Sexually Transmitted Infections (STIs) 101

This presentation covers the essential information about Sexually Transmitted Infections (STIs), including transmission, treatment, prevention, and national and Maryland statistics. Presented by Jill Smith, MHS, CAC-AD, Maryland Department of Health.

1. Sexually Transmitted Infections Sexually Transmitted Infections
101101
Jill Smith, MHS, CAC-AD
Program Managers
Center for HIV Prevention & Health Services
Last updated January 31, 2018

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The United States has the
highest rates of
Sexually Transmitted Infections
among industrialized nations in
the world, with nearly 20 million new
cases each year
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
Sexually Transmitted Infections (STIs)

3. STIs in US in 2016
Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 3

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•STIs are more easily transmitted from males to
females
•Women tend not to have symptoms and hence
usually have more serious complications of STIs+
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
Sexually Transmitted Infections (STIs)

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HIV and STIsHIV and STIs
The CDC says that people with an STI are at least
two to five times more likely than an uninfected
person to acquire HIV. That’s because STIs
create breaks in the skin and entryways for HIV,
and also because the inflammation from the STI
causes the body to create more white blood cells,
which are the targets for HIV.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

6. Reportable STIs
Regulations vary from state to state
Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 6
Chlamydia
Gonorrhea
Syphilis
Chancroid
Hepatitis B
HIV/AIDS
Reportable in all states
Human Papillomavirus
Genital herpes
Trichomoniasis
Generally not reportable

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3 Most Common STIs
•Increasing numbers of Chlamydia infections have made it
the most widespread bacterial STI in the United States.
•Gonorrhea remains the second most commonly reported
bacterial STI in the United States.
•Syphilis is the third highest reported STI.
•Of the three main STIs reported, only syphilis has more
male than female cases.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Most Common STIs Among TeensMost Common STIs Among Teens
•The most common infection is HPV (human
papillomavirus), which can cause genital warts and cervical
cancer.
•About 79 million Americans are currently infected with
HPV. About 14 million people become newly infected each
year.
•HPV is found in 18% of young women. HPV is NOT even a
reported STI in most states!
•In second place is chlamydia, with a 4% infection rate
•A study presented in 2008 revealed that around 26% of
young American women aged 14-19 are infected with at
least one of the four most common sexually transmitted
infections (Nationally Representative CDC Study Find 1 in 4 Teenage
Girls has A STD, CDC Press Release, 11 March 2008).
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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The Major STI’sThe Major STI’s
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
•Herpes Simplex Virus (HSV)
•Human Papilloma Virus (HPV)
•Human Immunodeficiency Virus (HIV)
•Hepatitis B Virus (HBV)
Not curable, some life-long
•Syphilis
•Chlamydia
•Gonorrhea
•Trichomoniasis
•Pubic Lice (crabs)
Treatable, but repeatable

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Causes?Causes?
•Bacteria - A type of microorganism that are usually treated
with antibiotics.
–It is estimated that each person carries 100 trillion bacteria on
and in our bodies. Some bacteria create disease in people and
can be harmful. However, there are also bacteria that co-exist
with the human body without causing disease.
•Virus - A virus is a parasitic organism because it totally
depends upon the human cell for nutrients to survive.
–Infection with a virus stimulates an antibody response from the
body. Once in the body, they cannot be removed.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Causes?Causes?
•Protozoa - These are the simplest form of animals.
–Most protozoa are single-celled and have mobility, using tail-like
structures called flagella. Protozoa are larger than both viral and
bacterial organisms. There are medicines that kill protozoa and
are used in treatment of infected people (Ex: Flagyl for
treatment of Trichomoniasis).
•Parasites- Tiny insects.
–They can be killed by multiple treatments with insecticides such
as RID.
•Yeast and Bacterial Vaginitis are NOT considered STIs even
though the symptoms may mimic having an STI.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

12. Close Up on STIs
Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 12
•Trichomoniasis
•Public Lice
•Scabies
•Genital Herpes (HSV)
•Human Papilloma Virus (HPV)
•Gonorrhea
•Syphilis

13. Trichomoniasis: Trichomoniasis:
KEY POINTSKEY POINTS
•Caused by Trichomonas vaginalis, a tiny parasite(protozoa).
•In women, causes malodorous yellow-grey, that may be thin and frothy, with
irritation and vulvar itching, pain when passing urine or with sex.
•In men, usually gives no symptoms but can cause urethritis, (thin white
discharge from tip of penis, pain and burning when urinating). Men tend to act as
carriers.
•Resistance to common treatment (metronidazole) does occur.
Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 13

14. Pubic Lice (Crabs)
•Pubic lice have six legs, but
their two front legs are very
large and look like the pincher
claws of a crab; this is how
they got the nickname "crabs."
Pubic lice are tan to grayish-
white in color.
•A lice-killing shampoo is
recommended to treat pubic
lice.
Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 14

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Pubic Lice (Crabs)
•Pubic lice (crabs) are tiny
parasitic insects that live in
pubic hair, underarm hair,
hair on the body and,
occasionally, in eyebrows
and eyelashes.
•The eggs are called 'nits'
and appear as brownish
dots fixed to coarse body
hair.
•They're easily passed
through close body/sexual
contact.
Photo: www.bbc.co.uk
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Pubic Lice Symptoms
•It can take several weeks after
coming into contact before any
symptoms appear. You might
notice:
–Itching in the affected areas
–Black powdery droppings
from the lice in underwear
–Brown eggs on pubic or
other body hair
–Irritation and inflammation in
the affected area,
sometimes caused by
scratching
–Sky-blue dots (which
disappear within a few days)
or very tiny specks of blood
on the skin
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

17. And now this…
Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 17
http://www.cc.com/video-clips/cdnpoy/the-daily-show-with-jon-stewart-beasts-of-the-southern-wild

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Scabies mite
•Scabies is an infestation by the
human itch mite.
•The microscopic mite burrows into
the upper layer of the skin where it
lives and lays its eggs
•The mite is usually spread by direct,
prolonged, skin to skin contact with a
person with scabies.
•Scabies can spread rapidly under
crowded conditions such as nursing
homes, child care and extended care
facilities. Prisons are often sites of
outbreaks.
•A person usually only had 10-15
mites, unless they have crusted
scabies (Norwegian)
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Scabies Symptoms
Scabies causing eczema-like hand
condition
•The most common symptoms are
intense itching and a pimple like skin
rash.
•If a person never had scabies,
symptoms may take 4-6 weeks. (The
person is still contagious)
•If a person has been infected before,
symptoms usually appear in 1-4
days.
•Itching and rash may be any where
or limited to sites such as the wrist,
elbow, armpit, webbing of fingers,
nipple, penis, waist, belt-line, and
buttocks.
•Scabies may live 1-2 months on a
person and 48-72 hours off a
person.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Scabies Treatment: Topical
Treatment is by a product
called a scabicide available by
prescription only.
–Apply a mite-killer like
permethrin (Elimite). These
creams are applied from
the neck down, left on
overnight, and then
washed off. This
application is usually
repeated in seven days.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Scabies Treatment: Oral
•Ivermectin, is an oral antiparasitic
medication that has also been
shown to be an effective
scabicide, although it is not FDA-
approved for this use. It is taken
at a dosage of 200 micrograms
per kilogram body weight as a
single dose, followed by a repeat
dose two weeks later.
•It is typically used only when
topical medications have failed or
cannot be tolerated.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Herpes: Epidemiology
•Estimated annual incidence: 600,000 to 1 million cases
•NHANES data provided new view of HSV-2 prevalence in
the U.S.
–Twenty-two percent of adults estimated to be infected
with HSV-2
–Rates are higher in HIV infected persons, African
Americans and adults of lower socioeconomic status
–Most infections are unrecognized because of mild
symptoms or absence of symptoms
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Herpes
•Herpes is caused by a
virus called herpes
simplex (HSV).
–HSV I - the mouth and
nose (cold sores),
fingers and hand
(whitlows).
–HSV II - genital and
anal area (genital
herpes).
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

24. Genital Herpes: Transmission
•Major routes: sexual & mother-to-infant (usually during delivery)
•Most sexual transmission probably occurs when infected person is
asymptomatic* (not having any symptoms)
•Efficiency of transmission is greater from men to women than
women to men
24Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Herpes: Infection
•Initial infection
–Virus enters through microscopic breaks in skin
• Establishes chronic infection
–Virus becomes latent in nerves cells along spinal cord
–Infection persists despite immune response
–Virus may remain latent indefinitely or can reactivate
•Virus can reactivate
–Precipitating factors: trauma, fever, UVL, stress
–Virus reproduces and moves along nerve axon to skin
or mucosa, and recurrent lesions can occur
–Reactivation (shedding) can also be asymptomatic (no
symptoms)
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Herpes:
Asymptomatic Shedding
•Multiple studies have documented asymptomatic shedding
•Occurs in up to 90% of patients with HSV-2
–Most common in first two years after infection (5-10% of days),
less common thereafter (2% of days)
–Shedding may occur from cervix, vulva, urethra, rectum, penis
–Asymptomatic shedding reduced by antiviral suppression
medication
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Herpes Symptoms
•Flu-like symptoms: fever,
tiredness, headache, swollen
glands, aches and pains in the
lower back, legs or groin
•Stinging, tingling or itching in the
genital or anal area
•Small, fluid-filled blisters in the
genital or anal area, on the
buttocks and tops of the thighs;
these burst within a day or two
leaving small red sores
•Pain when urinating (caused by
urine touching the sores)
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Herpes: Treatment
•Treatment of symptomatic outbreaks
•Suppression of symptoms by daily medication
•Daily medication to lessen chance of transmission
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Herpes (HSV):
KEY POINTS
•About 1/5 of adult Americans have HSV 2
•Most do not recognize or get symptoms
•New type-specific blood tests can accurately diagnose HSV 2
infection even when no symptoms are present
•Treatment to control symptoms and lessen the chance of
transmission are available
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
HSV is a virus and is not
CUREABLE!

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Human Papillomavirus (HPV):
Genital Warts
•Genital warts are caused by the human papillomavirus
(HPV).
•HPV is the most common STI.
•Genital warts can be passed from one person to another
during sex, and by skin-to-skin contact.
•The virus can remain in the body and be passed on before
warts are noticeable, or after they have disappeared.
•Warts can be external or internal.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Human Papillomavirus (HPV):
Genital Warts
•Two disease processes caused by different viral types
–Pre-cancer and cancer of the genital tissues (abnormal Paps
and anal cancer)
–Skin growths in the genital area (genital warts)
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Warts: Symptoms
•Most people infected will
not have any visible signs
or symptoms at all.
•It can take from two weeks
to several months after
coming into contact with
the virus before warts
appear.
•The highest rates of genital
warts are diagnosed in
women aged 16 to 19 and
men aged 20 to 24.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Warts
DOIA Website, 2000
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Condyloma acuminata, anal
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

35. HPV among U.S. Females 14-34 Years
Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 35
Figure 46. Human Papillomavirus — Cervicovaginal Prevalence of Types 6, 11, 16
and 18 Among Females Aged 14–34 Years by Age Group and Time Period,
National Health and Nutrition Examination Survey (NHANES), 2003–2006 and
2009–2012

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The GARDASIL Vaccine
•There are over 30 types of HPV. The vaccine
treats types 6,11,16,18.
•It is estimated that 75% to 80% of people will be
affected in their lifetime
•Each day in the U.S., 30 women are diagnosed
with cervical cancer, it is est. that each minute
there is a new case of genital warts.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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The GARDASIL Vaccine
•In females aged 9 to 26, GARDASIL helps protect
against 2 types of HPV that causes 75% of cervical
cancer cases, and 2 more types that cause 90% of
genital warts cases
•In males aged 9 to 26, GARDASIL helps protect against
90% of genital warts cases.
•GARDISIL does not treat cancer or genital warts.
GARDASIL is given as 3 injections over 6 months
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Genital Warts (HPV):
KEY POINTS
•Extremely common virus
•Some types cause genital warts
•Other types cause cervical and anal cancer
•HPV tests can help in managing female patients with abnormal
Paps
•Best approach to anal dysplasia (abnormal cell growth) is unclear
•Vaccination before first sexual debut can prevent up to 90% of HPV
infections.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
HPV is a virus and is not
CURABLE!

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Gonorrhea (GC)
•Gonorrhea is caused by a
bacteria found mainly in
semen and vaginal fluids.
•Gonorrhea is usually passed
from one person to another
during vaginal, oral or anal
sex, or by sharing sex toys.
•It can live inside the cells of
the cervix, the urethra, the
rectum, the throat and,
occasionally, the eyes.
•Gonorrhea can also be
passed from a pregnant
woman to her baby.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Gonorrhea in Maryland
Maryland had 6,858 cases of
Gonorrhea in 2015
In 2015 Maryland ranked 24
th
in the nation
for new cases of Gonorrhea
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Gonorrhea: Symptoms
•Women might notice:
–Unusual vaginal discharge -
this may be thin, watery,
yellow or green
–Pain when urinating
–Lower abdominal pain or
tenderness
–Bleeding between periods
•Men might notice:
–Unusual discharge from the
tip of the penis - this may be
white, yellow or green, and
there may be inflammation
of the foreskin
–Pain when urinating
–Painful or tender testicles
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Gonococcal ophthalmia
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Gonorrhea Infections
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Gonorrhea:
KEY POINTS
•Second most common bacterial (curable) STI in the U.S.
•Infects the mucous membranes of the cervix, uterus, and fallopian
tubes in women, and the urethra in women and men.
•Highest reported rates of infection are among sexually active
teenagers and young adults (especially ages 15-24), and African
Americans.
•Resistance to medications is a growing problem.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Chlamydia
•Chlamydia is a bacterial
infection, which is found in
semen and vaginal fluids.
•Up to one in ten sexually
active young people have
chlamydia.
•Chlamydia is usually passed
from one person to another
during vaginal, oral or anal
sex, or by sharing sex toys. It
can live inside cells of the
cervix, urethra, rectum and
sometimes in the throat and
eyes.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Chlamydia: Symptoms
•Most don't have any obvious
signs or symptoms.
•Symptoms can appear 1 – 3
weeks after contact, many
months later, or not until the
infection spreads to other
parts of your body.
•Women notice: discharge/
bleeding between periods/
pain during sex or when
passing urine/abdominal pain
•Men notice: White, watery
discharge from the tip of the
penis / Pain when passing
urine or painful testicles.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

47. Pelvic Inflammatory Disease
•Not an STI itself, pelvic inflammatory
disease (PID) is a serious complication of
untreated STIs, especially chlamydia and
gonorrhea. It happens when bacteria
spread to infect the uterus and other
female reproductive organs. Prompt
treatment is essential to prevent damage
to a woman's fertility.
•Signs and Symptoms: Lower abdominal
pain, fever, unusual discharge, painful
intercourse, painful urination, and
spotting. There are often no warning
signs.
47Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

48. 2016 New Chlamydia Cases in U.S.
Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 48
Figure 5. Chlamydia — Rates of Reported Cases by Age
Group and Sex, United States, 2016

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Chlamydia in Maryland
Maryland had 27,450 cases of
Chlamydia in 2015
In 2015 Maryland ranked 23
rd
in the nation
for new cases of Chlamydia
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Chlamydia:
KEY POINTS
•Most common bacterial (curable) STI in the U.S.
•Most common STI among
•Most cases in women and men give no symptoms
•Leading cause of Pelvic Inflammatory Disease (PID) and
infertility in women
•All sexually active women 25 yrs. and younger should be
tested at least annually.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Syphilis
Syphilis was almost eliminated in the U.S.
until a resurgence in 2001
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
treponema pallidum

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History of Syphilis
•Syphilis has been around since early history. The first large
outbreak was in Europe in 15
th
century. (Babies were born with it,
adults were taken outside of the city and banned)
•1890 Control of the disease focused on prostitutes. Syphilis was
associated with sin and sex outside of marriage.
•1905 German researchers discovered the bacteria that causes
syphilis
•1932 The Tuskeegee Study began in Macon County, Alabama
•1943 Use of penicillin to treat syphilis began. Tuskeegee
participants excluded
•1947 2
nd
Syphilis outbreak in U.S.
•1972 End of Tuskeegee Study
•1997 President Clinton apologizes for Tuskeegee Study
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Syphilis
•Syphilis is caused by a
bacteria known as
Treponema pallidum.
•Syphilis is usually passed
from one person to
another during vaginal,
oral or anal sex.
•It can be passed on by
direct skin contact with
someone who has syphilis
sores or a syphilis rash,
and by sharing sex toys.
•Syphilis can be passed
from a pregnant woman to
her unborn baby. This is
known as congenital
syphilis
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Syphilis
•Primary (1
o
) syphilis manifests as a single, painless, clean-
based ulcer which untreated resolves in 4-6 weeks
•The lesion usually appears within 3 weeks of infection (can
range from 10-90 days)
•In women the labia and vaginal wall are most often affected,
but the cervix may also be involved
•Primary stage: a sore, usually painless, at the site where the
bacteria entered the body. Occurs within 3 weeks of exposure
(range from 10 to 90 days). A person is highly contagious.
MANIFESTATIONS (1
O
)
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Primary Syphilis
Photos: Dr. Joseph Engelman, San Francisco City Clinic
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Primary Syphillis
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Syphilis
The signs and symptoms of
2
o
syphilis usually resolve even
without treatment
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Secondary Syphilis
•Symptoms include:
–Rash – generalized and inclusive of palms and soles
that appears 4-6 weeks after first sore
–Lesions which may occur on the mucous membranes
and in the genital region
–Systemic symptoms:
•Fever
•Arthralgias (joint pain)
•Pharyngitis (hoarseness)
•Lymphadenopathy (swollen glands)
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
MANIFESTATIONS (2
O
)

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Secondary Syphilis
Photo: Dr. Joseph Engelman, San Francisco City ClinicSTD Atlas, 1997
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
Rash caused by secondary syphilis

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Secondary Syphilis
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Secondary Syphilis: Other Symptoms
Photo: Dr. Joseph Engelman
San Francisco City Clinic
Comdyloma lata
DOIA Website, 2000
STD Atlas, 1997
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Secondary Syphilis: Other Symptoms
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
Alopecia: hair loss caused by syphilis

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Latent Syphilis
•The latent stage of syphilis is a period of time when there are
no visible signs or symptoms of syphilis.
•If you do not receive treatment, you can continue to have
syphilis in your body for years without any signs or symptoms.
•The diagnosis is only through serologic testing.
•Illness occurring up to 1 year after inoculation is considered
“early” latent disease.
•Illness presenting more than 1 year after inoculation is
considered “late” latent disease.
•The stage of disease has important treatment implications.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Tertiary Syphilis
•Tertiary (late) syphilis develops in about 10%-40% of
untreated persons.
•Most people with untreated syphilis do not develop tertiary
syphilis. However, when it does happen it can affect many
different organ systems.
–These include the heart and blood vessels, and the brain
and nervous system.
–Tertiary syphilis is very serious and would occur 10–30
years after infection began. In tertiary syphilis, the disease
damages your internal organs and can result in death.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018
MANIFESTATIONS (3
O
)

65. Syphilis Cases in U.S.: 2007-2016
Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 65
Figure 31. Primary and Secondary Syphilis — Rates of
Reported Cases by Region, United States, 2007–2016

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Syphilis in Maryland
Maryland had 509 cases of
P&S Syphilis in 2015
In 2015 Maryland ranked 10
th
in the nation
for new cases of Syphilis
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Syphilis:
KEY POINTS
•Outbreaks in MSM in urban areas since 1970
•MSM accounted for the majority of reported P&S syphilis cases in
the U.S. and in Maryland in 2016.
•Nationally, the highest rates of P&S syphilis in 2016 were observed
among men aged 20–34 years, among men in the West, and
among Black men.
•Serious systemic infection
•Strong connection with HIV transmission
•Yearly testing of all HIV-positive patients is recommended
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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STI Transmission
•STIs are transmitted through direct contact via oral, anal, vaginal
sex as well as activities that involve sexual rubbing or grinding.
The common direct contact STIs are HPV, HSV, and syphilis.
•STIs are transmitted through the exchange (or discharge) of
infected sexual fluids. Infectious fluids are vaginal fluids, semen,
and pre-cum for some STIs. Common STIs transmitted via fluid
are Trichomonasis, Chlamydia, Gonorrhea, HIV, Hep B
•STIs transmitted through blood are HIV, Hep B, and Hep C.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Are STI’s Serious?
•A young girl or woman with
an STI could end up with:
–Cervical cancer
–Pelvic inflammatory
disease
–Tubal pregnancy
–Chronic pelvic pain
–Infertility
•In men or women STI’s
can lead to:
–Anal cancer
–Liver disease / cancer
–Nervous system
problems
–AIDS
–Death
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Partner Management
•Transmissibility:
–Male to female: 50 - 90%
–Female to male: 20 - 80%
•Partners with contact during the 60 days preceding the diagnosis
should be evaluated, tested and treated
•If no sex partners in previous 60 days, treat the most recent partner
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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STIs and Pregnancy
If someone has an STI while pregnant, the baby
could end up with:
–Eye infections causing blindness
–Lung infections
–Brain infections
–Birth defects
–Death (still-birth)
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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How Do You Protect Yourself ?
•By NOT having sex.
•By having ONE partner, who only has sex with you and
does not have an STI.
•By using BARRIER protection.
•By TALKING about STI and HIV risk behaviors and how to
stop the spread.
•By NOT having sex while under the influence of alcohol or
drugs.
•By getting TESTED for HIV and other STI’s each year .
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Condom EffectivenessCondom Effectiveness
Latex condoms, when used consistently and
correctly, are highly effective for:
–HIV
And can reduce the risk of:
–GC, CT, and Trichomonas
–Genital herpes, syphilis, chancroid, and HPV,
only when the infected areas are covered by the
condom
CDC, 2002
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Quick Facts
•Birth control pills, the shot
(Depo), the ring, the birth
control patch DO NOT protect
against STI or HIV
transmission.
•Latex condoms REDUCE the
possibility of transmission.
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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STI Wrap-up
•Questions
•Comments
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

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Content & Data Contributors
•Maryland Department of Health, Center for STI Prevention
•Centers for Disease Control and Prevention
•Dermnet Skin Disease Image Atlas
•Baylor Pediatric AIDS Atlas
•Screening for Infectious Diseases Among Substance Abusers
•Google Images
Infectious Disease Prevention and Health Services BureauLast updated January 31, 2018

77. Last updated January 31, 2018 Infectious Disease Prevention and Health Services Bureau 77
Prevention and Health Promotion Administration
Jill Smith, MHS, CAC-AD
[phone] • [email protected]
http://health.maryland.gov