W11 L3 Fri STI

• Sexually Transmitted/Transmissible Infections • Spread primarily through person-to-person sexual contact (horizontal). – Some can also be transmitted from mother to child (ie vertically) – blood products and tissue transfer (blood borne viruses BBV)

-Bacteria (chlamydia, gonorrhea, syphilis) -Viral (all name start with H) -Parasitic (trichonomas, pubic lice, scabies)

• 1884 - 1924 SIV transfere to humans as HIV HIV 1: chimpanzee origin from cameroon, Congo (high virulence) HIV2 sooty mangabe from monkey, less virulent

-Up to 39 million people world wide -1.3 million newly acquired per year -630000 people die per year -there has been a decline in number of people acquiring HIV and HIV related death globally over time

• HIV in Australia (end of 2021) – 27,390 people living with HIV – HIV notifications coming down – 68% new notifications are amongst Men who have sex with men • 27% Heterosexuals • <2% Injecting drug use

-unprotected sexual intercourse with an infected partner -vertical transmission ( utero, delivery or breast milk) -injection drug use ( shared needle, blood transmissions)

`-Virus bind to CD4 receptor -binding to coreceptor CCR5 or CXC4 -the virus fuse and release it’s viral load -the viral RNA is reverse transcript and integrated into the genome -cell produce viral mRNA, translation and make new virus

• in the past, need to take anti-viral tablet at precise time -now, only one pill per day (combinational drug), allow them to have a normal live -long acting treatment, injection once every 2 month(6 month injection might be available)

-Spectrum of inflammatory disorders of the upper female genital tract * Polymicrobial infection * Sexually transmitted pathogens more likely in younger, sexually active women

– Chlamydia (50%) * ~10% of chlamydial cervical infection ascend to cause PID – Gonorrhea (25%) * Overseas contact, remote Aboriginal communities – Mycoplasma genitalium (?%) – Bacterial vaginosis (?%)

-increase in infection per year, only slowed down a bit due to covid but infection rate has increasing since then

• ‘silent epidemic’ • ~10,000 Australian women treated for PID in hospital each year – Aged 20-29 years have highest incidence

-STD bacteria enter vagina with semen -bacteria pass through cervix, into uterus. finally into ovarian tubes and ovary. become infected -from there, it can spread to other region of the body

• Range from no symptoms to severe – Lower abdominal pain – Menstrual disturbances – Vaginal discharge – Deep pain during sex – Fever

– Tubal infertility (1 in 8) – Chronic pelvic pain – Ectopic pregnancy due to inflamed and scarring of ovary and fallopian tube

• Triple antibiotics – BUT is it too late?? – (doesn’t reverse damage) • Reduce chlamydia, gonorrhea incidence – Consistent condom use – Monogamy

• Genital herpes caused by HSV 2 – But rising numbers of HSV1 cause over recent years • > 50% initial genital episodes now caused by HSV 1 • Most (2/3rd ) HSV infections are asymptomatic – ~80% unaware • Seroprevalence – HSV 1 – 20-80% – HSV 2 – 12% • 80% FSW, 60% MSM, 50% STD clinic attendees

• Double stranded DNA virus • Phases of herpes infection – Primary infection (flue like illness) – Latency * Nerve cell ganglia – Re-activation

• First episode – Flu like symptoms – Genital ulcers – Swelling/pain genital area – More subtle features( Erythema with tingling/itching, Fissures) • Recurrences – Less painful, shorter duration than first episode

• Psychosexual morbidity • Enhanced HIV transmission • Eye disease (corneal ulceration, keratitis, acute retinal necrosis) • Neurological (meningitis) • Neonatal herpes

• Rare but serious • Disseminated infection – Untreated 90% mortality • “Localized” – skin, eyes, mouth (SEM) • CNS infection

• No cure but manageable – Analgesia – Antivirals (Episodic, Suppressive) – Psychosexual counseling

• Overall prevalence ~20 million (2016) • 6.3 million incident cases annually worldwide – Mainly heterosexual adults – BUT congenital syphilis continues to be a major issue • In high income countries, MSM are primary risk group (with about half coinfected with HIV) increase regconisation in low income countries too

– Most through sexual contact * Vaginal, anogenital, orogenital – Congenital * In utero, (birth canal)