually Transmitted Infections

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• Bacterial STIs include chlamydia, gonorrhea, and syphilis
  • Chlamydia often presents with no symptoms, can lead to pelvic inflammatory disease
  • Gonorrhea causes painful urination and discharge, may lead to infertility
  • Syphilis progresses through stages, starting with painless sores and potentially leading to severe organ damage
• Viral STIs consist of herpes simplex virus (HSV), human papillomavirus (HPV), and hepatitis B
  • HSV causes recurring outbreaks of painful blisters on genitals or mouth
  • HPV can lead to genital warts and certain types increase risk of cervical cancer
  • Hepatitis B affects the liver, potentially causing chronic infection and liver damage
• Parasitic STIs encompass trichomoniasis and pubic lice
  • Trichomoniasis causes genital itching and discharge
  • Pubic lice (crabs) cause intense itching in the pubic area

HIV/AIDS and Its Progression

• Human Immunodeficiency Virus (HIV) attacks the immune system
  • Targets CD4 T cells, crucial for immune function
  • Progresses through acute, chronic, and AIDS stages if left untreated
• Acquired Immunodeficiency Syndrome (AIDS) develops in advanced HIV infection
  • Characterized by severely compromised immune system (CD4 count below 200 cells/mm³)
  • Increases susceptibility to opportunistic infections and cancers
• HIV progression without treatment typically spans 8-10 years from infection to AIDS
  • Early detection and antiretroviral therapy can prevent progression to AIDS

Transmission Routes and Risk Factors

• Sexual transmission occurs through vaginal, anal, and oral sex
  • Unprotected anal sex carries the highest risk of HIV transmission
  • Presence of other STIs increases risk of HIV transmission
• Blood-borne transmission happens through sharing needles or blood transfusions
  • Intravenous drug use with shared needles poses significant risk
  • Modern blood screening has greatly reduced transmission via transfusions
• Mother-to-child transmission can occur during pregnancy, childbirth, or breastfeeding
  • Antiretroviral therapy during pregnancy significantly reduces transmission risk
• Factors increasing STI transmission risk include multiple sexual partners, inconsistent condom use, and substance abuse
  • Young adults and men who have sex with men (MSM) are at higher risk for certain STIs

Prevention and Safe Practices

Comprehensive Prevention Strategies

• Abstinence provides complete protection against sexually transmitted STIs
  • Includes refraining from all forms of sexual contact
• Regular STI testing helps detect infections early, preventing further transmission
  • Recommended annually for sexually active individuals or more frequently for high-risk groups
• Vaccination protects against certain STIs
  • HPV vaccine (Gardasil 9) prevents infection from nine HPV types
  • Hepatitis B vaccine offers long-term protection against the virus
• Behavioral interventions focus on education and risk reduction
  • Promote safer sex practices and decision-making skills
  • Address substance abuse and its role in risky sexual behavior

Safe Sex Practices and Barrier Methods

• Consistent and correct condom use significantly reduces STI transmission risk
  • Male condoms offer 98% effectiveness when used properly
  • Female condoms provide an alternative option, controlled by the receptive partner
• Dental dams serve as barriers for oral sex on female genitalia or anus
  • Reduce risk of STI transmission during oral-vaginal or oral-anal contact
• Mutual monogamy between uninfected partners eliminates risk of new STI acquisition
  • Requires trust and open communication between partners
• Regular communication with sexual partners about STI status and testing
  • Promotes transparency and informed decision-making

Pre-exposure Prophylaxis (PrEP) for HIV Prevention

• Daily medication regimen for HIV-negative individuals at high risk
  • Typically consists of a combination of two antiretroviral drugs
  • Reduces risk of HIV infection by up to 99% when taken consistently
• Recommended for various high-risk groups
  • Men who have sex with men (MSM) with recent STI or multiple partners
  • Heterosexual individuals with high-risk sexual behavior or HIV-positive partners
  • Injection drug users who share needles
• Requires regular HIV testing and medical follow-up
  • Monitoring for potential side effects and drug resistance

Post-exposure Prophylaxis (PEP) for Emergency HIV Prevention

• Short-term antiretroviral treatment started within 72 hours of potential HIV exposure
  • Most effective when started as soon as possible after exposure
  • Typically prescribed as a 28-day course of medication
• Indicated for various exposure scenarios
  • Occupational exposures (healthcare workers with needlestick injuries)
  • Sexual assault victims
  • Consensual sex with a known HIV-positive partner when other prevention methods fail
• Requires immediate medical evaluation and risk assessment
  • Not intended for regular use as a primary prevention method

Diagnosis and Treatment

STI Testing and Diagnostic Procedures

• Screening tests detect STIs in asymptomatic individuals
  • Blood tests for HIV, syphilis, and hepatitis B
  • Urine tests for chlamydia and gonorrhea
  • Swab tests for genital herpes and HPV
• Diagnostic tests confirm suspected infections based on symptoms
  • Microscopic examination of discharge or lesion samples
  • Nucleic acid amplification tests (NAATs) for precise pathogen identification
• Window periods vary for different STIs
  • HIV antibody tests may take up to 3 months to detect infection
  • Chlamydia and gonorrhea can be detected within 1-2 weeks of exposure

Treatment Options for Various STIs

• Bacterial STIs respond to antibiotic treatment
  • Chlamydia and gonorrhea often treated with single-dose azithromycin or ceftriaxone
  • Syphilis treated with penicillin injections, duration depends on stage of infection
• Viral STIs managed with antiviral medications
  • Herpes outbreaks controlled with acyclovir or valacyclovir
  • Chronic hepatitis B treated with antivirals like tenofovir or entecavir
• Parasitic infections eliminated with antiparasitic drugs
  • Trichomoniasis treated with single-dose metronidazole
  • Pubic lice eradicated with topical permethrin or oral ivermectin
• Partner notification and treatment crucial for preventing reinfection
  • Many clinics offer expedited partner therapy for certain STIs

Antiretroviral Therapy (ART) for HIV Management

• Combination of multiple antiretroviral drugs to suppress HIV replication
  • Typically includes three drugs from at least two different drug classes
  • Regimens tailored to individual patient needs and potential drug interactions
• Goals of ART include viral suppression and immune reconstitution
  • Reduces HIV viral load to undetectable levels (< 200 copies/mL)
  • Allows CD4 T cell count to recover, strengthening the immune system
• Treatment adherence critical for effectiveness and preventing drug resistance
  • Daily medication intake required for most regimens
  • Newer long-acting injectable formulations offer monthly or bimonthly dosing options
• Regular monitoring of viral load and CD4 count guides treatment adjustments
  • Viral load measured every 3-6 months to ensure continued suppression
  • CD4 count monitored to assess immune system recovery

Social and Health Implications

Medical Complications of Untreated STIs

• Reproductive health issues arise from various STIs
  • Pelvic inflammatory disease from chlamydia or gonorrhea can lead to infertility
  • HPV increases risk of cervical, anal, and oropharyngeal cancers
  • Syphilis in pregnancy can result in congenital syphilis, causing severe birth defects
• Systemic health problems develop in advanced stages of certain STIs
  • Untreated HIV progresses to AIDS, leaving the body vulnerable to opportunistic infections
  • Chronic hepatitis B can lead to liver cirrhosis and hepatocellular carcinoma
  • Neurosyphilis affects the nervous system, causing dementia and paralysis
• Increased susceptibility to other infections
  • STIs can cause inflammation and microabrasions, facilitating HIV transmission
  • HIV-positive individuals more vulnerable to tuberculosis and pneumocystis pneumonia

Stigma, Discrimination, and Psychosocial Impact

• Social stigma surrounding STIs and HIV/AIDS persists
  • Misconceptions about transmission lead to fear and avoidance
  • Internalized shame can delay seeking testing and treatment
• Discrimination affects various aspects of life
  • Employment discrimination against HIV-positive individuals, despite legal protections
  • Healthcare disparities due to provider bias or lack of cultural competence
  • Social isolation and relationship difficulties stemming from STI diagnosis
• Mental health consequences of STI diagnosis and stigma
  • Increased rates of depression and anxiety among individuals living with HIV/AIDS
  • Post-traumatic stress disorder (PTSD) in sexual assault survivors with STI exposure
  • Relationship strain and trust issues following STI transmission between partners
• Public health implications of stigma on STI control efforts
  • Reduced testing rates due to fear of judgment or discrimination
  • Incomplete contact tracing when individuals hesitate to disclose sexual partners
  • Barriers to accessing prevention services like PrEP due to associated stigma