Sexually Transmitted Diseases PREVENTION ! IS KNOWLEDGE Edited by Mori Giovanni (Specializing in Infectious and Tropical Diseases) and Franzinelli Arianna (Graphic Designer) Assistance and protection project in favor of victims of trafficking, financed by the Equal Opportunities Department, carried out in partnership with the private social organizations active on the territory Finalized in September 2022 Abnormal vaginal discharge (e.g. increase of secretions, change of color and/or odour) Abnormal blood loss (outside the menstrual cycle) Pain in the lower abdomen and/or during sexual intercourse Itching and/or vaginal burning Burning/pain, difficulty urinating +/- secretions from the urethra (penis) Anal burning/pain, abnormal secretions +/- urge to defecate Small close bubbles around the penis, vagina or anus and pain/burning/itching Genital herpes Non-sore ulcer on the penis, vagina, anus or mouth Enlarged lymph nodes Rash Fever, headache and general fatigue Small pink or greyish growths on the penis, around or inside the vagina or the anus Genital warts Chronic fatigue, headache, sore throat, cough, muscle pain, lymph node enlargement, diarrhea, weight loss, rashes (even just some of these symptoms).... Syphilis FROM SYMPTOMS TO DISEASE Chlamydial cervicitis and/or gonorrhea or candida vulvovaginitis (rarely other microorganisms) Chlamydial urethritis and/or gonorrhea (rarely other microorganisms) Chlamydial proctitis and/or gonorrhea (rarely other microorganisms) HIV TAKE THE TESTS REGULARLY (AT LEAST ONCE/YEAR) No symptom? You may still have any sexually transmitted disease (STD) The infection usually remains asymptomatic for a long time, even for several years, during which the virus gradually weakens the immune system. If left untreated, the infection progress to AIDS (acquired immunodeficiency syndrome), fatal if left untreated. With a simple blood sample Use of condoms Regular STD screening and treatment Use of prep (pre-exposure prophylaxis) Use of pep (post-exposure prophylaxis) in case of condom breakage Transmission occurs even in the absence of symptoms and other STDs facilitate it HIV TRANSMISSION Unprotected sex (anal, viginal and rarely oral) Contact with infected blood (e.g. exchange of syringes) Transition from mother to baby during pregnancy, childbirth or breastfeeding Infection caused by the human immunodeficiency virus (HIV) SYMPTOMS Recurrent infections Tumors There are also self-tests (less reliable) that can be purchased at the pharmacy HIV ≠ AIDS AIDS is characterized by the development of: It is not transmitted by: kissing, hugs/handshakes or insect bites TREATMENT AND PREVENTION HIV infection can be treated with a combination of antiviral drugs called “ART”. Therapy, when taken regularly, for a lifetime, it prevents the weakening of the immune system and allows you to live a normal life. N.B. it is important to start the treatment early, before the immune system weakens too much! The best treatment of HIV infection is prevention, feasible through: prep and pep do not protect against all other STD If the viral load drops below a certain threshold with ART, the infection is NO longer transmissible The risk of transmission to the baby can be reduced with: ART, cesarean delivery and artificial lactation. DIAGNOSIS Mucocutaneous rashes , which can affect any part of the body and occur in various forms (macular, paupulary or pustulous). Other common symptoms: fever, headache, general fatigue, bone/muscle pain and lymph node enlargement. With a simple blood sample It manifests itself only in some people, untreated, at an average distance of 15 years from the initial infection, with: Cardiovascular system disorders Nervous system disorders Granulomas ("gums") involving bones, skin and/or liver The disease proceeds in consecutive, non obligatory stages Congenital syphilis can cause: miscarriage, stillbirth or malformations of various organs SYPHILIS TRANSMISSION Unprotected sex (oral, vaginal and anal) Contact with skin lesions Transition from mother to baby during pregnancy Infection caused by a bacterium called Treponema pallidum, spiral-shaped. SYMPTOMS DIAGNOSIS TREATMENT Syphilis is treatable with antibiotics (almost always intramuscular injections). N.B. it is important to start treatment early, before the infection proceeds to later stages, more difficult to treat and with irreversible consequences PRIMARY SYPHILIS Non-sore ulcer on the penis, vagina, anus or oral cavity (also hidden) +/- enlargement of the lymph nodes SECONDARY SYPHILIS TERTIARY SYPHILIS Treatment of the partner(s) is essential to avoid reinfection after treatment Depending on the symptoms: These infections are usually symptomatic. Depending on the type of contact they can give: These infections are usually asymptomatic. Depending on the type of contact they can give: Cervicitis (abnormal vaginal secretions, burning and/or Proctitis Pharyngitis intermenstrual bleeding) Swabs: for pharyngitis, proctitis, urethritis and cervicitis Urine: for urethritis and cervicitis CHLAMYDIA AND GONORRHEA TRANSMISSION Unprotected sex (oral, vaginal and anal) Transition from mother to child during childbirth Infections caused by widespread bacteria, often present together. SYPMTOMS DIAGNOSIS TREATMENT Chlamydia and Gonorrhea infections are treatable with antibiotics (by mouth or intramuscularly). N.B. Treatment, even in the absence of symptoms, prevents possible complications. IN MEN IN WOMEN Treatment of partner(s) is essential to avoid reinfection after treatment Infection of the newborn can affect the eyes, lungs or give a very dangerous disseminated disease. It is essential to treat the infection before childbirth Urethritis (burning/pain, difficulty urinating and/or secretions from the urethra) Proctitis (itching/anal pain, secretions and/or feeling of having to defecate) Pharyngitis (sore throat) Vaginal/cervical infection is very often asymptomatic. If left untreated it can cause abdominal infections, infertility and chronic pain! Sex (oral, vaginal and anal) Transition from mother to child during pregnancy or childbirth Treatment of genital warts is done with ointments or surgical removal. However, relapses are frequent. Treatment of carcinomas depends on the stage at diagnosis. The best treatment of HPV infections is prevention, feasible through: The vaccine is offered free of charge to some categories and in co-payment to others Early diagnosis is essential, therefore screening is recommended: - Pap test every 3 yrs from 25 to 33 yrs -HPV test every 5 yrs from 34 to 64 yrs SYMPTOMS Some subtypes of papillomavirus (e.g. HPV 6 and 11) cause "genital warts" or "acute warts" (small flat, papular or pedunculated pink or greyish lesions), which are localized: On the penis Around or inside the vagina Around or inside the anus Infection of the newborn can cause respiratory papillomatosis Other subtypes of papillomavirus (e.g. HPV 16 and 18) can cause various malignant tumors (carcinomas) Cervical cancer Anal carcinoma Oropharyngeal cancer Other cancinomas (more rarely) The diagnosis of genital warts is made with inspection. Sometimes a biopsy may be needed. The diagnosis of carcinomas and precancerous lesions that precede them is made with a smear test or HPV test HUMAN PAPILLOMA VIRUS (HPV) TRANSMISSION Infection caused by different types of viruses DIAGNOSIS TREATMENT AND PREVENTION Condoms decrease the risk of transmission, but it does NOT eliminate it! Transmission occurs even in the absence of visible lesions Constant use of condoms HPV vaccination Regular screening with smear test/HPV test (women) Acute infection of the liver, which can be asymptomatic or symptomatic, up to very severe cases. Symptoms, when present, include: Jaundice ( yellowish pigmentation of skin and eyes) Abdominal pain Fever, tiredness and loss of appetite/nausea Pharyngitis Usually it does not require treatment EPATITE A e B (HBV e HCV The best treatment of HAV, HBV and HCV infections is prevention, which can be implemented through: Constant use of condom HAV and HBV vaccination STD regular screening The vacc ine for HAV and HBV is offered free of charge to some categories and in co-payment to others SYMPTOMS HEPATITIS (HBV, HAV AND HCV) TRANSMISSION Infections caused by 3 viruses that mainly affect the liver With a simple blood sample DIAGNOSIS TREATMENT HEPATITIS A (HAV) HEPATITIS B and C (HBV and HCV) Through food (rare in Italy) Oro-anal sex (even indirect) Contact with infected blood (e.g. syringes) Unprotected sex (HCV rarely) Transition from mother to child during or after pregnancy The virus is present in the feces of infected people HEPATITIS A (HAV) They can cause an acute liver infection, such as HAV, or a chronic liver infection, which within 20-30 years can progress to cirrhosis and malignant tumor (hepatocellular carcinoma). Chronic infection is usually asymptomatic until the last stages. HEPATITIS A (HAV) HCV is easily treatable HBV is kept under control, but it is more difficult to treat You can treat them with antiviral drugs: HEPATITIS B and C (HBV and HCV) HEPATITIS B and C (HBV and HCV) Often it is enough to inspect or tell about signs/symptoms in case there are no lesions. Sometimes it may be necessary to confirm the diagnosis with: Unprotected sex (oral, vaginal and anal) Transition from mother to child during childbirth Swabs Blood sample GENITAL HERPES TRANSMISSION Caused by 2 types of viruses ( HSV2 and HSV1 ) SYMPTOMS DIAGNOSIS TREATMENT and PREVENTION Treatment is not always necessary: lesions and pain often subside spontaneously within a few (1-4) weeks. There are specific antiviral drugs, which can be used: The majority of infections are asymptomatic. When the first infection is symptomatic, usually it is manifested by: Suppressive therapy also reduces the risk of transmission The use of condoms decreases the risk of transmission, but it does NOT eliminate it! Transmission occurs even in the absence of visible lesions Fever, headache and general malaise Cluster vesicular rash , preceded and/or accompanied by pain/burning/itching Some people may have frequent +/- relapses (especially HSV2), usually characterized only by the vesicular rash, of shorter duration. N.B. Once the infection is acquired, it lasts for a lifetime! Infection of the newborn can cause very serious consequences To treat single episodes, reducing the intensity and the duration of symptoms. As a long-term suppressive therapy, to reduce the rick of reoccurrence Combination of 3 drugs, effective in preventing HIV infection after unprotected sex. To be taken as soon as possible (within 48h) for 4 weeks. Daily (all) : 1 pill every day On-demand: (only men) Combination of 2 drugs, in one pill, effective in preventing HIV infection, having unprotected sex. There are 2 ways of administration: PREVENTION MALE CONDOM PREP (pre-exposure prophylaxis) PEP (post-exposure prophylaxis) VACCINES There are specific antiviral drugs, which can be used: It is the most effective method in preventing STDs, when used correctly. This vaccines are offered free of charge to some categories or in co-payment to other categories. Hepatitis A vaccines (HAV) Hepatitis B vaccines (HBV) Papillomavirus vaccines (HPV) It is essential to perform regularly (at least 1 time/year), even in the absence of symptoms, the STD screening through: Blood sample (all) Urine sample/vaginal swabs (women) PREP INFORMATION Pep is an emergency measure, prescribed by an infectious desease doctor, in a hospital center. LOMBARDIA VACCINES There are some available vaccines, highly effective in preventing STDs: Some STD can be transmitted, although more difficult, using the condom correctly The prep can be purchased at the pharmacy, on prescription by an infectious disease doctor. 30 pills = about 60 euro SITO LOMBARDIA MTS STRUTTURE LOMBARDIA MTS USEFUL LINKS