HIV/AIDS and STIs

1. Go to the following web sites to answer the following questions:

http://www.hc-sc.gc.ca/hc-ps/dc-ma/aids-sida-eng.php
http://www.hc-sc.gc.ca/hc-ps/dc-ma/sti-its-eng.php
What does HIV and AIDS stand for?
The Human Immunodeficiency Virus (HIV) is the virus that causes Acquired
Immunodeficiency Syndrome (AIDS).
What happens when you get these diseases?
HIV attacks the immune system, resulting in a chronic, progressive illness that
leaves infected people vulnerable to opportunistic infections and cancers.
How is HIV transmitted?
The following activities can place a person at high-risk for HIV infection:
engaging in unprotected sexual intercourse (anal or vaginal)
sharing sex toys
sharing needles or equipment for injecting drugs or steroids
mother-to-child transmission during pregnancy, delivery, and breastfeeding
Why is HIV so difficult to treat or develop preventions for?
There is no cure for the HIV infection. Treatments, known as antiretrovirals, only
suppress the virus replication in the body and disrupt the action of the virus.
Which groups of people are most at risk today?
New HIV infections in Canada in 2011 are classified as follows:

46.6 percent were MSM

37.2 percent were heterosexuals
13.7 percent were injection drug users
Go to one of the reports on AIDS. Describe two things in the report that you did
not know before about AIDS.
It is easy to prevent it as wearing a condom. And Aids dont transfer through
kissing. Guess I should kiss more.

4. Go to the STIs web site and describe the symptoms of each of the following:
i) Chlamydia
Symptoms for men can include:

discharge from the penis

burning sensation when urinating
burning or itching at the opening of the penis
pain and/or swelling in the testicles

ii) Gonorrhea
For men who do experience symptoms, these may include:

a burning sensation when urinating

yellowish/white discharge from the penis
burning or itching at the opening of the penis
painful or swollen testicles

iii) Herpes (Genital)

Men's symptoms can include:

sores on the penis, around the testicles, near the anus, or on the thighs or
buttocks
tender lumps in the groin (lymphadenopathy)

iv) Human Papillomavirus (HPV)

In men, the warts may appear on the penis, scrotum, thigh, anus, rectum, or in
the urethra.
v) Syphilis
In secondary syphilis, the symptoms can sometimes overlap with those of the
primary stage and vary considerably. They can include:

patchy hair loss

a rash on the soles of the feet, the palms of the hands, or elsewhere on
the body
fever
malaise
swollen glands
flat grayish-white sores in mouth and on genitals

5. How are each of the above treated or cured?

i) Chlamydia

Since bacteria cause chlamydia, the disease can often be treated with antibiotics.
Azithromycin is an antibiotic usually prescribed in a single dose, while
doxycycline must be taken twice per day for about one week.
There are other antibiotics that your doctor may prescribe. No matter which
antibiotic you are given, you will need to follow the dosage instructions carefully
to make sure the infection clears up fully. This usually takes two weeks at most,
during which time you will need to refrain from sexual contact.

ii) Gonorrhea
Gonorrhea treatment is complicated by the ability of N. gonorrhoeae to develop
resistance to antimicrobial therapies. Quinolone-resistant N. gonorrhoeae strains
are now widely disseminated throughout the United States and the world. As of
April 2007, quinolones are no longer recommended in the United States for the
treatment of gonorrhea and associated conditions, such as PID ,Consequently,
only one class of antimicrobials, the cephalosporins, is recommended and
available for the treatment of gonorrhea in the United States. The CDC website)
and state health departments can provide the most current information.
iii) Herpes (Genital)
There is no cure for genital herpes, and once a person is infected with genital
herpes, the infection persists throughout the individual's life, with the potential for
recurrent outbreaks. However, there are medications that can reduce the severity
and frequency of outbreaks and treatments to manage the symptoms.
iv)Human Papillomavirus (HPV)
Women (1525 years) were vaccinated at months 0, 1, and 6. Analyses were
done in the according-to-protocol cohort for efficacy (ATP-E; vaccine, n=8093;
control, n=8069), total vaccinated cohort (TVC, included all women receiving at
least one vaccine dose, regardless of their baseline HPV status; represents the
general population, including those who are sexually active; vaccine, n=9319;
control, n=9325), and TVC-naive (no evidence of oncogenic HPV infection at
baseline; represents women before sexual debut; vaccine, n=5822; control,
n=5819). The primary endpoint was to assess vaccine efficacy against cervical
intraepithelial neoplasia 2+ (CIN2+) that was associated with HPV-16 or HPV-18
in women who were seronegative at baseline, and DNA negative at baseline and
month 6 for the corresponding type (ATP-E).
v) Syphilis

Penicillin is used to treat all stages of syphilis. Despite over 60 years of use, the
syphilis bacterium has not yet developed resistance to this original antibiotic. For
primary syphilis, one injection (usually given as half a dose into each buttock) is
enough to permanently cure this disease that once claimed so many lives.
Secondary and latent syphilis are treated the same way. But instead of one
injection there are 3 injections over successive weeks. Most people with
infectious syphilis, especially those in the secondary stage, suffer a reaction
when they're first treated. The symptoms include a sudden fever with headache,
sweating, and possibly a rash. This clears up in less than 24 hours.
Penicillin stops the infectivity within a day or two, and cures the disease in a week
or two. A person should wait until the treatment is finished before engaging in
sex. If the person is allergic to penicillin, another antibiotic can be substituted.
Tertiary syphilis is also treated with penicillin injections. Usually therapy is longer
than just a few doses. Though this doesn't always kill all the hidden bacteria, it
does generally stop further damage. There's no way to repair the organ damage
that's already been done, however.
It is important to keep your follow-up appointments with your doctor. Even though
you may have been treated with antibiotics, treatments have been known to fail.
Your doctor will do some blood tests to make sure that the antibiotics have
worked and that the bacteria have been cleared away.
The best way to avoid these complications is to avoid syphilis by practicing safe
sex. Wearing a condom correctly is a good first step, but standard intercourse is
not the only way to get syphilis. Any mouth-to-genital contact and sometimes
even mouth-to-mouth contact is enough to transmit the disease. To minimize your
risk, limit your number of sexual partners and be careful who they are - ask for a
syphilis (and other STI) test. If you develop syphilis, your sexual partners should
be notified, tested, and possibly treated.

6. What are the consequences of each of these diseases?

i) Chlamydia
If chlamydia is treated early it is unlikely to cause
any long-term problems. Not everyone who has chlamydia has

complications. However; without proper treatment the infection can

spread to other parts of the body. The more times you have chlamydia the
more likely you are to get complications.
In women; chlamydia can spread to other reproductive
organs causing pelvic inflammatory disease (PID). This can lead to
long-term pelvic pain; blocked fallopian tubes; infertility and ectopic
pregnancy (when the pregnancy develops outside the uterus; usually in a
fallopian tube). In women; chlamydia can also spread to the liver
causing pain and inflammation. This usually gets better with the correct
antibiotic treatment.
In men; chlamydia can lead to infection in the testicles and possibly reduced
fertility.
Rarely; chlamydia can lead to inflammation of the joints
in both men and women. This is known as reactive arthritis and it is
sometimes accompanied by inflammation of the urethra and the eye when itis
known as Reiter's Syndrome. This is more likely to occur in men than
women.
ii) Gonorrhea
In women;
Gonorrhoea can spread to other reproductive organs causing pelvic
inflammatory disease (PID). This can lead to long-term pelvic pain; blocked
fallopian tubes; infertility and ectopic pregnancy (when the pregnancy develops
outside the womb).
In men;
Gonorrhoea can lead to a painful infection in the testicles and prostate gland
and possibly reduced fertility.
Less commonly; gonorrhoea can cause inflammation of the joints and tendons;
and skin lesions.
Rarely; gonorrhoea can also cause inflammation of the membranes of the
brain and spinal cord (meningitis) and the heart.
iii) Herpes (Genital)
It is not essential to have treatment as genital herpes will clear up by itself.

However; prompt treatment at the start of an outbreak can be a great help it

can reduce the time the outbreak lasts; help the healing process and can
reduce the risk of you passing the virus on to someone else.
iv) Human Papillomavirus (HPV)
Human papillomavirus (HPV) is an agent responsible for squamous cell tumors
(Verrucae, condylomata and papillomas) at various sites of the body, the oral
cavity included. Due to the recently pointed-out association between these HPV
lesions and the squamous cell dysplasias and malignancies in the uterine cervix,
in the bronchus and in the larynx, the present work was carried out to assess,
whether morphological signs (cytopathic effects of HPV) or HPV antigens could
be found in lesions of oral squamous cell carcinomas.
v) Syphilis
Without proper treatment the infection can spread to other parts of the body
causing serious; long-term complications.
Left untreated; syphilis may start to cause very serious damage to the heart;
brain; eyes; other internal organs; bones and nervous system.
This damage could lead to death.
7. Find a RELIABLE source to describe the different types of hepatitis:
i) Hep A http://www.who.int/mediacentre/factsheets/fs328/en/
ii) Hep B http://www.who.int/campaigns/hepatitis-day/2014/hepatitis-b-c-d.pdf?
ua=1
iii) Hep C http://www.who.int/campaigns/hepatitis-day/2014/hepatitis-b-c-d.pdf?
ua=1
8. What are the symptoms of hepatitis?
i) Hep A
Symptoms of hepatitis A range from mild to severe, and can include fever,
malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, darkcoloured urine and jaundice (a yellowing of the skin and whites of the eyes).
Not everyone who is infected will have all of the symptoms.
Adults have signs and symptoms of illness more often than children, and the
severity of disease and mortality increases in older age groups. Infected
children under six years of age do not usually experience noticeable
symptoms, and only 10% develop jaundice. Among older children and adults,

infection usually causes more severe symptoms, with jaundice occurring in

more than 70% of cases.
ii) Hep B
Most people do not experience any symptoms during the acute infection
phase. However, some people have acute illness with symptoms that last
several weeks, including yellowing of the skin and eyes (jaundice), dark urine,
extreme fatigue, nausea, vomiting and abdominal pain. A small subset of
persons with acute hepatitis can develop acute liver failure which can lead to
death.
In some people, the hepatitis B virus can also cause a chronic liver infection
that can later develop into cirrhosis of the liver or liver cancer.
More than 90% of healthy adults who are infected with the hepatitis B virus will
recover naturally from the virus within the first year.
iii) Hep C
The incubation period for hepatitis C is 2 weeks to 6 months. Following initial
infection, approximately 80% of people do not exhibit any symptoms. Those who
are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea,
vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and
jaundice (yellowing of skin and the whites of the eyes).
9. Describe the treatments or cures?
i) Hep A
There is no specific treatment for hepatitis A. Recovery from symptoms
following infection may be slow and may take several weeks or months. Therapy
is aimed at maintaining comfort and adequate nutritional balance, including
replacement of fluids that are lost from vomiting and diarrhoea.
ii) Hep B
There is no specific treatment for acute hepatitis B. Therefore, care is aimed
at maintaining comfort and adequate nutritional balance, including
replacement of fluids lost from vomiting and diarrhoea. Chronic hepatitis B
infection can be treated with drugs, including oral antiviral agents. Treatment
can slow the progression of cirrhosis, reduce incidence of liver cancer and
improve long term survival.
WHO recommends the use of oral treatments - tenofovir or entecavir, because
these are the most potent drugs to suppress hepatitis B virus. They rarely lead

to drug resistance as compared with other drugs, are simple to take (1 pill a
day), and have few side effects so require only limited monitoring.
However, in most people, the treatment does not cure hepatitis B infection, but
only suppresses replication of the virus. Therefore, most people who start
hepatitis B treatment must continue for life.
Treatment using interferon injections may be considered in some people in
certain high-income settings, but its use is less feasible in low-resource
settings due to high cost and significant adverse effects requiring careful
monitoring.
There is still limited access to diagnosis and treatment of hepatitis B in many
resource-constrained settings, and many people are diagnosed only when
they already have advanced liver disease. Liver cancer progresses rapidly,
and since treatment options are limited, the outcome is in general poor. In lowincome settings, most people with liver cancer die within months of diagnosis.
In high-income countries, surgery and chemotherapy can prolong life for up to
a few years. In high-income countries, liver transplantation is sometimes used
in people with cirrhosis, with varying success.
iii) Hep C
Hepatitis C does not always require treatment as the immune response in
some people will clear the infection. When treatment is necessary, the goal of
hepatitis C treatment is cure. The cure rate depends on several factors
including the strain of the virus and the type of treatment given. Careful
screening is necessary before starting the treatment to determine the most
appropriate approach for the patient.
The current standard treatment for hepatitis C is combination antiviral therapy
with interferon and ribavirin, which are effective against all the genotypes of
hepatitis viruses (pan-genotypic). Unfortunately, interferon is not widely
available globally and it is poorly tolerated in some patients. This means that
management of the treatment is complex, and many patients do not finish their
treatment. Despite these limitations, interferon and ribavirin treatment can be
life-saving.
Scientific advances have led to the development of new antiviral drugs for
hepatitis C, which are much more effective, safer and better-tolerated than
existing therapies. These therapies, known as oral directly acting antiviral
agent (DAAs) therapies simplify hepatitis C treatment by significantly
decreasing monitoring requirements and by increasing cure rates. Although
the production cost of DAAs is low, the initial prices set by companies are very

high and likely to make access to these drugs difficult even in high-income
countries.
Much needs to be done to ensure that these advances lead to greater access
to treatment globally.

l0. What are the consequences of each of the three types of hepatitis?
Hep A
Hepatitis A is a viral liver disease that can cause mild to severe illness.
Globally, there are an estimated 1.4 million cases of hepatitis A every
year.
The hepatitis A virus is transmitted through ingestion of contaminated
food and water, or through direct contact with an infectious person.
Hepatitis A is associated with a lack of safe water and poor sanitation.
Epidemics can be explosive and cause significant economic losses.
Improved sanitation and the hepatitis A vaccine are the most effective
ways to combat the disease.

Hep B
Hepatitis B is a viral infection that attacks the liver and can cause both
acute and chronic disease.
The virus is transmitted through contact with the blood or other body
fluids of an infected person.
An estimated 240 million people are chronically infected with hepatitis B
(defined as hepatitis B surface antigen positive for at least 6 months).
Approximately 780 000 persons die each year from hepatitis B infection
-- 650 000 from cirrhosis and liver cancer due to chronic hepatitis B
infection and another 130 000 from acute hepatitis B.1
Hepatitis B is an important occupational hazard for health workers.
However, it can be prevented by currently available safe and effective
vaccine.
Hep C
Hepatitis C is a liver disease caused by the hepatitis C virus: the virus
can cause both acute and chronic hepatitis infection, ranging in severity
from a mild illness lasting a few weeks to a serious, lifelong illness.
The hepatitis C virus is a bloodborne virus and the most common
modes of infection are through unsafe injection practices; inadequate

sterilization of medical equipment in some health-care settings; and

unscreened blood and blood products.
130150 million people globally have chronic hepatitis C infection.
A significant number of those who are chronically infected will develop
liver cirrhosis or liver cancer.
350 000 to 500 000 people die each year from hepatitis C-related liver
diseases.
Antiviral medicines can cure hepatitis C infection, but access to
diagnosis and treatment is low.
Antiviral treatment is successful in 5090% of persons treated,
depending on the treatment used, and has also been shown to reduce
the development of liver cancer and cirrhosis.
There is currently no vaccine for hepatitis C, however research in this
area is ongoing.