SEXUALLY TRANSMITTED DISEASE

 Refers to any infection contracted primarily through sexual activities or contact.

 Also known as STI (Sexually-Transmitted Infection) (The difference between STI and STD, STD it has a recognizable
signs and symptoms, whereas infections may or may not manifest specific signs and symptoms)

Characteristics:

1. STD can be transmitted by any sexual activity between opposite-sex or same – sex partners (not only vaginal –
penile sex but also oral and anal sex).
2. Having one STD confers no immunity against future reinfection with that STD or with any other STD
3. Sexual partners of infected clients need to be assessed for treatment.
4. STD affect people from all socio-economic classes, cultures, ethnicities and age-groups.
5. Women bear a disproportionate number of the effects of STDs.
6. Frustrations, anger, anxiety, fear, shame and guilt are common emotions associated with an STD diagnosis.

HERPES SIMPLEX

Cause

 Herpes febrilis or herpes simplex virus 1 (HSV-1)

 Herpes simplex virus 2 (HSV-2)

*Both type can infect nearby sensory neuron. Trigeminal ganglia in face and sacral ganglia in genitalia, where
herpes virus settle in and herpes virus makes copies of itself and are released and infect other epithelial
cells. Herpes lesions develop on the ipsilateral (same side) at the affected ganglion.

Mode transmission

 Herpes febrilis or herpes simplex virus 1 (HSV-1)

- Transmitted through contact with open lesions, usually on the lips or inside the mouth. Usually, non-genital,
with lesion typically above the waist.
 Kissing
 Touching a person`s skin near the mouth
 Sharing food utensils, lip balm or razors
 Oral sex from someone with cold sore, may spread herpes infection to genitals
  Herpes simplex virus 2 (HSV-2)
 generally transmitted by sexual contact. Vaginal or anal intercourse and oral-genital contact are the primary
transmission modes but HSV 2 can be transferred by hand contact as well.
 Skin to skin contact without ejaculation
 Touching open sores, including while breastfeeding
 Childbirth by a mother or gestational parent who has an active infection.
 Using shared sex toys

Type 2 is considered an STI because it is most often below the waist and is transmitted by genital contact. A
characteristic of herpes viruses is the ability to become latent. The virus can remain in the tissues in an
inactive state for long periods of time and then reactivated.

*Transmission is by direct contact with the exudates during the sexual activity, but it is possible by fomites such as towels
used by an infected person.

Signs & symptoms: usually occur 3 to 7 days after contact.

 Most people have no symptoms or only mild symptoms & many people are not aware that they have the
infection and can pass along the virus to others without knowing.
 rash appear first, followed by small clusters of fluid filled blisters that ooze an eventually ulcerate
 Painful, itching sores on or around the genitals or anus approximately 2 to 20 days after infection. These
symptoms last about 2 to 3 weeks
 People often complain of flu-like symptoms and a burning sensation during urination. Episodes of active
symptoms may recur and are frequently precipitated by anxiety.
 Recurrent outbreaks usually last between 3 to 7 days

Women: Men:

 Blisters in labia majora & minora Shaft of Penis

 Mons pubis
 Vaginal mucosa
 Cervix
Other parts of body

 Herpetic Whitlow

- Happens when finger rubs a lesion

- Easy to transfer virus to other parts of the body

 Herpes Gladiatorum – infection of trunk, extremities & head

  Keratoconjunctivitis- infection of the eye usually inflammation of cornea and conjunctiva

Conjunctiva
- Pain
- Redness
- Tearing
- Sensitivity to light

Cornea
-blurry vision
-a branching dendritic lesion-classic sign of herpes

*Recurrent episodes can occur but less severe (sometimes no symptoms) (If symptoms occurs, patients feel tingling
and burning sensation before appearance of blisters)

Complications

Risk of cervical cancer exists in women who have genital herpes. (an infected woman should be taught to have a
Papanicolaou (Pap) test done annually to detect cervical cancer early.

Herps simple virus does not affect fertility or ability to conceive. Pregnant women diagnosed with HSV 2 should
start a daily anti-viral at 36 weeks of pregnancy as prescribed. Various guidelines are used to determine whether
the patient should have vaginal delivery or cesarean section. The goal is to decrease the risk of transmission to
the baby. Newborns can be infected during vaginal delivery when active genital lesions are present. Caesarean
section prevents this transmission.

*Transmission happens at birth when baby passes through

maternal vaginal secretions. Neonatal HSV causes 3 patterns of
illness:
1. Skin, eye and mucous membrane – lesions pop up at skin 1-2
weeks after delivery
2. CNS infection/brain damage – lethargy, irritability, seizures,
2-3 weeks after delivery
3. Disseminated infection- sepsis & organ failure

Babies with neonatal herpes can recover fully with treatment. The danger of neonatal herpes are much
higher if the infection spreads to the baby`s organs.
 Herpes simplex encephalitis is a dangerous complication, usually caused by HSV 1. It has a mortality rate of 30 %
and half of survivors have moderate to severe neurologic impairment.

-When there is Brain involvement, lumbar puncture results increased RBC, WBC,
elevated protein level.

Diagnostic

Viral culture- the best test to confirm a herpes simplex infection. This test is done with a sample of fluid from a
herpes sore or from genital secretions. The sample is collected by gently pressing a soft swab into one or more
sores, or placing the swab on the tip of the penis or in the vagina. Test results are generally available in 1 to 2
days. Normal results are negative, meaning that no HSV was found in the sample. Positive results mean that HSV
was found. The results may also show which type of HSV the person have.

Papsmear- is when a practitioner scrapes a few cells off the cervix and puts them on a slide, and looks at them
under a microscope. If herpes on the cervix exists, the results will have abnormal papsmear.
Treatment & Management

 It is treatable but not curable

 no cure for HSV Infection exists but the oral antiviral drugs acyclovir (Zovirax), valacyclovir (Valtrex) and
famciclovir (Famvir) help partially controlling the signs and symptoms during initial episodes taken orally for 7 to
10 days and recurrent episodes, acyclovir (Zovirax), valacyclovir (Valtrex) and famciclovir (Famvir) are taken for 5
days.
 Paracetamol (Acetaminophen), Naproxen or ibuprofen to help with pain related to sores
 Benzocaine and 1% or 2% Topical lidocaine can be applied to numb the affected area

Herpes simplex virus lives inside the nerve cells and alternates between inactive and actie. Certain triggers
can make the virus active including:

Illness or fever
Sun exposure (for people whose oral herpes is activated by sunlight, avoiding sun exposure and wearing
sunscreen can lower the risk of recurrences)
Menstrual period
Injury
Emotional stress
surgery

 To decrease symptoms of oral herpes, people can:

1. Drink cold dinks or suck on popsicles
2. Use over-the-counter pain medicine

For genital herpes, people can:

1. Keeping the involved area clean and dry
2. Wearing loose-fitting non-synthetic undergarments. Avoid tight-fitting clothes because moist sores take
longer to heal.
3. Using Sitz bath for 20 minutes (without soap)
4. Cooling applications- Apply an ice pack to the genitals. Wrap the ice pack in a washcloth or apply it over the
underwear
5. analgesics medications

Prevention

 People with symptoms of oral herpes should avoid oral contact with others (including oral sex) and sharing
objects that touched saliva.
 Infected clients should have separate towels and other personal items and avoid touching their eyes.
 Individuals with symptoms of genital herpes should abstain from sexual activity while experiencing symptoms.
Both HSV-1 and HSV-2 are most contagious when sores are present but can also be transmitted when no
symptoms are felt or visible.
 Clients should use condoms during latent periods. The possible risk of transmission exists even when lesions are
not present.
 For sexually active people, consistent and correct use of condoms is the best way to prevent genital herpes and
other STIs. Condom reduce risk; however, HSV infection can still occur through contact with genital or anal areas
not covered by the condoms.
 Use dental dams during oral sex.

Dental Dam Dos and Don’ts

 DO use a new latex or polyurethane dental dam every

time you have oral sex.
 DO read the package and check the expiration date.
 DO make sure there are no tears or defects.
 DO put on before starting oral sex and keep it on until
finished.
 DO use water-based or silicone-based lubricant to
prevent breakage.
 DO store dental dams in a cool, dry place.
 DON’T reuse a dental dam.
 DON’T stretch a dental dam, as this can cause it to tear.
 DON’T use nonoxynol-9 (a spermicide), which can cause
irritation.
 DON’T use oil-based products like baby oil, lotion,
petroleum jelly, or cooking oil because they will cause
the dental dam to break.
 DON’T flush dental dams down the toilet as they may
clog it.

 Wash sex toys before and after using, do not share. If sharing, protect them with a condom
 Be monogamous with one sexual partner
 Handwashing by health care providers is critically important.
 Women should have annual pelvic examinations and pap smear.
 If there is an active outbreak while breastfeeding, it is possible to spread the infection from the nipples through
touch. Careful handwashing can prevent the spread. Do no breastfeed from the breast that has herpes sores.
Pump breastmilk until the sores heal. Do not give the baby expressed breastmilk if the pump comes into contact
with an open sore.