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STDs@SMU Nancy Merrill, MD Peter F. Davis, MD SMU Student Health Center

STD Risk Factors Sexual activity Early age of sexual initiation Increased number of partners Use of drugs or alcohol Belief in invulnerability--”It doesn’t happen to people like me”

Genital Warts Caused by Human Papilloma Virus (HPV) Sexually active persons who have had > 3 partners or whose partners have had > 3 partners  have a 75 % chance of being infected with virus. Over 80% of sexually active students will contract and transmit HPV by the time they graduate from college.

Intercourse vs.. Outercourse “Rub a dub dub” Penile – Vaginal penetration is not required to contract HPV. Genital contact or hand/oral manipulation may result in  HPV infection. “Virgins” (no vaginal penetration by penis) can and do still contract HPV.

Facts (aka Bad News) Minimal symptoms Low risk strains cause genital warts High risk strains (oncogenic=cancer causing) usually have no symptoms Cancer is only detected by Pap or biopsy Most often transmitted without visible warts SMOKING greatly increases progression to cervical cancer!!!

Good (?) News Most (70%) of all HPV infections will disappear in an immunocompetent (healthy) non-smoker without any treatment within 12 to 24 months! 2 pharmaceutical companies are now applying for FDA approval for HPV vaccines!

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Genital Warts   Diagnosis and Treatment Physical exam, Pap smear, HPV DNA typing from Pap (or rectal swab from rectal penetration) or colposcopy Topical therapy, freezing, laser ablation, LEEP Condoms and spermicides decrease transmission Treatment of abnormal (pre-cancerous) cervical cells can aid cancer prevention.

Herpes Simplex Virus (HSV) Prevalent among college students Type 1 - Oral  (Freshmen: 37%       Seniors: 46%) Type 2 - Genital  (Freshmen: 0.4%      Seniors: 4%) Types 1 & 2 found in genital lesions Diagnosed by examination and cultures Can be transmitted even without visible lesions

Herpes Simplex Virus (HSV) Symptoms Blisters or ulcers on genitalia Tingling and burning Fever Body aches Swollen glands Recurrent episodes may be less severe

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Herpes Simplex Virus (HSV) Management Can be controlled but not cured Acyclovir for primary outbreak and flares Recurrent flares in 80% of infected individuals exacerbated by: Stress Heat Menstruation Trauma

Chlamydia 5% of college students infected Frequent association with other STD’s Symptoms Often no symptoms Women: discharge, painful urination, pain with sex, heavy and irregular menstrual periods Men: discharge, epididymitis (painful scrotum) Can cause PID and infertility

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Gonorrhea (GC) Incidence highest among sexually active  15-19 year olds  (24 cases per 1000) Often associated with other STDs Symptoms Often no symptoms Women: discharge, painful urination, pain with sex, irregular menstrual periods Men: discharge, epididymitis (painful scrotum) Both:  throat and joint infections Can cause PID and infertility

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Syphillis Rates increasing among youth/young adults (recent decrease in Dallas County) Progressive disease Primary phase:  single genital chancre (ulcer), swollen lymph nodes Secondary phase:  more sores, usually on genitals Late phase:  involvement of multiple organs Curable with antibiotics

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Other Ulcerative Diseases Lymphogranuloma Venereum (LGV) Granuloma Inguinal Chancroid

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Vaginitis and Cervicitis Symptoms:  discharge, lower abdominal pain, abnormal menstrual bleeding, pain with urination, frequent urination Sexually transmitted: trichomonas, bacterial vaginosis, yeast Non-sexually transmitted:  bacterial vaginosis, yeast, soap or spermicide allergies, perfumes, foreign bodies (e.g. forgotten tampons)

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Other Genital Disorders Yeast infections (Candida Albicans) Scabies Pubic lice Molluscom contagiosum Tinea cruris (jock itch) Folliculitis (infected hair follicles)

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Hepatitis B Virus (HBV) More prevalent and contagious than HIV Transmitted by sharing body fluids Kissing, sexual contact, sharing razors, transfusions, sharing IV needles 40% no known contact Symptoms:  fatigue, nausea, malaise, liver enlargement 10% have chronic disease and risk for liver failure Texas laws require immunization for all students entering 8th grade and now for infants.

Hepatitis B Virus (HBV) Vaccine ACHA recommends all college students be vaccinated Series of 3 immunizations, given several months apart Available at SMU Student Health Center

Human Immunodeficiency Virus Only latex condoms can decrease transmission of HIV Dallas County Health Department offers free, anonymous testing at SMU Health Center Every other Friday. Call 8-2141 to obtain phone # to schedule an appointment directly with Aids Prevention Project (funded by Dallas County Health Department)

HIV and AIDS in the US (6/97) Total AIDS cases :  612,078 Estimated HIV prevalence : 650,000-- 900,000 1 in 300 Americans infected with HIV 1 in 300 Americans (all ages) 1 in 160 males (adult/adolescent) 1 in 800 females (adult/adolescent)

HIV and AIDS:  The Present AIDS is the second leading cause of death among persons aged 25-44 in the United States (as of 4/98) Mean (average) time between infection and development of AIDS is 8 to11 years Increasing in women, African Americans, and Latinos

HIV in College Students Study of 16,863 students at 19 large universities and colleges, 1989 (CDC & ACHA) 0.2% (or 1 in 500) infected with HIV Compare to rate of HIV infection in military recruits = 0.14%

HIV Prevention and Risk Reduction Abstinence, Abstinence, Abstinence Condoms Latex (male or female) Significantly reduce but do not eliminate risk Avoid petroleum-based lubricants, many medicated vaginal creams, massage oils Spermicide (Nonoxynol-9) Presence of other STDs increases risk

HIV Testing Seroconversion (time from infection to positive antibody status) takes generally 6 weeks to 6 months (most convert in 90 days) Two-step method (Elisa, Western Blot) AIDS Prevention Project (UTSW Medical School) offers free, anonymous testing at SMU Health Center (call 214-944-1050 to schedule)

The Good News HIV education is increasing awareness of AIDS and other STDs Studies show modest but significant decrease in recent sexual activity Use of condoms is increasing Research has brought new and better therapies for many STDs in recent years

Making Sex Safer ABSTAIN from sexual intercourse until you are in a long-term, committed relationship Experiment with non-sexual ways to express affection Communicate with your partner about sex

Making Sex Safer Use condoms and spermicide every time you have sex Limit your number of partners (1x2x10=20) Women:  get yearly Pap smears Get checked regularly for STDs