The Impact of Sexually Transmitted Diseases(STD) on Women GAL Community Symposium AUM September 2, 2011 Agnes Oberkor, MPH, MSN, CRNP, Nurse Practitioner Senior Alabama Department of Public Health STD DIVISION 1
Goals To provide current information on common Sexually Transmitted Diseases (STD) impacting women s life. 2
Objective Describe STDs impacting women s life. List complications of untreated STDs in women. Describe STD prevention control programs available for women. 3
Common STDs COMMON SEXUALLY TRANSMITTED DISEASES (STD) IN WOMEN 4
Common Sexually Transmitted Diseases (STD) in Women Vaginitis: Bacterial Vaginosis (BV); Candidiasis (yeast); and Trichomoniasis Human Papillomavirus (HPV) Chlamydia (CT) Herpes Simplex Virus (HSV) Type 2 (genital herpes) Gonorrhea (GC) Hepatitis B Human Immunodeficiency Virus (HIV) Syphilis 5
Risk Factors Associated with most STDs New sex partner or multiple sex partners Teenager Douching Low socioeconomic status History of STDs Lack of barrier protection (condom use) High-risk heterosexual contact Injection drug use 6
Selected STDs by Gender, 1996-2009 Disease Women Men Rate Per 100,000 Women Men Chlamydia 9,026,526 2,628,037 553.85 170.37 Gonorrhea 2,388,405 2,287,843 145.22 147.04 Primary & Secondary Syphilis 32,250 92,354 1.96 5.94 Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 7
Estimated Number of STDs in Pregnant Women each Year Bacterial vaginosis: 1,080,000 Herpes simplex virus 2: 880,000 Chlamydia: 100,000 Trichomoniasis: 124,000 Gonorrhea: 13,200 Hepatitis B: 16,000 HIV: 6,400 Syphilis: <1,000 Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 8
Chlamydia Women Rates by State, United States and Outlying Areas, 2009 Guam 592 480 427 558 554 1,024 366 589 297 442 452 603 695 406 549 432 582 602 678 389 447 623 734 913 531 681 499 680 667 1,177 808 624 441 591 290 919 475 567 701 637 253 VT NH MA RI CT NJ DE MD DC Rate per 100,000 population 282 231 412 480 498 423 794 646 1,331 <400.0 (n = 8) 400.1 600.0 (n = 24) 689 Puerto Rico 308 Virgin Islands 753 566 >600.0 (n = 22) Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 9
Chlamydia Rates by Race/Ethnicity and Sex, United States, 2009 Rate (per 100,000 population) Men Women Race/ 2,500 2,000 1,500 1,000 500 0 Ethnicity 0 500 1,000 1,500 2,000 2,500 323.8 AI/AN* 1,214.9 72.0 A/PI* 221.9 970.0 Blacks 2,095.5 237.7 Hispanics 788.8 84.0 Whites 270.2 219.3 Total 592.2 Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 10
Gonorrhea Women Rates by State, United States and Outlying Areas, 2009 Guam 37.0 28.9 26.5 64.8 51.3 157.0 6.7 45.5 5.2 9.5 16.8 61.3 56.7 27.5 47.1 91.3 109.3 152.4 131.9 48.5 69.0 118.6 175.9 110.0 225.8 171.9 168.0 123.2 137.0 97.7 166.0 30.4 286.2 147.4 176.4 115.3 217.7 88.4 109.2 167.2 79.0 9.2 VT NH MA RI CT NJ DE MD DC Rate per 100,000 population 9.2 8.1 29.2 26.9 83.1 55.0 125.4 118.9 395.3 <19.0 (n = 8) 19.1 100.0 (n = 22) 41.3 Puerto Rico 6.1 Virgin Islands 155.7 >100.0 (n = 24) Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 11
Gonorrhea Rates by Race/Ethnicity and Sex, United States, 2009 Rate (per 100,000 population) Men Women Race/ 750 600 450 300 150 0 Ethnicity 0 150 300 450 600 750 78.2 AI/AN* 147.3 17.6 A/PI* 18.5 555.2 Blacks 557.5 54.5 Hispanics 63.0 21.5 Whites 32.8 91.9 Total 105.5 Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 12
Primary and Secondary Syphilis Women Rates by State, United States and Outlying Areas, 2009 Guam 1.2 0.0 0.2 0.1 0.5 0.4 0.0 0.7 0.0 0.0 0.4 0.2 0.6 0.3 0.0 0.0 0.6 1.3 4.0 0.0 0.4 0.5 7.1 0.4 15.4 0.8 4.8 0.4 0.8 3.8 5.7 0.2 1.1 2.1 0.2 0.4 0.7 0.6 2.3 0.5 0.0 VT NH MA RI CT NJ DE MD DC Rate per 100,000 population 0.0 0.0 0.1 0.2 0.1 0.6 2.4 1.4 3.2 <0.2 (n = 19) 0.21 4.0 (n = 31) 0.9 Puerto Rico 1.1 Virgin Islands 0.0 1.6 >4.0 (n = 4) Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 13
Primary and Secondary Syphilis Rates by Race/Ethnicity and Sex, United States, 2009 Men Rate (per 100,000 population) Women Race/ 35 28 21 14 7 0 Ethnicity 0 7 14 21 28 35 3.9 AI/AN* 0.9 3.0 A/PI* 0.2 31.3 Blacks 8.2 8.1 Hispanics 0.6 3.9 Whites 0.4 7.8 Total 1.4 Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 14
Human Papillomavirus Prevalence of High-risk and Low-risk Types Among Females Aged 14 59 Years, National Health and Nutrition Examination Survey, 2003 2004 Prevalence, % 45 Low-risk HPV* 40 High-risk HPV 35 30 25 20 15 10 5 0 14 19 20 24 25 29 Age 30 39 40 49 50 59 Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 15
Genital Warts Prevalence Among Sexually Transmitted Disease (STD) Clinic Patients by Sex, Sex of Partners, and Site, STD Surveillance Network, 2009 Percentage MSM* 10 MSW* Women 8 6 4 2 0 San Francisco Los Angeles Seattle Denver Chicago New Orleans Richmond Baltimore Philadelphia Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 16
Trichomoniasis and Other Vaginal Infections Women Initial Visits to Physicians Offices, United States, 1966 2009 Visits (in thousands) 4,500 3,600 Trichomoniasis Other Vaginitis 2,700 1,800 900 0 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 Year Sexually Transmitted Disease Surveillance 2009 Division of STD Prevention 17
HIV among men and women, United States, 2009 18
HIV Among Women Estimated new HIV infections among women in the United States in 2009-- 11,200. In 2009, women comprised 51% of the US population and 23% of those newly infected with HIV. Of the total number of new HIV infections in US women in 2009, 57% occurred in blacks, 21% were in whites, and 16% were in Hispanics/Latinas. At this rate 1 in 139 women will be diagnosed with HIV infection. Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 19
Complications COMPLICATIONS OF UNTREATED SEXUALLY TRANSMITTED DISEASES 20
Complications of Untreated Bacterial Vaginosis Having BV increases the chances that an HIV-infected woman can pass HIV to her sex partner. Having BV has been associated with an increase in the development of an infection following surgical procedures such as a hysterectomy or an abortion. Having BV while pregnant may put a woman at increased risk for some complications of pregnancy, such as preterm delivery. BV can increase a woman's susceptibility to other STDS such as, Herpes, Chlamydia, and Gonorrhea if she is exposed. Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 21
Complications of Untreated Trichomoniasis The genital inflammation caused by trichomoniasis can increase a woman s susceptibility to HIV infection if she is exposed to the virus. Having trichomoniasis may increase the chances that an HIV-infected woman passing HIV to her sex partner(s). Pregnant women with trichomoniasis may have babies who are born early or with low birth weight (low birth weight is less than 5.5 pounds). Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 22
Complications of HPV Infection Genital warts usually appear as a small bump or group of bumps in the genital area. Cervical cancer usually does not have symptoms until it is quite advanced. Respiratory papillomatosis (RRP)is a condition in which warts grow in the throat. Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 23
Complications of Untreated Chlamydia in Women Serious reproductive and other health problems with both short-term and long-term consequences. The damage that chlamydia causes is often "silent. CT can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). The damage can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Chlamydia may also increase the chances of becoming infected with HIV, if exposed. Chlamydia can lead to premature delivery. The leading cause of early infant pneumonia and conjunctivitis (pink eye) in newborns. Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 24
Complications of Herpes Simplex Virus Type 2 in Women Recurrent painful genital sores in many adults. Psychological distress in people who know they are infected. Genital HSV can lead to potentially fatal infections in babies. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 25
Complications of Untreated Gonorrhea in Women Can lead to serious and permanent reproductive health problems Gonorrhea is a common cause of pelvic inflammatory disease (PID). PID can lead to internal abscesses (pus-filled pockets that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy. More susceptible to HIV acquisition and spread Gonorrhea can spread to the blood or joints. Blindness, joint infection, or a life-threatening blood infection in babies. Content source: Centers for Disease Control and Prevention, National Center for 26
Complications of Hepatitis B Infection in Women Hepatitis B virus (HBV) infection in a pregnant woman poses a serious risk to her infant at birth. Without post exposure immunoprophylaxis, approximately 40% of infants born to HBVinfected mothers in the United States will develop chronic HBV infection. Approximately one-fourth of these infants will eventually die from chronic liver disease. Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 27
Complications of HIV Infection in Women Pregnant women with the disease can pass it to the babies they are carrying. AIDS Women accounted for more than 25% of the estimated 34,247 AIDS diagnoses in 2009. Women represent nearly 20% of cumulative AIDS diagnoses (including children) in the United States to date. Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 28
Complications of Syphilis Infection in Women Pregnant women with the disease can pass it to the babies they are carrying. Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 29
Prevention and Control STD PREVENTION AND CONTROL FOR WOMEN 30
STD Prevention and Control for Women Infertility Prevention Project (IPP): 1. Clinical (screening, treatment, partner management) 2. Training and Education (of clinicians and laboratorians) 3. Laboratory (tests, bulk purchasing, performance, turn-around-time, quality assurance) 4. Surveillance (local, state, regional data collection, management, and analysis). STD Awareness Month (April) Get Yourself Tested (GYT) Campaign Syphilis Elimination Effort (SEE) Content source: Centers for Disease Control and Prevention, National Center for 31
Abstinence STD Prevention and Control: Responsibility of a Women Monogamous sexual relationship Proof of partner negative test results for all common STDs including HIV and herpes before sexual contact Barrier Protection (condom use -male or female condom) Hepatitis B Vaccine Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 32
STD Prevention and Control: Responsibility of a Women Routine STD screening (CT, GC, HIV, HPV, Syphilis) Prompt notification of healthcare provider of any unusual vaginal discharge, sore, rash or lower abdominal pain and request STD testing Correct contact information to healthcare provider Prompt treatment/complete all antibiotics Partner management Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 33
STD Prevention and Control: Responsibility of a Women Risk reduction --Avoid unprotected sex --Avoid having sex with a new partner before knowing the person s STD status --Avoid having multiple sex partners --Avoid douching --Avoid unnecessary antibiotic use --Complete course of treatment --Have partners get tested and treated Content source: Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention 34