A communicable disease is an illness caused by a specific infectious agent or its toxic products.

It arises through transmission of that agent or its products from an infected person, animal, or inanimate reservoir to a susceptible host, either directly or indirectly (through an intermediate plant or animal host, vector, or the inanimate environment). Control of disease is the reduction of disease incidence, prevalence, morbidity, or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction. Control is to be contrasted with elimination (reduction to zero of the incidence of a specified disease in a defined geographic area as a result of deliberate efforts; continued intervention measures are required), eradication (permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed), and extinction (the specific infectious agent no longer exists in nature or the laboratory). Communicable diseases may be classified according to the causative agent, the clinical illness caused, or the means of transmission. Often all three characteristics are used (e.g., food-borne Salmonella gastroenteritis). Causative agents include bacteria, viruses, and parasites. Examples of bacterial diseases include pneumococcal pneumonia and gonorrhea. Viral diseases include influenza, measles, and ebola. Parasitic diseases include malaria and schistosomiasis. Other communicable diseases may be caused by other types of microorganisms such as fungi (e.g., histoplasmosis). The types of illness include pneumonia, diarrhea, meningitis, or other clinical syndromes. Various categorizations of means of transmission have been used. The American Public Health Association uses these categories: direct transmission, indirect transmission, and airborne. Direct transmission refers to direct contact such as touching, biting, kissing, or sexual intercourse, or the direct projection of droplet spray into the eye, nose, or mouth during sneezing, coughing, spitting, singing, or talking. This projection usually is limited to a distance of 1 meter or less. Examples of direct contact transmission include rabies and sexually transmitted HIV (human immunodeficiency virus). Direct projection is responsible for transmission of diseases such as measles and influenza. Indirect transmission may occur through a vehicle or an arthropod vector. The causative agent may or may not multiply or develop in or on the vehicle. Examples of possible vehicles include water, food, biological products, or contaminated articles (such as syringe needles). Water-and foodborne diseases have the potential for causing outbreaks involving thousands of persons. Before the causative agent was identified, many cases of HIV resulted from blood transfusion. Since all donor blood in the United States is now screened for HIV, this is no longer a significant means of transmission. However, sharing of needles by injection drug users remains an important factor in the AIDS (acquired immunodeficiency syndrome) epidemic. Arthropod vectors can spread disease mechanically (as a result of contamination of their feet or passage of organisms through the gastrointestinal tract) or biologically (in which the agent must multiply or go through one or more stages of its life cycle before the arthropod becomes infective). Mechanical spread by arthropod vectors is uncommon. However, arthropod-borne diseases such as malaria (in which the parasite develops within the mosquito vector) are still responsible for millions of cases and hundreds of thousands of deaths each year in tropical countries.

Some infectious agents can be spread through the air over long distances. Airborne spread requires that infectious particles are small enough to be suspended in the air and inhaled by the recipient. Tuberculosis and histoplasmosis are bacterial and fungal diseases spread in this fashion. Airborne transmission could also be used to disseminate agents of biological warfare or bioterrorism. Anthrax and smallpox have been considered among the most likely biological weapons. Diseases of animals that can be spread to humans are called zoonoses. Some zoonotic diseases include rabies, plague, and tularemia (rabbit fever). Methods of Control Communicable diseases occur only when the causative agent comes into contact with a susceptible host in a suitable environment. Prevention and control efforts for communicable diseases may be directed to any of these three elements. Communicable diseases affect both individuals and communities, so control efforts may be directed at both. Treatment of persons with communicable diseases with antibiotics typically kills the agent and renders them noninfectious. Thus, treatment is also prevention. A simple way to prevent the occurrence of communicable diseases is to eliminate the infectious agent through, for example, cooking food, washing hands, and sterilizing surgical instruments between use. Assuring the safety of drinking water through filtration and chlorination and treating sewage appropriately are other important means of preventing the spread of communicable diseases. For most communicable diseases there is an interval between infection and occurrence of symptoms (the incubation period) in which the infectious agent is multiplying or developing. Some persons who are infected may never develop manifestations of the disease even though they may be capable of transmitting it (inapparent infection). Some persons may carry (and transmit) the agent over prolonged periods (carriers) whether or not they develop symptoms. Treatment during the incubation period may cure the infection, thereby preventing both disease and transmission. This preventive treatment (chemoprophylaxis) is often used in persons who have been exposed to sexually transmitted diseases such as syphilis and gonorrhea. It also is effective in persons who have been infected with tuberculosis, although the preventive treatment must be given for several months. The susceptibility of the host to a specific infectious agent can be altered through immunization (e.g., against measles) or through taking medications that can prevent establishment of infection following exposure (chemoprophylaxis). Since malnutrition and specific vitamin deficiencies (such as vitamin A) may increase susceptibility to infection, ensuring proper nutrition and administering vitamin A can be more general ways of increasing host resistance. If persons survive a communicable disease, he or she may develop immunity that will prevent the disease from recurring if re-exposed to the causative agent. The environment may be rendered less suitable for the occurrence of disease in a variety of ways. For example, food can be kept hot or cold (rather than warm) to prevent multiplication of organisms that may be present. Individuals can use mosquito repellents or mosquito nets to prevent being bitten by infected mosquitoes. Breeding places can be drained or insecticides used to eliminate vectors of disease. Condoms

can be used to prevent sexually transmitted diseases by providing a mechanical barrier to transmission. Reduction of crowding and appropriate ventilation can reduce the likelihood of droplet or airborne transmission. Respiratory protective devices can be used to prevent passage of microorganisms into the respiratory tract. The sociocultural environment is also important in affecting the occurrence of communicable diseases. For example, in the 1980s there was a change in the social norms in men who have sex with other men on the West Coast of the United States, where unprotected anal intercourse had been the norm and was responsible for considerable transmission of HIV. As a result of a variety of educational and social marketing approaches, the social norm changed to the use of condoms and the rate of new HIV infections (and of rectal gonorrhea) declined. Similarly, aggressive social marketing of condom use in Uganda has led to a change in sexual practices and a decline in new HIV infection rates. Other societal approaches to control of communicable diseases include safe water and food laws, provision of free immunization and chemoprophylaxis through public health departments, enactment and enforcement of school immunization requirements, isolation of individuals with communicable diseases to prevent transmission, and quarantine of individuals exposed to communicable diseases to prevent disease transmission during the incubation period if they have been infected. Impact of Communicable Diseases The gathering of humans in settlements (and subsequently cities) resulted in the development of periodic epidemics of communicable diseases, often with devastating impact. In the fourteenth century, for example, bubonic plague (carried by rats and transmitted to humans by fleas) swept through Europe, killing approximately onequarter of the population of the continent. Epidemics of "crowd" diseases such as measles and influenza resulted from person-to-person transmission, and inadequate water and sewage management led to epidemics of diseases such as cholera and typhoid. Milk-and food-borne diseases also were common. Until the end of the nineteenth century, communicable diseases were the leading cause of death throughout the world. In the United States in 1900, tuberculosis was the leading cause of death, followed by pneumonia and diarrhea. Along with diphtheria (in tenth place), these conditions accounted for more than 30 percent of all deaths in the country. Major reductions in morbidity and mortality from communicable diseases have resulted from improvements in sanitation, housing, and nutrition as well as introduction and use of vaccines and specific therapies. Improvements in sanitation have dramatically reduced the burden of water-and foodborne diseases. Improvements in housing have also played an important role in reducing transmission of tuberculosis, and improvements in nutrition have made persons with infectious diseases less likely to die from their infections. The introduction and use of vaccines have resulted in global eradication of smallpox, significant progress toward eradication of poliomyelitis, and a marked reduction in illness and death due to diseases such as diphtheria, whooping cough (pertussis), and measles. Specific therapies such as antibiotics and antiparasitic drugs have had a significant impact on deaths due to infectious diseases as well as having some impact

on the occurrence of the diseases by shortening the period in which an infected person is infectious to others. The most dramatic improvements have been seen in the United States and other developed nations. Although significant progress has also been made in developing nations, the World Health Report 2000 reports that 14 million deaths (25 percent of all deaths in the world in 1999) resulted from infectious diseases or their complications. There is a marked disparity in the importance of infectious diseases in high-income countries compared to middle-and low-income countries. In high-income countries, infectious diseases accounted for only 6 percent of all deaths, whereas in middle-and low-income countries they accounted for 28 percent of all deaths. Worldwide, lower respiratory infections (e.g., pneumonia) and diarrhea are the leading infectious causes of death; each of these conditions can be caused by a variety of microorganisms. AIDS was the single leading infectious cause of death in 1998, with an estimated 2.2 million deaths, followed by tuberculosis, with nearly 1.5 million deaths, and malaria, with 1.1 million deaths. Nearly 900,000 children died as a result of measles in 1998, even though an effective vaccine against measles was introduced in 1963 and has had a major impact in developed nations. Half of the children who died from measles lived in sub-Saharan Africa. Much of the continuing toll of communicable diseases could be reduced by more effective use of existing vaccines and other tools for control of infectious diseases. For example, more effective use of measles vaccine and administration of vitamin A could prevent most of the deaths from measles. More widespread use of oral rehydration therapy in diarrhea (to combat the dehydration that is one of the major causes of death) could dramatically reduce current mortality. More effective use of bed nets, anti-mosquito strategies, and appropriate treatment could dramatically reduce malaria deaths. However, new tools will be needed to bring about maximum control of some diseases. Because microorganisms are continually evolving, they may change enough so that prior experience (infection) with the infectious agent does not provide protection. For example, influenza viruses may undergo dramatic changes with the result that pandemics (worldwide epidemics) may occur. In 19181919, pandemic influenza killed millions of people worldwide, more than 500,000 in the United States alone. Preventive Measures Vaccine-Preventable Diseases. Some communicable diseases can be prevented by the use of vaccines. The word vaccine comes from vaccinia, the Latin name for cowpox. The first vaccine was developed by Edward Jenner, an eighteenth-century English physician and naturalist who noticed that milkmaids who had acquired cowpox (a condition that caused lesions to appear on the udders of cows) on their hands did not seem to be affected by smallpox. He believed that infection with cowpox would protect against smallpox, a serious, often fatal epidemic disease. In 1796 he took material from a skin lesion on the hand of a milkmaid and inoculated it into the arm of a young boy. The boy was subsequently exposed to smallpox and did not become ill. Thus began the vaccine era.

It was nearly one hundred years until the next vaccine (rabies) was developed by Louis Pasteur. In the twentieth century, a number of vaccines were developed; many more are under development as a result of the biotechnology revolution. Widespread use of vaccines in children has had a dramatic impact on the occurrence of the diseases. Because smallpox has been eradicated, smallpox vaccination is no longer carried out. The last case of naturally occurring smallpox in a human was in 1977, and in 1980 the World Health Assembly certified that smallpox had been eradicated from the face of the earth. Stocks of smallpox virus have been maintained (under security) in both the United States and Russia, though the debate continues whether they should be destroyed. Concerns have arisen about the possibility that some groups or nations have retained the smallpox virus and developed it for use in biological warfare or bioterrorism. Chemoprophylaxis. Chemoprophylaxis refers to the practice of giving anti-infective drugs to prevent occurrence of disease in individuals who are likely to be exposed to an infectious disease or who might have already been infected but have not developed disease. For example, individuals traveling to areas where malaria is common can take anti-malarial drugs before arriving, during their stay, and for a few weeks after leaving and thus protect themselves against malaria. Similarly, persons who have been exposed to syphilis can be given penicillin to prevent the possibility of their developing syphilis, and persons who have been infected with tuberculosis can be given six months of treatment to prevent the development of tuberculosis. Antibiotics and Resistance. Antibiotics are compounds that are produced by microorganisms that kill or inhibit the growth of other microorganisms. Those that kill bacteria are called bactericidal; those that prevent multiplication (and rely on the body's defense mechanisms to deal with the limited number of living organisms) are called bacteriostatic. Some antibiotics are effective against a limited number of microorganisms, others may have more widespread effect. Because microorganisms are continually in a state of evolution, strains may evolve that are resistant to a particular antibiotic. In addition, resistance characteristics can be transferred from some microorganisms to others (this is particularly true of organisms that inhabit the gastrointestinal tract). The likelihood that resistance will develop is increased if antibiotics are used in an indiscriminate manner and in inadequate amounts (either in terms of individual dosage or in length of therapy). Antimicrobial resistance is a growing problem: organisms that once were exquisitely sensitive to a particular antibiotic may now have developed significant (or total) resistance to it. This necessitates either increasing the dose of the antibiotic administered (in the case of partial resistance) or developing totally new drugs to treat the infection (in the case of total resistance). A few microorganisms (such as enterococcus, an organism that lives in the intestinal tract and is particularly likely to cause infections in gravely ill patients with compromised immune systems) have developed such widespread resistance that it is a real challenge to treat them effectively, resulting in a need to develop even more antibiotics. Emerging and Re-Emerging Infectious Diseases

New infectious diseases continue to be recognized and others, once thought under control, are reemerging as significant problems. To cite a few examples of "new" diseases, the following have been recognized for the first time since 1975: legionnaire's disease, ebola virus, HIV/AIDS (acquired immunodeficiency syndrome), toxic shock syndrome, Escherichia coli O157:H7 (cause of hemolytic-uremic syndrome), Lyme disease, Helicobacter pylori (major cause of peptic ulcer), hepatitis C, and hantavirus. Some of these are conditions previously known but without a known infectious cause (e.g., peptic ulcer) while others represent apparently new clinical syndromes that have not occurred or have not been recognized in the past. Old diseases, such as tuberculosis and malaria, are reemerging in areas where they were once under control. This may be a result of the lack of continued application of known effective interventions but also may result from ecological changes. Some of the factors involved in the increase in infectious diseases, whether new or old, include population shifts and growth (and encroachment on previously unpopulated areas); changes in behavior (e.g., injection drug use, sexual practices); urbanization, poverty, and crowding; changes in ecology and climate; evolution of microbes; inadequacy of the public health infrastructure to deal with the problems; modern travel and trade; and the increasing numbers of persons with compromised immune systems (whether as a result of HIV/AIDS, chemotherapy for cancer, or immunosuppresive therapy for organ transplants). Many of these factors are interrelated. In addition to these new and reemerging diseases, there may be specific interactions between diseases. This is particularly true with HIV and tuberculosis (TB), in which each infection is a very potent co-factor for worsening the other: Persons with HIV infection who become infected with TB are more likely to develop TB disease that is serious and rapidly progressive than persons without HIV infection, and persons with TB who contract HIV infection are very likely to have a rapid progression to fullblown AIDS. In the United States, the incidence of foodborne disease has received increasing attention in the past several years. This relates in part to improved surveillance but also relates to changes in patterns of food production, distribution, and consumption. With modern transportation, it is possible to get fresh vegetables and fruits at all times of the year. This means that salad ingredients purchased at a modern supermarket (and eaten raw) may have been grown in a developing country, where the average American traveler would not eat raw vegetables. The consolidation of producers of prepared foods makes possible large interstate outbreaks of food-borne disease such as the 1994 outbreak of Salmonella infections associated with ice cream that affected an estimated 224,000 persons nationwide. It is currently estimated that food-borne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Epidemic Theory and Mathematical Models of Infectious Diseases Based on observed characteristics of infectious diseases, epidemiologists have attempted to construct mathematical models that would make it possible to predict the pattern of spread of a condition within the population. Some diseases have constant features, which make mathematical modeling particularly attractive. Measles, for example, has a predictable incubation period (ten to fourteen days) and limited

duration of infectivity of a given patient (four to seven days). In addition, it is highly infectious (nearly every susceptible person who comes in contact with an infectious person will become infected), and nearly everyone who is infected develops clinical illness. Lifelong immunity follows infection. There is no nonhuman reservoir. Given these relatively constant parameters, it is possible to predict the pattern of transmission if measles is introduced into a population, using different estimates for the proportion of susceptible persons in the population, the distribution of these susceptibles (e.g., randomly dispersed, clustered together), and the likelihood of contact between the infectious patient and the susceptibles. Because of the extreme infectiousness of measles, models indicate that it is necessary to reach very high levels of immunity in a population (on the order of 95 percent or greater) in order to prevent sustained transmission of measles. Given the fact that measles vaccine is approximately 95 percent effective, this indicates that, to eradicate measles, it will be necessary to reach 100 percent of the population with a single dose of the vaccine or to reach 90 percent of the population on each of two rounds of vaccination (assuming that the second round will reach 90 percent of those who were not reached by the first round). Since babies are being born all the time, this also must be an ongoing process. The major reason for continuing debate over whether measles eradication is an achievable goal using current vaccines is the necessity to achieve and maintain such high levels of immunity. (SEE ALSO: Emerging Infectious Diseases; Food-Borne Diseases; Immunizations; Sexually Transmitted Diseases; Vector-Borne Diseases; Waterborne Diseases; Zoonoses; and articles on specific diseases mentioned hereine) Bibliography Centers for Disease Control and Prevention (1999). "Achievements in Public Health, 19001999: Control of Infectious Diseases." Morbidity and Mortality Weekly Report 48 (29):621629. Chin, J., ed. (1999). Control of Communicable Diseases Manual, 17th edition. Washington, DC: American Public Health Association. Goodman R. A.; Foster, K. L.; Trowbridge, F. L.; and Figueroa, J. P. (1998). "Global Disease Elimination and Eradication as Public Health Strategies." Bulletin World Health Organization 76 (Supp. 2):1162. Hinman, A. R. (1998). "Global Progress in Infectious Disease Control." Vaccine 16 (11/12):11161121. Wallace, R. B., ed. (1998). Maxcy-Rosenau-Last Public Health and Preventive Medicine, 14th edition. Stamford, CT: Appleton and Lange. World Health Organization (1999). The World Health Report 1999. Geneva: Author. The term "emerging infection," first widely used in the early 1990s, refers to newly identified and previously unknown infectious agents that cause public health problems either locally or internationally. Their impact, in terms of economic repercussions, goes well beyond the immediate costs to health systems. They may impede trade or

travel or cause disproportionate alarm, especially if rumors of intentional use become widespread. During the last three decades of the twentieth century, over thirty emerging infections were identified in humans. They range from the Ebola, Marburg, and Nipah viruses to the more common hepatitis C virus and HIV (human immunodeficiency virus). Emergence of infectious agents has occurred throughout the world, causing many unexpected outbreaks. Contributing factors for these outbreaks include widening development gaps, collapse of public health infrastructures, poverty, urbanization, civil strife, environmental change and degradation, and globalization of travel and trade. Newly Identified Infectious Agents In 1976, the Ebola virus was identified for the first time during simultaneous outbreaks in Zaire (now the Democratic Republic of the Congo) and southern Sudan. It has since come to symbolize emerging diseases and their potential impact on populations without previous immunological experience. Ebola has caused at least four severe epidemics and numerous smaller outbreaks. In an outbreak that took place in Zaire in 1995 there were 315 cases, with a case-fatality rate of 77 percent. Approximately one-third of those infected were health care workers who came into contact with the blood or body fluids of infected patients. In a smaller outbreak in Gabon two years later, 61 cases occurred, with a case-fatality rate of 78 percent. During a recent outbreak, which was reported in Uganda in October 2000, nearly 425 cases and over 224 deaths had been reported by the end of the epidemic in February 2001. The Marburg virus, a member of the same family of filoviruses as Ebola, was first recognized in 1967 when laboratory workers in Germany were infected by handling monkeys imported from Uganda. Since then, there have been reports of sporadic cases in 1975, 1980, and 1987. A recent outbreak took place in 1999 among gold miners in the Democratic Republic of the Congo. In 1996, the occurrence in the United Kingdom of 10 cases of an apparently new variant of Creutzfeldt-Jakob disease (vCJD) was linked to an epidemic of bovine spongiform encephalopathy (BSE), also known as mad cow disease, among cattle. By September 2000, at least 84 people in the United Kingdom, 1 in Ireland, and 3 in France had contracted vCJD. Accurate prediction of the future number of vCJD cases is not possible, but the possibility of a significant and perhaps geographically diverse epidemic occurring over the next two decades cannot be excluded. The economic impact of this unexpected disease is being felt throughout the agricultural sector of all European countries, and costs continue to escalate. Since first being recognized as a human pathogen in 1982, enterohaemorrhagic Escherichia coli has gained increasing importance as a human pathogen. The best known serotype, E. coli 0157:H7, has been responsible for recent large food-borne outbreaks in Japan, Scotland, and the United States, placing heavy demands on medical and public health response systems, while also causing major political concern about food safety. In 1997, the World Health Organization global surveillance system for human influenza virus (FluNet) received reports of an isolated and fatal influenza infection in

a three-year-old child in Hong Kong. The virus was identified as influenza A (H5N1), and was associated with epidemics of avian influenza with high fatality rates in live poultry markets. By the end of 1997, a total of 18 human infections had been confirmed, 6 of which were fatal. Thanks to prompt action on the part of public health authorities, the outbreak did not spread further. In 1999, FluNet received reports of another new influenza virus, A (H9N2), isolated from 2 human cases in Hong Kong, but no further spread is known to have occurred. In the United States, Legionella infection was first identified in 1976 in an outbreak of fatal respiratory illness among war veterans. Legionellosis (Legionnaire's disease) is now known to occur worldwide and is a threat to travelers and others exposed to poorly maintained airconditioning systems. Cases of the disease contracted by European residents anywhere in the world are tracked by a specialized network. This has revealed that the number of cases reported in 1999 in Europe was the highest ever, with 2,136 cases in European residents, almost 700 more than were reported in 1998. One outbreak in Belgium and one in the Netherlands, both linked to trade shows, collectively gave rise to about 300 cases. At both trade fairs, whirlpool spas were on display and people became infected by breathing in contaminated aerosols after walking past them. Although Rift Valley fever (RVF) had already been recognized in 1930 as the agent for a zoonotic disease in Kenya, outbreaks outside sub-Saharan Africa were first described in Egypt from 1977 to 1978 and in 1993. A large outbreak occurred in East Africa in 1998, and the disease has now extended its reach outside Africa. RVF virus transmission on the Arabian peninsula was documented for the first time in 2000, during a vast outbreak which has encompassed the border area between Saudi Arabia and Yemen. The disease, which affects both animals and humans, causes severe hardship in populations whose subsistence depends on their herds. Hepatitis C, first identified in 1989, had already spread worldwide with an estimated global prevalence of at least 3 percent in the mid-1990s. Meanwhile Hepatitis B, identified several decades earlier, continues an upward trend in many countries, reaching a prevalence exceeding 90 percent in populations at high risk, in countries ranging from the tropics to Eastern Europe. Other newly identified viruses include Sin Nombre, which caused an outbreak of hantavirus pulmonary syndrome in the United States in 1993 (50 cases with a casefatality rate over 75%); Hendra virus, which affects humans and horses, first identified in Australia in 1994; and Nipah virus (causing febrile encephalitis), first identified in 1999 in Malaysia, where it caused a severe epidemic in those that had close contact with pigs, leading to grave economic losses owing to the destruction of around 900,000 pigs. One of the most important emerging infection is HIV. First identified in the early 1980s, it has rapidly spread worldwide, affecting over 36 million people by the end of 2000. Because working-age adults are the group most directly affected, it has become a significant impediment to economic development, especially in sub-Saharan Africa. The Public Health Threat

Emerging infectious diseases pose an international threat that can be countered through well-coordinated global surveillance and response. Whereas traditional approaches to containing outbreaks are defensivetrying to secure borders from the entry of infectious diseasesmodern solutions are built on a combination of early warning, surveillance systems, speedy communications, and information sharing through networks to facilitate action. Any disease transmitted by contaminated foods.

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Infectious or toxic disease caused by agents that enter the body through the consumption of food. The causative agents may be present in food as a result of infection of animals from which food is prepared or contamination at source or during manufacture, storage, and preparation. There are three main categories: (1)diseases caused by micro-organisms (including parasites) that invade and multiply in the body; (2)diseases caused by toxins produced by micro-organisms growing in the gastro-intestinal tract;(3)diseases caused by the ingestion of food contaminated with poisonous chemicals or containing natural toxins or the toxins produced by micro-organisms in the food. See also food poisoning. Encyclopedia of Public Health:

Food-Borne Diseases
Top Home > Library > Health > Public Health Encyclopedia Defined by the World Health Organization (WHO) as diseases "of an infectious or toxic nature caused by, or thought to be caused by, the consumption of food or water," food-borne diseases are an important cause of morbidity and economic loss worldwide. Countries that keep statistics (usually industrialized countries), may record tens of thousands of cases annually, but it is acknowledged that only a small proportion are reported centrally (see Table 1). A study in the early 1990s in England, for example, reported that only one in 136 cases of infectious intestinal diseases was recorded. Causes of Food-Borne Diseases The agents that cause food-borne diseases include microorganisms, natural toxins, and chemical residues. Microorganisms, including bacteria, viruses, Table 1 Reported and estimated annual cases and costs of food-borne disease in North America Country Reported Cases Estimated Cases Annual Cost SOURCE: Buzby et al. Canada 6 10 thousand 2 million $1 billion United States 30 50 thousand 6 12 million $6 11 billion parasitic protozoa, and worms, are the most commonly reported causes. The list of food-borne disease agents is expanding; the last years of the twentieth century saw the emergence of Campylobacter, now a commonly reported causes of diarrhea; verotoxin-producing Escherichia coli (VTEC), initially linked to undercooked hamburgers and a cause of hemolytic uremic syndrome (HUS) in children; the protozoa Cryptosporidium, which is often linked to consumption of contaminated water, and Cyclospora, which has caused diarrhea in consumers of soft fruit from

Central America. The most significant new agents may be "prions," which have been linked to transmissible spongiform encephalopathies. Bacteria. The mechanisms by which food-borne bacteria cause illness include the production of toxin in food before it is eaten or the production of toxin in the intestine, which is usually linked to multiplication of the organism in that environment. Illness is usually characterized by rapid onset, within hours or days, of vomiting and diarrhea, which may last a few hours or days in healthy people. Some pathogens, or their toxins, may escape the digestive tract and cause septicaemia, meningitis, or localized internal infection. For example, the toxins of VTEC damage the tissues of the intestines and kidneys, causing hemorrhagic colitis and HUS, potentially leading to kidney failure. Common food-borne bacteria, their mode of action, and symptoms are listed in Table 2. Viruses. Food and drink can also transport viruses, which replicate in living cells. The symptoms of viral infection reflect the tissues (organ) infected and the degree of damage caused. For example, enteric viruses (e.g., Norwalk virus) cause Table 2 Common Bacteria Causing Food-Borne Illness Bacteria Main Symptoms Incubation * Can last as long as several months. Can be as short as one day. SOURCE: Courtesy of author. Produce toxins in food: Staphylococcus aureus Vomiting 2 6 hours Bacillus cereus Vomiting or diarrhea 1 16 hours Clostridium botulinum Headache, double vision, paralysis, 12 96 hours (botulism) death Release toxins in intestines: Clostridium perfringens Diarrhea, stomach pains 8 22 hours Rapid multiplication in intestine: Diarrhea, fever, headache, some Salmonellaspecies 6 48 hours vomiting Fever, headache, diarrhea, stomach Campylobacterspecies 2 8 days pains, nausea Cramps, vomiting, fever, bloody Escherichia coli VTEC diarrhea, hemolytic uremic syndrome 1 5 days (HUS) Shigellaspecies Diarrhea, vomiting, fever, cramps 1 7 days Vibrio cholera 01 Profuse diarrhea, dehydration 1 3 days Diarrhea, fever, severe abdominal Yersinia enterocolitica 1 7 days and joint pain Watery diarrhea, cramps, fever, Vibrio parahaemolyticus 4 30 hours vomiting Extraintestinal infection:

Common Bacteria Causing Food-Borne Illness Bacteria Main Symptoms Fever, joint pains, weight loss, Brucella abortus (brucellosis) depression Listeria monocytogenes Fever, vomiting, diarrhea, headache, (listeriosis) constipation, meningitis, septicaemia Salmonellatyphi (l/c t) and Fever, constipation, headache (typhoid fever)

Incubation 5 60 days* 1 8 weeks about 3 weeks 1 4 weeks

acute vomiting and diarrhea twenty-four to forty-eight hours after infection. In comparison, Hepatitis A virus targets the liver, resulting in fever and jaundice two to eight weeks after infection. Food contaminated by infected human feces is the likely source of these viruses. Outbreaks are associated with filter-feeding mollusks (e.g., oysters) harvested from sewage-contaminated seawater, infected food handlers, and fresh produce (e.g., salads and soft fruit) infected by contaminated irrigation or rinse water or during handling. Parasites. Many parasites, including protozoa and worms, are transmitted by contaminated food or water. The risk of infection exists wherever standards of sanitation, hygiene, drinking water quality, and meat inspection are suspect. The protozoa Giardia and Cryptosporidium are important causes of diarrhea in developing and industrialized countries, and are linked particularly to contaminated water. More recently, Cyclospora has caused outbreaks of diarrhea in North America linked to contaminated berries. Tapeworms (e.g., Taenia) and the nematode Trichinella spiralis, which causes trichinosis, are among the commonly reported food-borne worms. These parasites have complicated life cycles, and human infection usually occurs when meat containing parasite cysts or eggs is consumed. Developing larvae then migrate from the intestines to other tissues. Symptoms vary with the infecting agent, from inapparent to fatal illness, and include gastrointestinal symptoms, muscle pain, and neurological and cardiac symptoms. Prions. In 1986, "mad cow disease" or bovine spongiform encephalopathy (BSE) was first identified in the United Kingdom. The disease spread rapidly in cattle and is characterized by behavioral changes, lack of coordination, weakness, and death. BSE was thought to infect only bovines, but increasing numbers of human cases of a variant of Creutzfeldt-Jakob disease (vCJD), first recognized in the UK in 1996, have been linked to eating meat from BSE-infected cattle in Europe, particularly in the United Kingdom. Approaches to reduce the Table 3 Food-handling practices commonly linked to outbreaks of bacterial food-borne disease Factor contributing Clostridium Staphylococus Bacillus Salmonella to outbreaks Perfringens Aureus Cereus Based on analysis of 1,479 outbreaks in England and Wales, 1970 1982, by Diane Roberts.

Food-handling practices commonly linked to outbreaks of bacterial food-borne disease Factor contributing Clostridium Staphylococus Bacillus Salmonella to outbreaks Perfringens Aureus Cereus = reported in 10% - 49% of outbreaks = reported in 50% or more of outbreaks SOURCE: Roberts, D. (1982). "Factors Contributing to Outbreaks of Food Poisioning in England and Wales 19701979. Journal of Hygiene 89 (3) 491498. Food prepared too early Stored at room temperature Not properly cooked Not properly reheated Undercooked Contaminated canned food Not properly thawed Cross contamination Improper warm holding Infected food handler risk of human infection have included depopulation of infected herds and rigid controls on the movement of cattle and bovine products. The effectiveness of these measures in limiting the spread of disease is unclear. Natural Toxins. Toxins exist naturally in plants (e.g., haemagglutinins in haricot beans), fungi, including mushrooms and moulds (e.g., aflatoxins produced by the mold Aspergillus flavus); and animals (e.g., tetrodotoxin, a neurotoxin present in puffer fish and some amphibians). Toxic substances may result from natural decomposition processes; for example, scombrotoxins (histamines) released during decomposition of scombroid (e.g., tuna) and other fish cause flushing, sweating, headache, nausea, dizziness, and a peppery taste within minutes of consumption. Normally safe plants and animals can pick up natural toxins, chemicals, and pollutants from their environment. Potent neurotoxins produced by algae (e.g., Gonyaulax, Pyrodinium, Gymnodinium species) accumulate in filter-feeding mollusks. Human intoxication usually coincides with algal blooms in harvesting areas, and results in sporadic cases and outbreaks of, for example, paralytic shellfish poisoning and other types of diarrhetic or neurotoxic poisoning. For example, an outbreak of amnesiac shellfish poisoning traced to mussels affected over one hundred people and caused three deaths, in Canada in 1987; memory problems and other neurologic symptoms were prolonged in severe cases. Incidents of human disease due to contaminated shellfish are reduced by regular monitoring of harvesting areas during high-risk periods. A further example, ciguatera fish poisoning, is common in tropical areas, such as the Caribbean and Pacific Islands. Algal toxins accumulate in reef fish,

particularly large predators. Early gastrointestinal symptoms are followed one to two days later by neurologic symptoms. Chemical Poisoning. Food-borne illness may result from chemical contamination of food or drink due to inappropriate use of pesticides and herbicides, contamination by cleaning agents during food preparation, leaching of chemicals from containers or the environment, or accidental or deliberate adulteration during food processing or preparation. A devastating example of chemical poisoning followed deliberate adulteration of cooking oil in Spain in 1981 and 1982. An estimated 20,000 people were affected, about 350 died, and others suffered serious long-term illness. Prevention of Food-Borne Diseases Food-borne diseases present public health challenges related to food-handling practices, as described by Diane Roberts, who analyzed causal factors in over 1,400 outbreaks (see Table 3). Other important factors include: Globalization of the food supply, resulting in rapid, international distribution of raw and processed foods and exposure to duced in less wellregulated environments. Economic pressures to provide products as cheaply as possible, requiring large scale production and distribution processes. Traditional food production and handling practices that may be inappropriate in the modern production and retailing environment. Public and political expectations about the safety of the food supply. Population-health factors that may increase risk of illness, including age (the young and elderly), existing illness (e.g., cancer), inherited traits (e.g., sickle cell disease; HLA B-27 susceptibility to reactive arthritis), and depressed immunity (from AIDS, cancer treatment, transplants, pregnancy, and poor nutrition). New pathogens and antibiotic-resistant strains possibly related to environmental factors and changes in farming and husbandry practices.

The response to these challenges involves government, the food industry, the public health community, and the public. Government action encompasses legislation to regulate the conditions under which foods are produced, distributed, and retailed, and the development of codes of good practice. Governments may collect statistics to monitor the incidence and causes of food-borne disease, and they may act to protect the public by investigating disease outbreaks and withdrawing unsafe products from sale. Modern processors and manufacturers generally adopt procedures to minimize risks of contamination, (e.g., the Hazard Analysis Critical Control Point [HACCP] approach) and to ensure product quality and safety through quality control procedures. The public health community is concerned with the development and enforcement of standards in manufacturing, processing, and retailing. Finally, the public, by becoming educated about food safety, can protect themselves by adopting appropriate

hygiene practices in food preparation, and by ensuring food retailers maintain high standards of hygiene by reporting poor practices to public health authorities. (SEE ALSO: Bovine Spongiform Encephalopathy; Campylobacter Infection; Cryptosporidiosis; E. Coli; Foods and Diets; Pathogenic Organisms; Prions; Trichinosis; Waterborne Diseases) Bibliography Buzby, J. C.; Roberts, T.; Jordan-Lin C. T.; and MacDonald, J. M. (1996). Bacterial Food-Borne Disease Medical Costs and Productivity Losses. Washington, DC: Food and Consumer Economics Division, Economics Research Service, U.S. Department of Agriculture. Cohen, F. L., and Tartesky, D. (1997). "Microbial Resistance to Drug Therapy: A Review." American Journal of Infection Control 25:5164. Chin, J., ed. (2000). Control of Communicable Diseases Manual, 17th edition. Washington, DC: American Public Health Association. Council for Agricultural Science and Technology (1994). Foodborne Pathogens: Risks and Consequences. Ames, IA: Author. Food and Drink Federation and the Institution of Environmental Health Officers (1993). National Food Safety Report. London: The Food and Drink Federation. Fox, N. (1997). SpoiledThe Dangerous Truth About a Food Chain Gone Haywire. New York: Basic Books. Hobbs, B. C., and Roberts, D. (1987). Food Poisoning and Food Hygiene, 5th edition. London: Edward Arnold. Lund, B. M.; Baird-Parker, T. C.; and Could, G. M., eds. (1998). The Microbiological Safety and Quality of Food. Gaithersburg, MD: Aspen. Mortimer, S., and Wallace, C. (1998). HACCP: A Practical Approach, 2nd edition. Gaithersburg, MD: Aspen. Roberts, D. (1986). "Factors Contributing to Outbreaks of Food Poisoning in England and Wales 19701982." In Proceedings of the World Congress of Foodborne Infections and Intoxications 1. Berlin: Institute of Veterinary Medicine. Scott, E., and Sockett, P. (1998). How to Prevent Food Poisoning. New York: John Wiley & Sons. Sockett, P. N. (1995). "The Epidemiology and Costs of Diseases of Public Health Significance in Relation to Meat and Meat Products." Journal of Food Safety 15: 91 112. PAUL N. SOCKETT

Waterborne diseases

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Waterborne Diseases
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An adult human needs to drink at least 1.5 liters of water a day to replace fluid lost in urine, sweat, and respired air and to perform essential biochemical functions. Moreover, almost 90 percent of body mass is water. Water, however, can also carry dangerous pathogens and toxic chemicals into the body. The catalogue of waterborne pathogens is long, and it includes many that are well-known as well as far larger numbers of more obscure organisms. Waterborne pathogens include viruses (e.g., hepatitis A, poliomyelitis); bacteria (e.g., cholera, typhoid, coliform organisms); protozoa (e.g., cryptosporidiosum, amebae, giardia); worms (e.g., schistosomia, guinea worm); and toxins (e.g., arsenic, cadmium, numerous organic chemicals). Water also harbors the intermediate stages of many parasites, either as free-living larvae or in some other form, and it is the vehicle for essential stages in the life cycle of many dangerous insect vectors, notably mosquitoes and blackflies. Chemical contamination or pollution of drinking water is another serious problem one that has become a great deal worse in the modern industrial era, due to the widespread, and often unregulated, discharge of toxic substances into rivers, lakes, and oceans. For practical purposes, this discussion of waterborne diseases and their control focuses mainly on the pathogenic organisms for which water is a common vehicle. It is important to note that not only drinking water, but also water used for cleaning fruit, vegetables, and cooking utensils, and for washing, can convey disease. Indeed, salads that have been washed in polluted water are a frequently overlooked and rather common source of waterborne disease, responsible for an occasional outbreak of cholera or typhoid. Water sources (springs, rivers, lakes, ponds, streams, wells, reservoirs, and rainwater runoff into tanks and cisterns) can all be contaminated by fecal matter of human or

animal origin. Organic matter of other origin (dead animals, decaying vegetation) can contaminate drinking water too, in ways that range from very dangerous to merely unpleasant. Water from suspect sources usually can be made safe to drink by boiling. Ancient empirical observation of this fact in India and China may have led to the popularity in those countries of drinking tea and other infusions made with boiling water. However, boiling is neither practical nor sensible for the treatment of large municipal water supplies. These must be protected by appropriate treatment measuresfiltration and purification (generally through chlorination) that were developed mainly in the nineteenth century in the industrial nations. Provision of safe drinking water supplies has been among the most effective and important measures ever taken to advance the public's health. The other essential components in the prevention of waterborne diseases are the sanitary disposal of sewage and the environmental control of toxic chemicals. Sanitary services are based on sewage disposal systems in most organized urban communities. Some rapidly growing suburban developments may lack adequate sanitation during their early stages, but local regulations usually prohibit occupancy until sanitation is installed and working. In rural regions and other sparsely settled localities, including campgrounds, human waste is often disposed of in septic tanks or pit privies. The combination of sanitary disposal of human sewage and the provision of safe water supplies has virtually eliminated many of the serious waterborne epidemic diseases that took such a heavy toll of life until the early years of the twentieth century. However, sanitary services break down when floods, earthquakes, and other disasters occur, and at such times it is essential to boil water to ensure that pathogens are killed. Other methods, such as the use of iodine or chloramine in tablet or powder form are sometimes used, both under emergency conditions and by backpackers and the like, but these methods are less effective than boiling. Even with the best protective measures, however, there are occasional serious large waterborne epidemics, and innumerable small ones. Recent large epidemics include the 1993 outbreak of cryptosporidiosis in Wisconsin, which affected about 400,000 people, and several lethal outbreaks of E. coli 0157:H7 infection, which is very dangerous because it causes kidney damage that can be fatal. Both these and other waterborne diseases are often due to pollution of public drinking water supplies by animal waste. Modern factory-farming methods generate enormous quantities of manure, and after heavy rains it is easy for runoff contaminated with animal manure to enter the water supply. Animal manure can contain the dangerous E. coli 0157:H7 strain. Even frequent testing can fail to detect evidence of pollution in time to prevent serious waterborne outbreaks. When testing laboratories have suffered budget cuts, the staff is often downsized, making waterborne disease outbreaks more likely. Several recent outbreaks in the United States and Canada are directly attributable to this sequence of events. Chemical pollution of water supplies presents problems of a different kind. Chemical contamination can cause acute illnesses, but more often the toxic contaminants are slow poisons, such as carcinogens, and the effects may be manifest in only a small proportion of all those who are exposed. The pollution can come to light when a cluster of cases of leukemia or some unusual variety of cancer or other illness is

detected in a community, as in Woburn, Massachusetts, where ethylene chloride that had leeched into the soil contaminated ground-water that fed several wells. Municipal water supplies should be routinely monitored by frequent bacteriological and chemical testing. Bacteriological testing focuses on coliform organisms that, if present, are not only harmful in themselves but also are a marker for other varieties of fecal contamination. Chemical pollution presents a more difficult problem because of the wide variety of chemicals that can pollute a water supply. (SEE ALSO: Ambient Water Quality; Cholera; Clean Water Act; Cryptosporidiosis; Typhoid; Water Treatment) JOHN M. LAST

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Waterborne diseases are caused by pathogenic microorganisms which are directly transmitted when contaminated fresh water is consumed. Contaminated fresh water, used in the preparation of food, can be the source of foodborne disease through consumption of the same microorganisms. According to the World Health Organization, diarrheal disease accounts for an estimated 4.1% of the total DALY global burden of disease and is responsible for the deaths of 1.8 million people every year. It was estimated that 88% of that burden is attributable to unsafe water supply, sanitation and hygiene, and is mostly concentrated in children in developing countries.[1] Waterborne disease can be caused by protozoa, viruses, or bacteria, many of which are intestinal parasites. Even before the establishment of the Germ theory of disease, traditional practices eschewed water in favor of beer, wine and tea. In the camel caravans that crossed Central Asia along the Silk Road, the explorer Owen Lattimore noted "The reason we drank so much tea was because of the bad water. Water alone, unboiled, is never drunk. there is a superstition that it causes blisters on the feet."[2]
Contents [hide] 1 Protozoal Infections 2 Parasitic Infections (Kingdom Animalia) 3 Bacterial Infections 4 Viral Infections 5 See also 6 References 7 Academic Resources

8 External links

Protozoal Infections
Disease and Transmission Amoebiasis Microbial Agent Protozoan Sources of Agent General Symptoms in Water Supply Sewage, non-treated Abdominal

(hand-tomouth)

(Entamoeba histolytica) (Cyst-like appearance)

drinking water, flies in water supply

discomfort, fatigue, weight loss, diarrhea, bloating, fever Flu-like symptoms, watery diarrhea, loss of appetite, substantial loss of weight, bloating, increased gas, nausea

Collects on water filters and Protozoan membranes that Cryptosporidio (Cryptosporidiu cannot be sis (oral) m parvum) disinfected, animal manure, seasonal runoff of water. Protozoan parasite Cyclosporiasis (Cyclospora cayetanensis)

cramps, nausea, Sewage, non-treated vomiting, muscle drinking water aches, fever, and fatigue Untreated water, poor disinfection, pipe breaks, leaks, groundwater contamination, campgrounds where Diarrhea, abdominal humans and wildlife discomfort, bloating, use same source of and flatulence water. Beavers and muskrats create ponds that act as reservoirs for Giardia. The genera of Encephalitozoon intestinalis has been detected in groundwater, the origin of drinking water [3]

Giardiasis (oral-fecal) (hand-tomouth)

Protozoan (Giardia lamblia) Most common intestinal parasite

Protozoan phylum Microsporidiosi (Microsporidia), s but closely related to fungi

Diarrhea and wasting in immunocompromised individuals

Parasitic Infections (Kingdom Animalia)

Disease and Transmission Microbial Agent Sources of Agent in Water Supply General Symptoms Rash or itchy skin. Fever, chills, cough, and muscle

Schistosomiasi Members of Fresh water s (immersion) the genus contaminated

with certain types of snails Schistosoma that carry schistosomes

aches

Dracunculiasis Stagnant water Allergic reaction, urticaria Dracunculus (Guinea Worm containing rash, nausea, vomiting, medinensis Disease) larvae diarrhea, asthmatic attack. Taeniasis Tapeworms Drinking water of the genus contaminated Taenia with eggs Intestinal disturbances, neurologic manifestations, loss of weight, cysticercosis GIT disturbance, diarrhea, liver enlargement, cholangitis, cholecystitis, obstructive jaundice. Abdominal pain, anorexia, itching around the anus, nervous manifestation Liver enlargement, hydatid cysts press on bile duct and blood vessels; if cysts rupture they can cause anaphylactic shock increases intacranial tension

Drinking water Fasciolopsis contaminated Fasciolopsiasis buski with encysted metacercaria Hymenolepiasi Drinking water s (Dwarf Hymenolepis contaminated Tapeworm nana with eggs Infection) Drinking water Echinococcosis contaminated Echinococcu (Hydatid with feces s granulosus disease) (usually canid) containing eggs coenurosis multiceps multiceps contaminated drinking water with eggs

Ascariasis

Mostly, disease is asymptomatic or Drinking water accompanied by contaminated inflammation, fever, and Ascaris with feces diarrhea. Severe cases lumbricoides (usually canid) involve Lffler's syndrome in containing eggs lungs, nausea, vomiting, malnutrition, and underdevelopment. Drinking water Enterobius contaminated vermicularis with eggs Peri-anal itch, nervous irritability, hyperactivity and insomnia

Enterobiasis

Disease

Morbidity

Mortality

(cases per year) 1,500,000,00 0 Schistosomiasi 200,000,000 s

(deaths per year) 100,000 200,000

Bacterial Infections
Disease and Transmission Microbial Agent Sources of Agent General Symptoms in Water Supply Dry mouth, blurred Bacteria can enter and/or double vision, a wound from difficulty swallowing, contaminated water muscle weakness, sources. Can enter difficulty breathing, the gastrointestinal slurred speech, tract by consuming vomiting and contaminated sometimes diarrhea. drinking water or Death is usually (more commonly) caused by respiratory food failure.

Botulism

Clostridium botulinum

Produces dysentery Most commonly Drinking water like symptoms along Campylobacteri caused by contaminated with with a high fever. osis Campylobacter feces Usually lasts 210 jejuni days. In severe forms it is known to be one of the most rapidly fatal illnesses known. Symptoms include very watery Spread by the Drinking water diarrhoea, nausea, bacterium contaminated with cramps, nosebleed, Vibrio cholerae the bacterium rapid pulse, vomiting, and hypovolemic shock (in severe cases), at which point death can occur in 1218 hours. Mostly diarrhea. Can

Cholera

E. coli Infection Certain strains Water

cause death in immunocompromised of Escherichia individuals, the very contaminated with coli (commonly young, and the the bacteria E. coli) elderly due to dehydration from prolonged illness. Naturally occurs in water, most cases from exposure in swimming pools or Mycobacterium more frequently marinum aquariums; rare infection since it mostly infects immunocompromis ed individuals Caused by a number of species in the genera Shigella Water and Salmonella contaminated with with the most the bacterium common being Shigella dysenteriae Symptoms include lesions typically located on the elbows, knees, and feet (from swimming pools) or lesions on the hands (aquariums). Lesions may be painless or painful.

M. marinum infection

Dysentery

Frequent passage of feces with blood and/or mucus and in some cases vomiting of blood.

Legionellosis (two distinct forms: Legionnaires disease and Pontiac fever)

Pontiac fever produces milder symptoms resembling acute influenza without Caused by pneumonia. bacteria Legionnaires disease Contaminated belonging to has severe water: the genus symptoms such as organism thrives in Legionella (90% fever, chills, warm aquatic of cases caused pneumonia (with environments. by Legionella cough that pneumophila) sometimes produces sputum), ataxia, anorexia, muscle aches, malaise and occasionally diarrhea and vomiting

Leptospirosis

Caused by bacterium of genus Leptospira

Water contaminated by the animal urine carrying the bacteria

Begins with flu-like symptoms then resolves. The second phase then occurs involving meningitis, liver damage (causes jaundice), and renal failure Ear canal swells causing pain and tenderness to the touch

Caused by a Otitis Externa number of (swimmers ear) bacterial and fungal species.

Swimming in water contaminated by the responsible pathogens

Salmonellosis

Drinking water Caused by Symptoms include contaminated with many bacteria diarrhea, fever, the bacteria. More of genus vomiting, and common as a food Salmonella abdominal cramps borne illness. Characterized by sustained fever up to 40C (104F), profuse sweating, diarrhea, less Ingestion of water commonly a rash contaminated with may occur. feces of an infected Symptoms progress person to delirium and the spleen and liver enlarge if untreated. In this case it can last up to four weeks and cause death. Can enter wounds from contaminated Symptoms include water. Also got by explosive, watery drinking diarrhea, nausea, contaminated water vomiting, abdominal or eating cramps, and undercooked occasionally fever. oysters.

Typhoid fever

Salmonella typhi

Vibrio Illness

Vibrio vulnificus, Vibrio alginolyticus, and Vibrio parahaemolytic us

[4][5]

Viral Infections

Disease and Transmissio n Adenovirus infection

Microbial Agent

Sources of Agent in Water Supply

General Symptoms

Adenovirus

Manifests itself Symptoms include common in improperly cold symptoms, pneumonia, treated water croup, and bronchitis

Astrovirus, Calicivirus, Gastroenteriti Enteric s Adenovirus, and Parvovirus SARS (Severe Acute Coronavirus Respiratory Syndrome)

Manifests itself Symptoms include diarrhea, in improperly nausea, vomiting, fever, treated water malaise, and abdominal pain

Symptoms include fever, Manifests itself myalgia, lethargy, in improperly gastrointestinal symptoms, treated water cough, and sore throat Symptoms are only acute (no chronic stage to the virus) and include Fatigue, fever, abdominal pain, nausea, diarrhea, weight loss, itching, jaundice and depression. 90-95% of patients show no symptoms, 4-8% have minor symptoms (comparatively) with delirium, headache, fever, and occasional seizures, and spastic paralysis, 1% have symptoms of non-paralytic aseptic meningitis. The rest have serious symptoms resulting in paralysis or death

Hepatitis A

Hepatitis A virus (HAV)

Can manifest itself in water (and food)

Poliomyelitis Poliovirus (Polio)

Enters water through the feces of infected individuals

BK virus produces a mild Very respiratory infection and can widespread, infect the kidneys of Two of can manifest immunosuppressed transplant Polyomavirus Polyomavirus itself in water, patients. JC virus infects the infection : JC virus and ~80% of the respiratory system, kidneys or BK virus population has can cause progressive antibodies to multifocal Polyomavirus leukoencephalopathy in the brain (which is fatal).

[3][6]

See also

Food Microbiology Free-living amebic infection Portable water purification Public health Swimming pool sanitation Water pollution Water quality Water resources Water supply Water Filter

References
1. ^ WHO | Burden of disease and cost-effectiveness estimates 2. ^ Lattimore, "The caravan routes of inner Asia," The Geographical Journal 72.6 (1928:500), quoted in Frances Wood, The Silk Road: two thousand years in the heart of Asia 2002:19. 3. ^ a b Nwachcuku N, Gerba CP (June 2004). "Emerging waterborne pathogens: can we kill them all?". Curr Opin Biotechnol. 15 (3): 17580. PMID 15193323. http://env1.gist.ac.kr/~aeml/paper/papers(pdf)/27waterborne_pathogens.pdf. 4. ^ Dziuban EJ, Liang JL, Craun GF, Hill V, Yu PA, et al (22 December 2006). "Surveillance for Waterborne Disease and Outbreaks Associated with Recreational Water United States, 20032004". MMWR Surveill Summ. 55 (12): 130. PMID 17183230. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5512a1.htm. 5. ^ Petrini B (October 2006). "Mycobacterium marinum: ubiquitous agent of waterborne granulomatous skin infections". Eur J Clin Microbiol Infect Dis. 25 (10): 60913. PMID 17047903. http://www.springerlink.com/content/7r65j4n6v54772h4/. 6. ^ Nwachuku N, Gerba CP, Oswald A, Mashadi FD (September 2005). "Comparative inactivation of Adenovirus serotypes by UV light disinfection". Appl Environ Microbiol. 71 (9): 56336. PMID 16151167. PMC 1214670. http://aem.asm.org/cgi/reprint/71/9/5633.pdf.

Academic Resources

Journal of Water and Health, ISSN: 1477-8920, IWA Publishing

External links
ICS 91.140.60 Water supply systems - A series of the ISO standards World Health Organization

Water-related Diseases, Contaminants, and Injuries Listing of water-related diseases, contaminants and injuries with alphabetical index, listing by type of disease (bacterial, parasitic, etc.) and listing by symptoms caused (diarrhea, skin rash, and many more ) including links to other resources (CDC's Healthy Water site) Center for Diseases Control U.S. [1] gives a rating of water safety worldwide Genome information on Shigella and Salmonella is available at the NIAID PathoSystems Resource Integration Center (PATRIC)

(znsz) (biology) Diseases which are biologically adapted to and normally found in lower animals but which under some conditions also infect humans.

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Zoonoses
Top Home > Library > Science > Sci-Tech Encyclopedia Infections of humans caused by the transmission of disease agents that naturally live in animals. People become infected when they unwittingly intrude into the life cycle of the disease agent and become unnatural hosts. Zoonotic helminthic diseases, caused by parasitic worms, involve many species of helminths, including nematodes (roundworms), trematodes (flukes), cestodes (tapeworms), and acanthocephalans (thorny-headed worms). Helminthic zoonoses may be contracted from domestic animals such as pets, from edible animals such as seafood, or from wild animals. Fortunately, most kinds of zoonotic helminthic infections are caused by rare human parasites. The best-recognized example of a food-borne zoonotic helminthic disease is trichinosis, caused by the trinchina worm, Trichinella spiralis, a tiny nematode. People commonly become infected by eating inadequately prepared pork, but a sizable proportion of victims now contract the worms by eating the meat of wild carnivores, such as bear. Trichinosis is usually a mild disease, manifested by symptoms and signs of intestinal and muscular inflammation, but in heavy infections damage done by the larvae to the heart and central nervous system can be life threatening. Because of public awareness about properly cooking pork and federal regulations about feeding pigs, trichinosis has become uncommon in the United States. People who eat inadequately prepared marine fish may become infected with larval nematodes. Of the many potential (and rare) helminthic zoonoses from wild animals in the United States, Baylisascaris procyonis is particularly dangerous. The nematode is highly prevalent in raccoons, the definitive host. See also Cestoda; Medical parasitology; Nemata; Trematoda. Sponsored Links SPIM to the next level Get cellular resolution in 3D from LARGE biological samples www.lavisionbiotec.com Eye Drops for Cataracts Reduction/improved vision in 83% of dogs, cats, birds and other animals www.ocluvet.com Encyclopedia of Public Health:

Zoonoses
Top Home > Library > Health > Public Health Encyclopedia Zoonoses, or zoonotic diseases, are caused by infectious agents that are transmissible under natural circumstances from vertebrate animals to humans. Zoonoses may arise from wild or domestic animals or from products of animal origin. Zoonoses have been known since early hystorical times. There are biblical references to plague, a bacterial zoonosis mainly transmitted to humans by fleas; and some historians contend that a

disease first described by Thucydides during the Plague of Athens (430425 B.C.E.) was typhus, a louse-borne zoonosis (Zinsser). Certain zoonoses, such as yellow fever, malaria, and rabies, are well known to the general public, but a vast number of lesserknown zoonoses exist in limited cycles in different parts of the world. There are undoubtedly many zoonoses lurking in nature that have the potential to cause serious public health consequences if introduced into humans. This is, in fact, what may be our greatest concern about zoonosesnot the diseases that we know they are capable of causing, but the hidden potential of what diseases might arise in the future. Examples that foster our concern include the emergence of AIDS (acquired immunodeficiency syndrome) from nonhuman primates, which has developed into one of the most significant infectious disease threats in the world today, and the crossing of the species barrier of certain influenza virus strains that have led to large human pandemics. Diseases such as AIDS and influenza have their origins as zoonoses, but they subsequently adapted to human-to-human transmission. There are a number of different types of microbial agents that cause zoonotic diseases, and various ways humans can become infected with these agents. This may best be explained by a few examples: (1) Lyme disease, a bacterial disease transmitted via the bite of an infected tick;(2) rabies, a viral disease acquired by the bite of an infected animal; (3) Ebola hemorrhagic fever, a viral disease spread by infected blood, tissues, secretions, or excretions; (4) hantaviral disease, a disease contracted by inhaling air contaminated with virus-infected excreta from rodents; (5) leptospirosis, a bacterial disease usually transmitted to humans through contact with urine from infected animals; (6) brucellosis, a bacterial disease contracted by ingestion of unpasteurized milk; and (7) cat-scratch disease, a disease contracted through bites or licks of infected cats. Enteric bacteria such as Salmonella and Escherichia coli and parasites such as Cryptosporidium and Giardia are responsible for major food-borne and waterborne disease outbreaks around the world, and recently the nonmicrobial, transmissible agent of bovine spongiform encephalopathy (mad cow disease) appears to have crossed over to humans to produce a degenerative neurological disease known as variant Creutzfeldt-Jakob disease. There has been a disturbing trend of reemergence of previously recognized zoonoses that were believed to be under control. This has been coupled with the emergence of new zoonotic diseases. Numerous factors may account for this, including: (1) alteration of the environment, affecting the size and distribution of certain animal species, vectors, and transmitters of infectious agents to humans; (2) increasing human populations causing an increased level of contact between humans and infected animals; (3) industrialization of foods of animal originthat is, changes in food processing and consumer nutritional habits; (4) increasing movements of people, as well as an increased trade in animals and animal products; and (5) decreasing surveillance and control of some of the major zoonoses. Some supposedly "new zoonoses" have been around for a long time but have simply not been recognized. For example, several types of hantaviruses are transmitted by rodents such as deer mice and can cause the disease known as hantavirus pulmonary syndrome. This disease has likely been around for decades, if not centuries, but human cases were first documented only in 1993. In addition, global warming has the potential to broaden

the geographic distribution and abundance of arthropods as well as the vertebrate hosts in which some zoonoses persist. There is no single clinical picture that can be drawn of zoonoses, given the diverse group of microorganisms that are capable of causing zoonotic diseases. A partial list of symptoms may include some, but not all, of the following: fever (sometimes hemorrhagic), headache, rash, muscle aches, arthritis, respiratory distress (sometimes pneumonia), abdominal pain, vomiting, diarrhea, jaundice, cardiac abnormalities, and neurological involvement ranging from stiff neck to meningitis or encephalitis. The course of disease varies between different zoonotic pathogens but can be more severe in the very young or very old, or in individuals who are immunocompromised. Many zoonoses can be treated with antimicrobial drugs, but there are few drugs that can be used to successfully treat viral zoonoses. Treatment for a known or suspected exposure to a viral zoonosis such as rabies involves administration of immune globulin, whereas only supportive treatment can be offered for many other viral zoonoses. Vaccines are available for the general public for a small number of zoonoses, such as Japanese encephalitis and yellow fever, and on a limited basis for individuals perceived to be at occupational or recreational risk. In addition, chemoprophylactic regimens such as antimalarial drugs are recommended for travellers to high diseaserisk areas. The risk of contracting vector-borne diseases can be reduced by avoidance of areas infested by arthropods, use of insect repellents, and appropriate clothing (the less skin exposed the better). Occasionally it is possible to reduce zoonotic disease risks by decreasing the abundance of certain reservoir hosts such as rodents. Individuals should also not drink untreated water or unpasteurized milk. Areas containing potentially contaminated animal material such as rodent excreta should be cleaned using appropriate disinfectants. Patients with diseases such as Ebola virus should be kept in strict isolation. Diseases such as tularemia and leptospirosis may be contracted by handling infected animal tissue, so trappers should use gloves when handling dead animals. The disease incidence and pattern of occurrence of zoonoses varies greatly between different regions within a country and between countries. In general, zoonoses do not occur in large numbers in the industrialized world. Because of this relative infrequency of occurrence, some zoonotic infections may be overlooked and underdiagnosed. Certain individuals may be at greater risk for contracting zoonoses. These include people with occupational exposure, such as veterinarians, farmers, and slaughterhouse workers, or individuals who participate in outdoor recreational activities, such as hunters. The best defense against contracting zoonoses is education. Individuals should be aware of the respective zoonoses that may be circulating in their environment and the times of year of greatest risk for contracting these zoonoses. This type of information is generally available from public health departments and veterinarians, and can also be found on the Internet. (SEE ALSO: Communicable Disease Control; Ecosystems; Epidemics; Epidemiology; Vector-Borne Diseases; Veterinary Public Health; and articles on diseases mentioned herein)

Bibliography Lederberg, J.; Shope, R. E.; and Oaks, S. C. (1992). Emerging Infections. Microbial Threats to Health in the United States. Washington, DC: National Academy Press. Meslin, F. X. (1997). "Global Aspects of Emerging and Potential Zoonoses: A WHO Perspective." Emerging Infectious Diseases, Vol. 3. Geneva: World Health Organization. Zinsser, H. (1934). Rats, Lice, and History. Boston: Little, Brown. HARVEY ARTSOB

Intelligence Encyclopedia:

Zoonoses
Top Home > Library > History, Politics & Society > Intelligence & Security Encyclopedia Zoonoses are diseases of microbiological origin that can be transmitted from animals to people. The causes of the diseases can be bacteria, viruses, parasites, and fungi. Some zoonotic diseases are identified as potential diseases (e.g., Tularemia) could be exploited by bioterrorists to cause deathincluding death or contamination of livestockand widespread economic damage. As of May 2003, the best scientific evidence available suggested that the cornonavirus responsible for Severe Acute Respiratory Syndrome (SARS) was originally transmitted from animal hosts. Zoonoses are relevant for humans because of their species-jumping ability. Because many of the causative microbial agents are resident in domestic animals and birds, agricultural workers and those in food processing plants are at risk. From a research standpoint, zoonotic diseases are interesting as they result from organisms that can live in a host innocuously while producing disease upon entry into a different host environment. Humans can develop zoonotic diseases in different ways, depending upon the microorganism. Entry through a cut in the skin can occur with some bacteria. Inhalation of bacteria, viruses, and fungi is also a common method of transmission. As well, the ingestion of improperly cooked food or inadequately treated water that has been contaminated with the fecal material from animals or birds present another route of disease transmission. A classic historical example of a zoonotic disease is yellow fever. The construction of the Panama Canal took humans into the previously unexplored regions of the Central American jungle.

A number of bacterial zoonotic diseases are known. A few examples are Tularemia, which is caused by Francisella tulerensis, Leptospirosis (Leptospiras spp.), Lyme disease (Borrelia burgdorferi), Chlaydiosis (Chlamydia psittaci), Salmonellosis (Salmonella spp.), Brucellosis (Brucella melitensis, suis, and abortus), Q-fever (Coxiella burnetti), and Campylobacteriosis (Campylobacter jejuni). Zoonoses produced by fungi, and the organism responsible, include Aspergillosis (Aspergillus fumigatus). Well-known viral zoonoses include rabies and encephalitis. The microorganisms called Chlamydia cause a pneumonia-like disease called psittacosis. Within the past two decades two protozoan zoonoses have definitely emerged. These are Giardia (also commonly known as "beaver fever"), which is caused by Giardia lamblia, and Cryptosporidium, which is caused by Cryptosporidium parvum. These protozoans reside in many vertebrates, particularly those associated with wilderness areas. The increasing encroachment of human habitations with wilderness is bringing the animals, and their resident microbial flora, into closer contact with people. Similarly, human encroachment is thought to be the cause for the emergence of devastatingly fatal viral hemorrhagic fevers, such as Ebola and Rift Valley fever. While the origin of these agents is not definitively known, zoonotic transmission is virtually assumed. Outbreaks of hoof and mouth disease among cattle and sheep in the United Kingdom (the latest being in 2001) has established an as yet unproven, but compelling, zoonotic link between these animals and humans, involving the disease causing entities known as prions. While the story is not fully resolved, the current evidence supports the transmission of the prion agent of mad cow disease to humans, where the similar brain degeneration disease is known as Creutzfeld-Jacob disease. The increasing incidence of these and other zoonotic diseases has been linked to the increased ease of global travel. Microorganisms are more globally portable than ever before. This, combined with the innate ability of microbes to adapt to new environments, has created new combinations of microorganism and susceptible human Top Home > Library > Business & Finance > Banking Dictionary Actions taken to safeguard against market risk. A bond portfolio is said to be immunized when it is structured to produce a target rate of return, regardless of any changes in bond prices or market interest rates. Banks can immunize the balance sheet by holding approximately equal amounts of assets and liabilities for a defined period of time. More generally, immunization can refer to investment strategies, such as interest rate and currency swaps to minimize investment risk. See also Duration; Gapping; Reinvestment Risk. Sponsored Links

Enhanced Ab Generation Genetic Immunization/Antibody Production - no protein needed! www.aldevron.com Vaccine storage tag Accurate, programmable to vaccine time-temperature stability curve clinisense.com World of the Body:

immunization
Top Home > Library > Health > World of the Body Immunization is the process of conferring increased resistance (or decreased susceptibility) to infection. The term vaccination is also used to describe this kind of protective measure, although, strictly speaking, this term refers only to the protection conferred against smallpox by material taken from a cow infected with vaccinia virus (which causes cowpox). Inoculation also is used synonymously for immunization, but less commonly nowadays. The history of immunization goes back to early attempts to prevent smallpox by the Chinese; much later, in the eighteenth century, came the classical experiments of Edward Jenner in Gloucestershire, who induced protection in a child by the inoculation of material from a cow infected with cowpox. Achievements in the history of immunization are summarized in Table 1. Although the early work to control infection was made before microbiological methods were firmly established, rapid progress was made, based on sound scientific principles, once modern bacteriology, and later virology, came on to the scene. For example, the isolation of poliovirus allowed for the development by Jonas Salk, and later by Albert Sabin in the 1950s, of highly effective poliovaccines, which led to a dramatic diminution in poliomyelitis. Before then, there were alarming outbreaks of this paralytic disease: over 8000 cases occurred in the UK in 1950. By the late 1980s, poliovirus capable of producing paralysis was still circulating widely in all continents of the world except Australia. But by 1998 the Americas were polio-free and elsewhere there is substantial progress being made towards the goal of worldwide eradication of this much dreaded disease. Similarly, with measles the isolation of measles virus in 1954 made it possible to culture a strain which is now the basis of the measles vaccine in use today. Prior to the use of the vaccine, in the UK as many as 800000 cases were notified annually, but its introduction has resulted in a dramatic decline. (?) BC 1721 1796 1880 1881 Early attempts in China to immunize against smallpox Introduction into Britain from Turkey by Lady Wortley Montagu of inoculation of material from smallpox patients into healthy persons (variolation) First vaccination against smallpox performed by Jenner Pasteur developed fowl cholera vaccine Pasteur, Roux, and Chamberland introduced anthrax vaccine

(?) BC Early attempts in China to immunize against smallpox 1885 Pasteur developed rabies vaccine 1895 Yersin produced plague vaccine 1898 Almroth Wright developed typhoid vaccine 1921 Calmette and Gurin introduced BCG vaccine 1923 Ramon developed diphtheria toxoid 1927 Ramon and Zoeller developed tetanus toxoid National immunization campaign launched in Britain by Ministry of Health; 1940 did not become widespread until 1942 1954 Salk (killed) polio vaccine introduced 1957 Sabin (live) polio vaccine introduced 1960 Measles vaccine developed by Enders 1962 Rubella vaccine developed by Weller 1967 Jeryl Lynn strain of live attenuated mumps vaccine licensed in the US 1968 Meningococcal (type C) vaccine developed 1968 Measles vaccine introduced on a national scale in Britain 1970 Rubella vaccine became available in Britain 1981 Hepatitis B vaccine licensed in US 1988 Measles, Mumps, Rubella (MMR) vaccine introduced into Britain 1992 Haemophilus influenzae b (HiB) vaccine introduced into Britain

Immunization is one of the most cost-effective public health measures available. But although it is possible to manufacture vaccines against a wide variety of viruses and bacteria, it is, of course, important to ensure that the introduction of a particular vaccine will always confer a major benefit to the population receiving it. Therefore certain broad principles are followed before a vaccine is recognized as being suitable for general use: (i) there should be a major risk of contracting the infection against which the vaccine is intended to protect; (ii) the vaccine should prevent an illness which (including complications and sequelae) is regarded as serious and especially if it can be fatal; (iii) the efficacy of the vaccine should be sufficiently high; (iv) any risk associated with the vaccine should be sufficiently low; (v) the procedures and the number of doses required for successful immunization should be acceptable to the public. An ideal vaccine should confer long-lasting, preferably lifelong, protection against the disease; it should be inexpensive enough for large scale use, stable enough to remain potent during transportation and storage, and have no adverse effect on the recipient. If the introduction of a vaccine is agreed upon at national level then a further decision has to be made as to whether it should be for general use (e.g. polio vaccine) or for specific use when exposure is possible (e.g. typhoid vaccine, given when travelling to regions where typhoid is endemic). Vaccines may induce immunity against infection either actively or passively. Active immunization

Active immunization is brought about by stimulating the individual's own immunity by introducing either inactivated (killed) or attenuated (live, but enfeebled) agents (Table 2). The protective response by the body is mainly expressed through: (i) specific antibodies, measurable by serological tests, which confer protection against many agents, particularly viruses and toxins. (ii) the cellular immune response, which involves both phagocytes and memory cells. Inactivated vaccines are prepared in three ways (examples in Table 2): (i) from killed whole organisms; (ii) from sub-units of the killed organisms; (iii) from the toxins which the organisms release, inactivated by formaldehyde (toxoids). When the organisms have been killed there can be no multiplication within the body, and thus these vaccines cannot produce infection similar to the natural disease. On the other hand, local and whole body reactions may result from response to the organism or to foreign protein used in the vaccine. If the person has not previously been immunized, more than one dose is usually required, although some response can be produced by even a single dose. Protection often lasts for many years, although periodic boosts by subsequent injections may be required to maintain immunity. Attenuated vaccines are prepared from modified strains of the causal organisms or from related organisms. Because of this, some live vaccines may sometimes cause illness resembling the natural disease, but the symptoms are usually milder. In general, however, these vaccines have fewer side-effects than inactivated ones and the immunity usually lasts for many years. Passive immunization Passive immunization is obtained by giving pre-formed, antibodies. These are usually injected in the form of human immunoglobulin or, rarely, antisera prepared in animals. Protection is usually rapid, but the immunity derived is often short-lived, being limited to the time taken for the antibodies to be broken down in the body from a week or so, with animal antisera, to about six months for protection against hepatitis A by human normal immunoglobulin. Special risk groups include those persons particularly liable to suffer from complications of infection, for whom protection by appropriate immunization is therefore of particular importance: for example, those with chronic lung disease, asthma, congenital heart disease, Down's syndrome, or Human Immunodeficiency Virus (HIV) infection, and babies who are born prematurely or are small-for-dates. Immunization of travellers to some countries overseas is often a particular problem, as the risk of certain infections may be especially high and it often has to be given when time is short. Surveillance of immunization procedures is necessary. Immunization it is not without its occasional hazard and it is important that those involved should balance the risk of the disease against the possible risk of the vaccine. Surveillance measures should be aimed at assessing not only the application, utilization, and effectiveness of vaccines in the control of infection, but also any side effects, so that rational decisions about whether to vaccinate can be made.

In conclusion, the achievements of successful immunization policies have been spectacular when the ravages caused by vaccine-preventable infections in former years are compared with those of today. Smallpox has now been eradicated, and other greatly feared infections (such as poliomyelitis) are well under control. Because immunization can often be given quite cheaply and quickly to large numbers of people, it is a remarkably cost-effective measure, which has undoubtedly made a major (if not the major) contribution to the overall protection of the world's population against infection. Inactivated (killed) Toxoids Attenuated (live) Influenza Yellow fever Poliomyelitis (Salk) Poliomyelitis (Sabin) Hepatitis A Measles Hepatitis B Rubella Mumps Rabies Bacterial vaccines Typhoid Diphheria BCG (tuberculosis) Cholera Tetanus Whooping cough Viral vaccines Daniel Reid Bibliography Department of Health, Welsh Office, Scottish Home and Health Department (1996). Immunisation against infectious disease. HMSO London. Nicholl, A. and Rudd, P. (ed.) (1989). British Paediatric Association Manual on infection and immunizations in children. Oxford University Press, Oxford. Wiedermann, G. and Jong, E. C. (1997). Vaccine-preventable diseases: principles and practice. In Textbook of travel medicine. B. C. Decker Inc., Hamilton, Ontario

See also immune response; infectious disease. Sponsored Links Math games for children Practice math, win awards and have fun! Try it now for free. www.ixl.com/math SPIM to the next level Get cellular resolution in 3D from LARGE biological samples www.lavisionbiotec.com Dental Dictionary:

immunization
Top Home > Library > Health > Dental Dictionary

n.pl 1. a fundamental element of preventative healthcare for dental workers, who should be fully immunized against influenza, hepatitis B, and all regular childhood diseases. HIV and hepatitis C vaccines are not available. 2. a process by which resistance to an infectious disease is induced or augmented. Sponsored Links ae.gladiatus.com Ask for Translation Quote Translation and Localization Worldwide professional service www.sentrodil.com Encyclopedia of Public Health:

Immunizations
Top Home > Library > Health > Public Health Encyclopedia Immunization is the induction of immunity against an infectious disease by a means other than experiencing the natural infection. The term is usually used interchangeably with vaccination. Active immunization involves administration of an antigenic substance that then induces development of protective antibodies by the person immunized. This protection usually lasts for years, even for life. Passive immunization refers to temporary immunity resulting from antibodies developed by someone else, either through administration of immune globulin (e.g., gamma globulin, rabies immune globulin) or through the natural transfer across the placenta of antibodies developed by the mother, which provide protection to the newborn infant. Passive immunity usually lasts only a few weeks to a few months. Substances used for active immunization include vaccines and toxoids. Vaccines may contain living, weakened (attenuated) organisms (measles), killed whole organisms (whole cell pertussis, influenza), portions of organisms (subunit influenza), purified components of organisms (acellular pertussis, pneumococcal polysaccharide), or they may be manufactured artificially (hepatitis B produced by recombinant DNA technology). For some diseases, vaccines may be available in more than one form (live attenuated and inactivated [killed] poliovirus vaccines, whole cell and acellular pertussis vaccines). Toxoids are made by preparing the toxins excreted by microorganisms and inactivating them physically or chemically. Diphtheria and tetanus are the most commonly used toxoids. Vaccines and toxoids may also contain adjuvants, substances that enhance the immune response, as well as preservatives. Some vaccines (particularly live, attenuated vaccines) provide long-term, even lifelong protection following administration of only a single dose. Others (particularly inactivated vaccines and toxoids) may require administration of more than one dose in order to induce long-lasting immunity. Some vaccines (diphtheria, tetanus) require periodic booster doses in order to maintain immunity. Many vaccines may be

inactivated by changes in temperature, particularly heat, and must be kept refrigerated or frozen from the time of manufacture until just before being administered. The need for this "cold chain" makes it difficult to carry out immunization programs in developing countries where refrigerators and freezers are not commonplace. The rate of development of new vaccines has been accelerating as a result of improved knowledge of immunity and improvements in biotechnology. It was nearly one hundred years between Edward Jenner's first use of smallpox vaccine in 1796 and Louis Pasteur's development of the second vaccine (against rabies) in 1885. In the last twenty years of the twentieth century, many new or improved vaccines were developed and introduced, including vaccines directed against Haemophilus influenzae type b (Hib), hepatitis A, hepatitis B, Japanese encephalitis, meningococcal meningitis, pertussis, typhoid, and varicella (chicken pox). Dozens of other vaccines are under development. Repeated economic analyses have shown that vaccines are among the most costeffective health interventions available. For most of the vaccines used in infants and young children, the economic benefits of vaccination (avoidance of costs of medical care, hospitals, etc.) far outweigh the costs of vaccination, and the vaccines are truly cost saving. For others, the cost to prevent an illness or death is quite small and is substantially smaller than the cost to treat or cure the condition. Vaccine Recommendations In the United States, recommendations for vaccine use are made by the Public Health Service Advisory Committee on Immunization Practices, in conjunction with the American Academy of Pediatrics, American Academy of Family Practice, American College of Physicians (representing adult medicine specialists), and other professional organizations. Some vaccines are recommended for use in all persons (typically infants and young children, since most communicable diseases primarily strike them) and others are recommended for specific persons or groups who are at increased risk of contracting the particular disease. Vaccines currently recommended for use in all infants and children in the United States are DTP/DTaP (diphtheria and tetanus toxoids and pertussis [or acellular pertussis] vaccine), IPV (inactivated poliovirus vaccine), MMR (measles, mumps, and rubella vaccine), Hib vaccine (Haemophilus influenzae type b vaccine), hepatitis B vaccine, and varicella (chicken pox) vaccine. Several of these vaccines require more than one dose. The recommended schedule of immunizations in the year 2000 for infants and young children is shown in Figure 1. Adolescents and adults also need vaccines, including MMR and hepatitis B if they have not already received them, as well as periodic boosters of tetanus and diphtheria toxoids. In addition, in the United States it is recommended that all persons sixty-five years of age or older receive a single dose of pneumococcal polysaccharide vaccine and annual doses of influenza vaccine because of the increased risk of complication or death if infected. Individuals younger than sixty-five who have chronic illnesses should also receive pneumococcal and influenza vaccines. Some vaccines recommended for persons at increased risk include yellow fever, hepatitis A, typhoid, meningococcal, and Japanese encephalitis vaccines for travelers to certain developing countries; rabies vaccine for veterinarians and persons working with potentially rabid

animals; and hepatitis B vaccine for health care workers and others who might come in contact with body fluids. Vaccine Safety Although modern vaccines are safe and effective, they are neither perfectly effective nor perfectly safe. Some persons who have been vaccinated may still be susceptible to the disease, and some persons who receive the vaccine may suffer an adverse event caused by the vaccine. In developing a vaccine, major efforts are made to maximize effectiveness and minimize the risk of adverse events. In determining whether to use a vaccine, it is necessary to balance the benefits of the vaccine against the risk of the disease and the risks from the vaccine. This balance may change over time. For example, oral polio vaccine (OPV, Sabin vaccine) is made from live, attenuated polioviruses. Rarely, the person who receives the vaccine or someone who is in close contact with him or her may develop paralysis. Vaccine-associated paralysis occurs with a frequency of approximately one case for every million doses of OPV administered. By contrast, the inactivated polio vaccine (IPV, Salk vaccine) has no such risk of paralysis. However, OPV has advantages over IPV because it may be spread from the person who receives the vaccine to family members or other persons in contact with the vaccinee, thereby protecting them. Because it provides greater intestinal immunity than IPV, it protects against the spread of wild poliovirus if the vaccinated individual is exposed to wild poliovirus. The relative advantages of OPV have resulted in its being the vaccine chosen by virtually all countries of the world to control and eradicate polio. However, as the risk of wild poliovirus becomes smaller, the rare complications associated with OPV assume greater prominence. In the United States, the marked decline in risk of exposure to wild poliovirus as a result of global polio eradication efforts led in 1999 to a change in policy to favor use of IPV rather than OPV. Assessment of adverse events associated with vaccines can be quite difficult. Prelicensure trials typically involve a few thousand individuals and cannot be expected to detect reactions that occur with a frequency as low as (or lower than) one in 100,000. Consequently, it is important to maintain surveillance for adverse events after vaccines are licensed and introduced for widespread use. It may be very difficult to determine whether an event that occurs after vaccination was caused by the vaccine rather than occurring by chance, particularly if the event is known to occur in that age group. For example, sudden infant death syndrome (SIDS) is the leading cause of death in children two to four months of age. Since children typically receive DTP vaccine at two and four months, it is inevitable that on occasion a child will die of SIDS in the twenty-four hours following vaccination (or in the twenty-four hours preceding planned vaccination). The question is whether there is an increased incidence of SIDS following vaccination. Several studies have demonstrated that the incidence of SIDS is not increased following DTP vaccination. Impact of Vaccines in the United States

Immunization provides protection both to the individuals immunized and to the community because immunized individuals do not transmit disease. If a high proportion of the population is immunized, the risk of exposure is reduced both for those who have not been immunized and those who have received vaccine but have not been protected. This "herd immunity" has led to the disappearance of disease in defined geographic areas, even though not everyone has received vaccine. Introduction and widespread use of vaccines has had a dramatic effect on the occurrence of many diseases in the United States. Table 1 demonstrates the maximum number of cases of specified diseases ever reported in the United States, the number of cases reported in 1998, and the proportion reduction in incidence. Declines of greater than 95 percent are the rule. Similar dramatic reductions have been seen from deaths due to these diseases. Smallpox is not shown on this table as smallpox has been eradicated from the world. Most industrialized countries have seen comparable declines in illnesses and deaths due to vaccine-preventable diseases. Most developing countries have not yet experienced the same level of decline because they have not achieved the same level of immunization coverage. In the United States, immunization levels in young children are at record highs and reported incidence of vaccine-preventable diseases are at record lows. Nonetheless, several factors threaten this continued success, including the birth every day of eleven thousand infants who will all need to be immunized, the changing immunization schedule, the movement of children between health care providers (25% of U.S. 2year-olds have received vaccines from two or more providers), continued overestimation of coverage by parents and providers, and the absence of disease as a continuing reminder of the need for immunization (even though the causative organisms are still in circulation). Because of the continuing birth of susceptible infants, unless communicable diseases are eradicated it will be necessary to continue immunizing Table 1 Maximum Reported Morbidity and 1998 Provisional Morbidity Vaccine-Peventable Diseases of Childhood United States Maximum Reported Provisional (1998) Disease Morbidity Morbidity *estimated SOURCE: Centers for Disease Control and Prevention Diphtheria 206,939 1 Pertussis 265,269 6,279 Tetanus 1,733 34 Poliomyelitis (paralytic) 21,269 0 Measles 894,134 89 Mumps 152,209 606 Rubella 57,686 345 Congenital rubella 20,000* 6

Decrease

99.99% 97.63% 98.04% 100% 99.99% 99.60% 99.40% 99.97%

Maximum Reported Morbidity and 1998 Provisional Morbidity Vaccine-Peventable Diseases of Childhood United States Maximum Reported Provisional (1998) Disease Morbidity Morbidity syndrome Haemophilus influenzae 20,000* 54 type b

Decrease

99.73%

against them indefinitely. Several examples exist in industrialized countries (including England and Japan) where epidemic resurgence of pertussis (whooping cough) has occurred as a consequence of declining use of pertussis vaccine. In the United States, a resurgence of measles resulted from the diversion of effort from measles vaccination to rubella vaccination following introduction of rubella vaccine in 1969 (at that time it was not combined with measles vaccine). Several techniques have been demonstrated to be highly effective in improving and maintaining immunization coverage, including improving access to immunization, developing reminder and recall systems to notify parents and providers about needed or overdue immunizations, assessing immunization coverage in individual facilities, and linking immunization services with other services. By providing accurate, up-todate information to health care providers, immunization registries (confidential, computerized information systems that contain information about immunizations and children) can make it easier to carry out the demonstrably effective immunization strategies. All states are currently in the process of establishing population-based immunization registries containing information on all children within their borders. In the United States, infants and children may receive immunizations from private providers (typically in conjunction with other well-child services) or from public sector sites such as local health departments (in which case immunizations might be the only services provided) or community health centers. Traditionally, vaccines provided in the public sector have been free, whereas private providers have charged for the vaccines. Consequently, lower-income families typically went to public sector facilities to receive vaccine, even though they might have been using a private physician for other care. Until the middle of the 1990s, it was estimated that approximately one-half of all U.S. children received immunizations from private providers and one-half from the public sector. Enactment of the Vaccines For Children (VFC) program in 1994 made free vaccine available to private providers for use in uninsured or under-insured children and led to a major shift in immunization provision. In 1998, approximately 70 percent of all childhood vaccines were administered in the private sector and 30 percent in the public sector, meaning that more children were receiving immunizations in their "medical home" than had been the case previously. Immunizations Worldwide Since 1979, the World Health Organization (WHO) has coordinated an Expanded Program on Immunization (EPI), which seeks to bring vaccines against six diseases diphtheria, measles, pertussis (whooping cough), poliomyelitis, tetanus, and

tuberculosisto all children in the world. An abbreviated immunization schedule has been developed that calls for a dose of BCG (Bacille Calmette-Guerin) at birth; three doses of DTP (combined diphtheria and tetanus toxoids and pertussis vaccine) and OPV (oral polio vaccine) given at six, ten, and fourteen weeks of age; and a single dose of measles vaccine at nine months of age. BCG protects infants against severe forms of tuberculosis (such as tuberculous meningitis) but does not alter the overall transmission of tuberculosis. The EPI succeeded in reaching immunization coverage levels of approximately 80 percent in the world's children by 1990 (the year of the Children's Summit), but levels have been relatively stagnant since that time, even decreasing in some areas. Coverage varied markedly among (and within) countries. Some of the reasons for the lack of further progress include: the overall economic situation in many countries, the fragile nature of the countries' health services, lack of political support, and problems in management of immunization programs. In 1991 a recommendation was made to administer hepatitis B vaccine to all children (three doses: at birth, six weeks, and fourteen weeks; or along with the DTP vaccine) but this has not been widely implemented in most developing countries. Introduction of other (newer) vaccines such as Hib is problematic. These vaccines are considerably more expensive than traditional vaccines, there are few manufacturers (sometimes only one, as a result of innovation and patent protection), and purchase of vaccines may require hard currency, which may be difficult for some developing countries to obtain. The development of the Global Alliance for Vaccines and Immunization and the Global Children's Vaccine Fund in early 2000 give hope that mechanisms may be developed to facilitate introduction of important new vaccines in developing countries. Eradication of Vaccine Preventable Diseases Global eradication of smallpox in the late 1970s is probably the greatest single achievement in health to date. Although both William Jenner and Thomas Jefferson predicted eventual eradication at the end of the eighteenth century, it took nearly two hundred years to accomplish. The intensive global effort for eradication began in 1967 with the result that the last naturally occurring case of smallpox occurred in 1977. The World Health Assembly certified eradication in 1980. The initial strategy to achieve eradication was mass vaccination of the population, but over time this was refined to a strategy of search and containment search for cases of smallpox and containment of transmission through vaccinating all persons who might have been exposed in a geographic area. An effort is currently underway to eradicate polio from the world by the end of 2000. The strategy for eradication involves attaining high levels of coverage with routine vaccination with OPV, special immunization campaigns, and vigorous surveillance to detect and investigate possible cases of polio. The special immunization campaigns typically occur as National Immunization Days, semiannual events in which all children in the country less than five years old are given OPV on a single day, regardless of their previous vaccination status. Significant progress is being made: no locally arising cases of polio have occurred in the Americas since 1991, none in the Western Pacific Region of the World Health Organization (including China) since 1997, and none in the European Region since 1998. At the beginning of 2000, the major problems remaining were in South Asia and sub-Saharan Africa. Whether the

target will be met on schedule is not clear. It is clear that eradication is technically feasiblethe uncertainties relate to political will and financial support. Other diseases that are potential candidates for eradication through appropriate use of vaccines include measles, mumps, and rubella. Measles is the most serious of these, still accounting for nearly 900,000 deaths a year (half of them in sub-Saharan Africa), and there is substantial support for consideration for elimination or eradication. The public health impact of rubella and mumps is not as widely recognized and there is not the same degree of enthusiasm for their eradication, although it is estimated that more than 100,000 cases of congenital rubella syndrome occur each year around the world. Although all three conditions could be attacked simultaneously by using MMR (combined measles-mumps-rubella) vaccine, the additional vaccine costs would be substantial. Future Vaccines Recent advances in biotechnology and understanding of the immune process make it likely that the pace of vaccine development and introduction will accelerate. Although this will mean that there is greater opportunity for prevention of disease and death, it will have additional consequences, such as increasing complexity of the immunization schedule and the need for additional injections. Development of combination vaccines can help alleviate this problem but, since there is at least a theoretical issue of incompatibility and interference between different vaccines, each combination must be tested thoroughly before it can be approved. Additionally, the prospective availability of combined vaccines from different manufacturers with slightly different components may add further complexity to the schedule and to decision making about what a given individual needs. The biotechnology revolution has made it possible to explore novel approaches to immunization, such as incorporating into other microorganisms the antigens that elicit protective antibodies (another way of making combination vaccines) or even incorporating antigens into foodstuffs such as potatoes or bananas. Additionally, the prospect of administering vaccines by aerosol or using transdermal patches is being investigated, as is the possibility of using purified DNA from the causative organism as the means to induce immunity. Because of the potential for transmission of infectious diseases (e.g., hepatitis B, HIV/AIDS) through reuse of needles or inadvertent needle-sticks, disposal of needles has become a significant problem and has led to the development of "auto-destruct" syringes and needles that cannot be used more than once. Most designs to date do not prevent inadvertent needlesticks, however. Consequently, needleless approaches to administration are being pursued, including pressure injection of liquid or powder vaccine, aerosol/inhalation, and use of transdermal absorption. Conclusion Immunizations have been among the most successful public health interventions to date. Through appropriate use of vaccines, smallpox has been eradicated from the earth, poliomyelitis is on the verge of eradication, and there have been dramatic reductions in morbidity and mortality due to with many other diseases. Recent scientific advances give promise that even more diseases can be brought under

effective control. A remaining challenge is to ensure that all people of the world benefit from immunizations. (SEE ALSO: Hepatitis A Vaccine; Hepatitis B Vaccine; Influenza; and articles on specific diseases mentioned herein) Bibliography Centers for Disease Control and Prevention (1999). "Achievements in Public Health, 19002000: Impact of Vaccines Universally Recommended for Children; United States, 19001998." Morbidity and Mortality Weekly Report 48(12):243248. "Recommendations of the Advisory Committee on Immunization Practices." Available online at http://www.cdc.gov/nip/publications/ACIP-list.htm. Offit, P. A., and Bell, L. M. (1998). What Every Parent Should Know About Vaccines. New York: MacMillan. Plotkin, S. A., and Orenstein, W. A., eds. (1999). Vaccines, 3rd edition. Philadelphia, PA: W. B. Saunders. World Health Organization/UNICEF (1996). State of the World's Vaccines and Immunization. Geneva: WHO/UNICEF. Available online at www.who.int/vaccinesdocuments/DocsPDF/www9532.pdf. ALAN R. HINMAN

Sponsored Links Twin Voices a memoir of polio and polio eradication twinvoices.com Unlimited Backup $4.95/Mo Protect Documents, Music & Photos Start In Seconds. Easy To Use! Mozy.com/Home Sports Science and Medicine:

immunization
Top Home > Library > Health > Sports Science and Medicine The process of conferring immunity by artificial means. Passive immunity may be conferred by the injection of antiserum. Active immunity is conferred by the administration, orally or by injection, of antigens in the form of a vaccine that promotes the production of antibodies. The vaccine may consist of dead or inactivated bacteria or viruses, or their toxins, which trigger the production of antibodies to a specific disease so that the individual is immune to it. All athletes should be immunized against tetanus, especially those who take part in activities in the

countryside or on fields used by farm animals. All athletes travelling abroad should seek medical advice about the immunization they need, and the effects that this immunization is likely to have on their training and competition. Health Dictionary:

immunization
Top Home > Library > Health > Health Dictionary The process of inducing immunity, usually through inoculation or vaccination. Frequently, schoolchildren are required by state law to be immunized against certain diseases. Because of such widespread immunization, many diseases that used to be fairly common, including smallpox, tetanus, and whooping cough, have become rare. Veterinary Dictionary:

immunization
Top Home > Library > Animal Life > Veterinary Dictionary The process of rendering a subject immune, or of becoming immune. See also vaccination. active i. stimulation with a specific antigen to promote an immune response. In the context of infectious diseases, the antigenic substances may include: (1) inactivated bacteria, as in botulism immunization; (2) inactivated viruses, as in the canine parvovirus vaccination; (3) live attenuated viruses, e.g. rabies virus, and (4) toxoids, chemically treated toxins produced by bacteria, as in immunization against tetanus and pasteurellosis. Any of a vast number of foreign substances may induce an active immune response. Since active immunization induces the body to produce its own antibodies and specifically reactive cells and to go on producing them, protection against disease will last several years, in some cases for life. antihormone i. immunization against hormones, e.g. against androstenedione for the stimulation of ovulation in ewes, is now a commercial reality and promises to be a significant management tool in intensive animal production. See also immunological contraception. deliberate i. the administration of an immunogen, usually by injection but sometimes orally or by inhalation, for the purpose of producing immunity. natural i. stimulation of the immune system through exposure to antigens that have not been deliberately administered. passive i. transient immunization produced by the introduction into the system of pre-formed antibody or specifically reactive lymphoid cells. The animal immunized is protected only as long as these antibodies or cells remain in the blood and are activeusually from 4 to 6 weeks. The immunity may be

natural, as in the transfer of maternal antibody to offspring, or artificial, passive immunity following inoculation of antibodies or immune cells. Wikipedia:

Immunization
Top Home > Library > Miscellaneous > Wikipedia For financial immunization, see Immunization (finance). This article does not cite any references or sources.
Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (July 2008)

A child being immunized against polio.

Dr. Schreiber of San Augustine giving a typhoid inoculation at a rural school, San Augustine County, Texas. Transfer from U.S. Office of War Information, 1944. Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen). When an immune system is exposed to [[ant]s that are foreign to the body (non-self), it will orchestrate an immune response, but it can also develop the ability to quickly respond to a subsequent encounter (through immunological memory). This is a function of the adaptive immune system. Therefore, by exposing an animal to an immunogen in a controlled way, its body can learn to protect itself: this is called active immunizating.

The most important elements of the immune system that are improved by immunization are the B cells (and the antibodies they produce) and T cells. Memory B cell and memory T cells are responsible for a swift response to a second encounter with a foreign molecule. Passive immunization is when these elements are introduced directly into the body, instead of when the body itself has to make these elements. Immunization can be done through various techniques, most commonly vaccination. Vaccines against microorganisms that cause diseases can prepare the body's immune system, thus helping to fight or prevent an infection. The fact that mutations can cause cancer cells to produce proteins or other molecules that are unknown to the body forms the theoretical basis for therapeutic cancer vaccines. Other molecules can be used for immunization as well, for example in experimental vaccines against nicotine (NicVAX) or the hormone ghrelin (in experiments to create an obesity vaccine). Contents [hide]

1 Passive and active immunization o 1.1 Active immunization o 1.2 Passive immunization 2 External links

Passive and active immunization

Immunization can be achieved in an active or passive fashion: vaccination is an active form of immunization.

Active immunization
Main article: Active immunity Active immunization entails the introduction of a foreign molecule into the body, which causes the body itself to generate immunity against the target. This immunity comes from the T cells and the B cells with their antibodies. Active immunization can occur naturally when a person comes in contact with, for example, a microbe. If the person has not yet come into contact with the microbe and has no pre-made antibodies for defense (like in passive immunization), the person becomes immunized. The immune system will eventually create antibodies and other defenses against the microbe. The next time, the immune response against this microbe can be very efficient; this is the case in many of the childhood infections that a person only contracts once, but then is immune. Artificial active immunization is where the microbe, or parts of it, are injected into the person before they are able to take it in naturally. If whole microbes are used, they are pre-treated, Attenuated vaccine. Depending on the type of disease, this technique also works with dead microbes, parts of the microbe, or treated toxins from the microbe.

Passive immunization

Main article: Passive immunity Passive immunization is where pre-synthesized elements of the immune system are transferred to a person so that the body does not need to produce these elements itself. Currently, antibodies can be used for passive immunization. This method of immunization begins to work very quickly, but it is short lasting, because the antibodies are naturally broken down, and if there are no B cells to produce more antibodies, they will disappear. Passive immunization occurs physiologically, when antibodies are transferred from mother to fetus during pregnancy, to protect the fetus before and shortly after birth. Artificial passive immunization is normally administered by injection and is used if there has been a recent outbreak of a particular disease or as an emergency treatment for toxicity (for example, for tetanus). The antibodies can be produced in animals ("serum therapy") although there is a high chance of anaphylactic shock because of immunity against animal serum itself. Thus, humanized antibodies produced in vitro by cell culture are used instead if available.

External links

National Network for Immunization Information (NNii) Centers for Disease Control National Immunization Program [hide]

vde

Artificial induction of immunity / Immunization: Vaccines, Vaccination, and Inoculation (J07)

List of vaccine ingredients Adjuvants Mathematical modelling Timeline Trials Development Classes: Inactivated vaccine Live vector vaccine (Attenuated vaccine, Heterologous vaccine) Toxoid Subunit/component/Viruslike particle Conjugate vaccine DNA vaccination Global: GAVI Alliance Policy Schedule Vaccine injury USA: ACIP VAERS VSD Vaccine court Anthrax Brucellosis Cholera# Diphtheria# Hib# Meningococcus# (NmVac4-A/C/Y/W-135, NmVac4A/C/Y/W-135 - DT, MeNZB) Pertussis# Plague Pneumococcal# (PPSV, PCV) Tetanus# Tuberculosis (BCG)# Typhoid# (Ty21a, ViCPS) Typhus combination: DTwP/DTaP Viral Adenovirus Tick-borne encephalitis Japanese

Administration Vaccines

Bacterial

encephalitis# Flu# (Pandemrix, LAIV, H1N1) HAV# HBV# HPV (Gardasil, Cervarix) Measles# Mumps# (Mumpsvax) Polio# (Salk, Sabin) Rabies# Rotavirus# Rubella# Smallpox (Dryvax) Varicella (chicken pox)# Yellow fever# combination: MMR MMRV research: Cytomegalovirus Epstein-Barr HIV Hepatitis C Protozoan Malaria Trypanosomiasis

HelminthiasisSchistosomiasis Hookworm Other Controversy See also

#

TA-CD NicVAX Cancer vaccines (ALVAC-CEA vaccine)

General MMR NCVIA Pox party Simpsonwood Thiomersal List of vaccine topics Epidemiology Eradication of infectious diseases

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sexually transmitted disease

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Sexually Transmitted Diseases

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Transmitted Diseases: Causes and symptoms Diagnosis Treatment Prognosis Prevention Resources

Definition Sexually transmitted disease (STD) is a term used to describe more than 20 different infections that are transmitted through exchange of semen, blood, and other body fluids; or by direct contact with the affected body areas of people with STDs. Sexually transmitted diseases are also called venereal diseases. Description The Centers for Disease Control and Prevention (CDC) has reported that 85% of the most prevalent infectious diseases in the United States are sexually transmitted. The rate of STDs in this country is 50 to 100 times higher than that of any other industrialized nation. One in four sexually active Americans will be affected by an STD at some time in his or her life. About 12 million new STD infections occur in the United States each year. One in four occurs in someone between the ages of 16 and 19. Almost 65% of all STD infections affect people under the age of 25.
Types of STDs

STDs can have very painful long-term consequences as well as immediate health problems. They can cause:

birth defects blindness bone deformities brain damage cancer heart disease infertility and other abnormalities of the reproductive system mental retardation death

Some of the most common and potentially serious STDs in the United States include:
Chlamydia. This STD is caused by the bacterium Chlamydia trachomatis, a microscopic organism that lives as a parasite inside human cells. Although over 526,000 cases of chlamydia were reported in the United States in 1997, the CDC estimates that nearly three million cases occur annually because 75% of women and 50% of men show no symptoms of the disease after infection. Approximately 40% of women will develop pelvic inflammatory

disease (PID) as a result of chlamydia infection, a leading cause of infertility. Human papillomavirus (HPV). HPV causes genital warts and is the single most important risk factor for cervical cancer in women. Over 100 types of HPV exist, but only about 30 of them can cause genital warts and are spread through sexual contact. In some instances, warts are passed from mother to child during childbirth, leading to a potentially life-threatening condition for newborns in which warts develop in the throat (laryngeal papillomatosis). Genital herpes. Herpes is an incurable viral infection thought to be one of the most common STDs in this country. It is caused by one of two types of herpes simplex viruses: HSV-1 (commonly causing oral herpes) or HSV-2 (usually causing genital herpes). The CDC estimates that 45 million Americans (one out of every five individuals 12 years of age or older) are infected with HSV-2; this number has increased 30% since the 1970s. HSV-2 infection is more common in women (one out of every four women) than men (one out of every five men) and in African Americans (45.9%) than Caucasians (17.6%). Gonorrhea. The bacterium Neisseria gonorrhoeae is the causative agent of gonorrhea and can be spread by vaginal, oral, or anal contact. The CDC reports that approximately 650,000 individuals are infected with gonorrhea each year in the United States, with 132.2 infections per 100,000 individuals occurring in 1999. Approximately 75% of American gonorrhea infections occur in persons aged 15 to 29 years old. In 1999, 75% of reported gonorrhea cases occurred among African Americans. Syphilis. Syphilis is a potentially life-threatening infection that increases the likelihood of acquiring or transmitting HIV. In 1998, the CDC reported approximately 38,000 cases of syphilis in the United States; this included 800 cases of congenital syphilis. Congenital syphilis causes irreversible health problems or death in as many as 40% of all live babies born to women with untreated syphilis. Human immunodeficiency virus (HIV) infection. In 2000, the CDC reported that 120,223 people in the United States are HIVpositive and 426,350 are living with AIDS. In addition, approximately 1,000-2,000 children are born each year with HIV infection. It is also estimated that 33 million adults and 1.3 million children worldwide were living with HIV/AIDS as of 1999 with 5.4 million being newly infected that year. As of 2001, there is no cure for this STD. Social groups and STDs

STDs affect certain population groups more severely than others. Women, young people, and members of minority groups are particularly affected. Women in any age bracket are more likely than men to develop medical complications related to STDs. With respect to racial and ethnic categories, the incidence of syphilis is 60 times higher among African Americans than among Caucasians, and four times higher in Hispanics than in Anglos. According to the CDC, in 1999 African Americans accounted for 77% of the total number of gonorrhea cases and nearly 46% of all genital herpes cases.

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Dictionary: sexually transmitted disease Top Home > Library > Literature & Language > Dictionary n. (Abbr. STD) Any of various diseases, including chancroid, chlamydia, gonorrhea, and syphilis, that are usually contracted through sexual intercourse or other intimate sexual contact.

Britannica Concise Encyclopedia:

sexually transmitted disease

Top Home > Library > Miscellaneous > Britannica Concise Encyclopedia sexually transmitted disease Disease transmitted primarily by direct sexual contact. STDs usually affect the reproductive system and urinary system but can be spread to the mouth or rectum by oral or anal sex. In later stages they may attack other organs and systems. The best-known are syphilis, gonorrhea, AIDS, and herpes simplex. Yeast infections (see candida) produce a thick, whitish vaginal discharge and genital irritation and itch in women and sometimes irritation of the penis in men. Crab louse infestation (see louse, human) can also be considered an STD. The incidence of STDs has been affected by such factors as antibiotics, birth-control methods, and changes in sexual behaviour. See also chlamydia; hepatitis; pelvic inflammatory disease; wart.

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Sci-Tech Encyclopedia:

Sexually transmitted diseases

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Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely dependent on sexual contact for their transmission and propagation in a population. The term venereal disease is literally synonymous with sexually transmitted disease but traditionally is associated with only five long-recognized diseases (syphilis, gonorrhea, chancroid, lymphogranuloma venereum, and donovanosis). Sexually transmitted diseases occasionally are acquired nonsexually (for example, by newborn infants from their mothers, or by clinical or laboratory personnel handling pathogenic organisms or infected secretions), but in adults they are virtually never acquired by contact with contaminated intermediaries such as towels, toilet seats, or bathing facilities. However, some sexually transmitted infections (such as human immunodeficiency virus infection, viral hepatitis, and cytomegalovirus infection) are transmitted primarily by sexual contact in some settings and by nonsexual means in others. See also Gonorrhea; Syphilis.

The sexually transmitted diseases may be classified in the traditional fashion, according to the causative pathogenic organisms, as follows: Bacteria Chlamydia trachomatis Neisseria gonorrhoeae Treponema pallidum Mycoplasma genitalium Mycoplasma hominis Ureaplasma urealyticum Haemophilis ducreyi Calymmatobacterium granulomatis Salmonella species Shigella species Campylobacter species Viruses Human immunodeficiency viruses (types 1 and 2) Herpes simplex viruses (types 1 and 2) Hepatitis viruses B, C, D Cytomegalovirus Human papillomaviruses Molluscum contagiosum virus Kaposi sarcoma virus Protozoa Trichomonas vaginalis Entamoeba histolytica Giardia lamblia

Cryptosporidium and related species Ectoparasites Phthirus pubis (pubic louse) Sarcoptes scabiei (scabies mite) Sexually transmitted diseases may also be classified according to clinical syndromes and complications that are caused by one or more pathogens as follows: 1. Acquired immunodeficiency syndrome (AIDS) and related conditions 2. Pelvic inflammatory disease 3. Female infertility 4. Ectopic pregnancy 5. Fetal and neonatal infections 6. Complications of pregnancy 7. Neoplasia 8. Human papillomavirus and genital warts 9. Genital ulcer-inguinal lymphadenopathy syndromes 10. Lower genital tract infection in women 11. Viral hepatitis and cirrhosis 12. Urethritis in men 13. Late syphilis 14. Epididymitis 15. Gastrointestinal infections 16. Acute arthritis 17. Mononucleosis syndromes 18. Molluscum contagiosum 19. Ectoparasite infestation
Acquired immune deficiency syndrome (AIDS); Cancer (medicine); Drug resistance; Gastrointestinal tract disorders; Hepatitis; Public health; Urinary tract disorders

Most of these syndromes may be caused by more than one organism, often in conjunction with nonsexually transmitted pathogens. They are listed in the approximate order of their public health impact.
World of the Body:

sexually transmitted diseases

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Sexually transmitted diseases were previously called venereal diseases, of which there were three: syphilis, gonorrhoea, and chancroid. Over time, but particularly

during the second half of the twentieth century, the range of diseases spread by sexual contact have increased considerably, and include infection by a variety of organisms, particularly bacteria and viruses, of which the newest is the Human Immunodeficiency Virus, causing AIDS (see table). Currently, the geographical distribution of the sexually transmitted diseases (STDs) varies in number and type of condition. The World Health Organisation (WHO) estimates 333 million new infections per year (excluding HIV/AIDS). The major focus is South and South-East Asia, with an estimated 150 million new cases in 1995, and sub-Saharan Africa, with 65 million. In the developing world, the commonest diseases are gonorrhoea, syphilis, chancroid, and HIV infection, whereas in developed countries they are chlamydial infections, non-specific urethritis, genital warts, and herpes. The STDs are important because of their complications and social stigma. The most serious sequelae occur in women, and are pelvic inflammatory disease (infection in the fallopian tubes) and ectopic pregnancy (pregnancy in the tubes), but the infections also increase the risk of stillbirth and prematurity, and can affect the new-born baby. In sub-Saharan Africa, 50% of cases of infertility can be attributed to prior tubal infection, usually with gonorrhoea or chlamydia.
Bacteria Chlamydia trachomatis Neisseria gonorrhoeae Gardenerella vaginalis Treponema pallidum Group B Haemolytic streptococcus Haemophilius ducreyi Calymmatobacterium granulomatis Shigella species Viruses Herpes simplex virus types 1 and 2 Wart virus (papillomavirus) Molluscum contagiosum virus (poxvirus) Hepatitis A, B, and C virus

Cytomegalovirus Human immunodeficiency virus 1 and 2 Mycoplasm Ureaplasma urealyticum as Mycoplasma hominis Parasites Sarcoptes scabiei Phthirus pubis Protozoa Entamoeba histolytica Giardia lamblia Trichomonas vaginalis Fungi Candida albicans

The risk of acquiring a sexually transmitted infection is related to a number of factors, which include demography, partner change, poverty, urbanization and migration, social unrest, and war, as well as lack of diagnostic and treatment facilities. The diseases and their features The three most common presenting symptoms of STDs are urethral discharge, genital ulceration, and vaginal discharge. Whereas the first two are usually due to an STD, vaginal discharge is not. Most women have a physiological vaginal discharge, which can vary from day to day, and can also be related to their menstrual cycle. It can be due to other infections, such as candida (thrush), which are not usually sexually transmitted. Pointers to the possibility that a vaginal discharge is due to an STD are development of symptoms after a recent partner change, recent multiple sexual contacts, symptoms that are recurrent or persistent, and symptoms in the woman's partner. Finally, there may be general symptoms such as abdominal pain, menstrual problems, or pain on intercourse. Gonorrhoea, non-specific genital infection, and chlamydia In heterosexual men, these conditions give rise to discharge from the penis, 3-14 days after exposure. In homosexual men, the rectum can be infected, but in many incidences the patient is unaware of this unless they attend a clinic for a routine check-up, or at the request of a partner who develops symptoms. In women, these three conditions can often be without specific symptoms, especially since vaginal discharge is common. These infections are particularly important in women because of the complication of pelvic inflammatory disease; if this arises, it usually causes abdominal pain, perhaps with menstrual disturbances, and pain on intercourse. Women may only become aware of

their infection when their male partner develops problems. Gonorrhoea can be treated with penicillin, and non-specific genital infection and chlamydia with tetracycline. Genital warts small lumps around the genital regions have become increasingly common. They have a very long incubation period after exposure (anything up to 6 months). Treatment is straightforward, by freezing or applying acidic substances such as podophyllin. Warts tend to recur. It is important that they are treated, particularly in women, where there is a possible association between some types of warts and the later development of carcinoma of the cervix. All women with genital warts should have regular cervical smears. Genital herpes is a viral condition with a short incubation period of approximately 3-7 days. If it is a first attack, the symptoms can be particularly severe, with pain, and blisters breaking down into sores, which sometimes can be extensive. Occasionally patients may have a temperature and headache, and feel generally unwell. There are two types of herpes simplex virus. Herpes type 1 normally causes cold sores, but oralgenital contact can transmit this from the lips to the genital area, therefore one should avoid this type of contact with people during the time that they have cold sores. There is no cure for this condition, and it tends to recur, but with unpredictable frequency from patient to patient. Pregnant women can pass herpes on to the baby at the time of delivery, so they should be under specialist care. Syphilis is now very uncommon in the UK. Primary syphilis occurs after an incubation period of about 9-90 days. Usually a solitary, painless ulcer appears at the site of exposure (penis, vulva, rectum, etc.). This will heal without treatment. Secondary syphilis appears 4-8 weeks later, in the form of a widespread rash, mainly on the shoulders, chest, back, abdomen, and arms. Tertiary syphilis occurs any time from 3-20 years after exposure, with complications affecting the central nervous system and heart. Candidiasis, trichomonas, and bacterial vaginosis cause vaginal discharge, and are not usually sexually transmitted. Genital ulcers are not necessarily due to STD. In Britain the commonest causes are genital herpes and syphilis, but in tropical countries there are other conditions commonly causing genital ulceration. HIV and AIDS Even though North America and Europe experienced the first impact of the AIDS epidemic, infections with HIV are now seen throughout the world, with the focus having switched to developing/resource-poor countries. WHO estimate that, by the end of 2000, 36.1 million people were living with HIV/AIDS, and that 5.3 million new infections occurred during that year. At the time of writing, 90% of all infections occur in developing countries and continents, with the major brunt of the epidemic in sub-Saharan Africa (22.5 million cases), and south and south-east Asia (6.7 million cases). It is now realized that cases of AIDS were first seen in central Africa in the 1970s, even though at that time it was not recognized as such. Current surveys from some African countries show that the level of infection is high amongst certain groups: in 50-90% of prostitutes and 30% of those attending departments for STDs and antenatal

clinics. The advent and increase of HIV infection since the 1980s has highlighted the importance of infections spread by the sexual route. It has also been recognized that the presence of a sexually transmitted disease, particularly (a) genital ulcer(s) and/or a vaginal/urethral discharge, can enhance both the acquisition and transmission of HIV by increased shedding of the virus within and from the genital tract. The most common mode of transmission of this virus throughout the world is by sexual intercourse, vaginal or anal. Other methods of transmission are through the receipt of infected blood or blood products, semen, or donated organs; and through the sharing or re-use of contaminated needles by injecting drug users, or for therapeutic procedures. Also, transmission from mother to child can occur, in the womb, possibly at birth, or through breast milk. Acute infection with HIV usually passes unnoticed, although there may sometimes be fever, swollen lymph nodes, muscular pain, and a rash. Most patients are unaware of their infection unless they are tested. The antibody test carried out on blood can take approximately three months to become positive (the window period). In view of this, patients are encouraged to delay being tested after possible exposure. Chronic infection follows and again the patient may not be aware that they are infected or they may have non-specific symptoms such as fever, night sweats, diarrhoea, and weight loss. The time between infection with HIV and developing AIDS can be very long: on average about 8-9 years. Once a patient develops AIDS, they can have tumours and/or infections in various parts of the body. There is no cure for AIDS, but the infections can be treated, and new antiviral agents against HIV are now more powerful, and may alter the medical history and life expectancy of those infected. Control of sexually transmitted diseases is served in the UK by a network of specialist clinics: departments of Sexually Transmitted Diseases or Genitourinary Medicine clinics. The image of such clinics has changed considerably; they have become more friendly, with far less associated stigma. Most people attend without medical referral, and because the remit of these clinics has extended in recent decades, many use them for check-ups, screening for HIV, and for gynaecological problems or contraceptive advice. In developing countries, such specialist services do not usually exist, and sexually transmitted diseases are normally managed in non-specialist services, usually in rural primary health centres by non-medical staff. Prevention of STDs involves primary and secondary approaches. Primary prevention aims to educate individuals about the advantages of discriminate and safe sex (prevention by the use of condoms), about the symptoms of the common sexually transmitted diseases, and about how to seek care for them. It is also important to point out that some conditions may cause no symptoms, so that regular check-ups are advised for those who often change their partners. Secondary prevention aims to encourage people to seek care without delay once the symptoms of a disease are recognized, to stop sexual intercourse until medical advice has been sought, and to adhere to the advice and treatment given. The final aspect of control is the tracing of the sexual contacts of the infected patient, who may have infection without being aware of it. M. W. Adler

Bibliography
Adler, M. W. (1980). The terrible peril a historical perspective on the venereal diseases. British Medical Journal, 281, 206-11. Adler, M. W. (1997). The ABC of AIDS, (4th edn). BMJ Publications, London. Adler, M. W. (1999). The ABC of sexually transmitted diseases, (4th edn). BMJ Publications, London

Children's Health Encyclopedia:

Sexually Transmitted Diseases

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Definition Sexually transmitted diseases (STDs) are viral and bacterial infections passed from one person to another through sexual contact. Description Adolescence is a time of opportunities and risk when many health behaviors are established. Although many of these behaviors are health-promoting, some are healthcompromising, resulting in increasingly high rates of adolescent morbidity and mortality. For example, initiation of sexual intercourse and experimentation with alcohol and drugs are normative adolescent behaviors. However, these behaviors often result in negative health outcomes such as the acquisition of STDs. As a consequence of STDs, many adolescents experience serious health problems that often alter the course of their adult lives, including infertility, difficult pregnancy, genital and cervical cancer, neonatal transmission of infections, and AIDS (acquired immunodeficiency syndrome). Examples of STDs with high prevalence among sexually-active adolescents include:
Gonorrhea: Caused by the bacteria Neisseria gonorrhoeae, gonorrhea infects the reproductive tract of women, causing pelvic inflammatory disease (PID), a major cause of infertility. The bacteria are found in vaginal secretions and semen. Chlamydia: The bacteria that causes chlamydia, Chlamydia trachomatis, trigger inflammation of the reproductive tract, leading to PID in women and epididymitis (inflammation of the epididymis) in men. Syphilis: Treponema pallidum is the bacteria that causes syphilis. The course of syphilis is broken down into four distinct segments: primary syphilis, occurring within a few weeks or months of initial exposure; secondary syphilis, occurring generally between six weeks and six months of initial exposure; latent syphilis, an asymptomatic period which may stretch for years; and late syphilis,

the most serious stage. If left untreated, syphilis can infect a number of organ systems and cause serious complications. Herpes simplex virus: Two different types of HSV (HSV-1 and HSV-2) cause lesions on the genitals, although HSV-2 is associated with the majority of cases. (HSV-1 is most commonly associated with oral lesions, or "cold sores.") Human papillomavirus (HPV): HPV causes condylomata acuminata, more commonly known as venereal warts or genital warts. The warts may affect any of the external and internal genital organs in men and women. Human immunodeficiency virus (HIV). HIV is the causative agent of acquired immune deficiency syndrome (AIDS), a potentially fatal condition in which the immune system fails and the individual becomes prone to frequent and unusual infections.
Transmission

The mode of transmission varies among the different sexually transmitted diseases. Some bacteria or virus are found in vaginal secretions or semen (e.g. HIV and gonorrhea), while others are shed from the skin of and around the genitals (e.g. HSV and HPV). Infection typically occurs during sexual intercourse or when the genitals come into close contact. Infection may also occur during oral sex, such as transmission of HSV from an oral lesion to the genitals or vice versa, or transmission of HIV from genital secretions through a cut in the mouth. STDs may be transmitted during nonconsensual sex acts such as rape or molestation. The transmission of many STDs is more efficient from men to women than from women to men. For example, with just one unprotected sexual encounter with an infected partner, a woman is twice as likely as a man to acquire gonorrhea or chlamydia. In addition, different STDs have different rates of transmissibility. For example, with one exposure of unprotected sexual intercourse, a woman has a 1 percent chance of acquiring HIV, a 30 percent chance of acquiring herpes, and 50 percent chance of contracting gonorrhea if her partner is infected. Demographics STDs among sexually experienced adolescents occur at alarmingly high rates. Onefourth of the estimated 12 million new cases reported annually occur among adolescents between 15 and 19 years of age. Moreover, since many STDs are asymptomatic, they are often undiagnosed and untreated, thus increasing their potential for proliferation among adolescents. Gonorrhea and chlamydia, the most prevalent bacterial STDs, disproportionately affect adolescents. The rates of gonorrhea in adolescents ages 15 to 19 years declined between 1990 and 2004, but in the early 2000s they continue to be higher than rates for any five-year age group between 20 and 44 years, particularly among women and African Americans. Numerous prevalence studies for chlamydia have shown rates to be highest among adolescents and young adults under 25 years of age, many of whom are minorities. Rates of chlamydia reported by gender indicate that women, overall, have higher rates

than men due in large part to increased efforts in screening women for asymptomatic chlamydial infections. The low rates of chlamydia for men suggest that the sexual partners of women diagnosed with chlamydia are not being diagnosed or treated. Chlamydia has been detected in more than 10 percent of sexually experienced women during screening. While rates of syphilis declined between 1990 and 2004, the disease continues to be an important cause of sexually transmitted infection. The rate of syphilis infection among adolescents ages 15 to 19 is 1.3 per 100,000 population for males and 2.2 per 100,000 population for females. For comparison, the syphilis rates among males 20 to 24 is 5.5 per 100,000, and among females of the same age, 3.3 per 100,000. HSV and HPS occur at alarming rates among sexually experienced adolescents. Studies indicate that one in six Americans is infected with HSV-2, reflecting a ninefold increase between 1975 and 2005. Prevalence of HSV-2 in adolescents and young adults varies by the demographic and behavioral characteristics of the populations studied as well as the diagnostic methods used. As of the early 2000s approximately 4 percent of Caucasians and 17 percent of African Americans are infected with HSV-2 by the end of their teenage years. One study of young pregnant women of low income status found an HSV-2 infection rate of 11 percent in women 15 to 19 years of age and 22 percent in women 25 to 29 years of age. In 2002, there were 4,785 reported cases of AIDS among teenagers between the ages of 13 and 19, more than double the 1994 figures. Most adolescents with AIDS were infected as a result of high risk sexual and substance use behaviors. Among adolescents ages 13 to 19 years infected with HIV, 49 percent are male and 51 percent are female. Studies also indicate that African-American and Latino teens are overrepresented among persons with AIDS relative to their proportion in the population. Although these epidemiological statistics on AIDS in the United States provide a descriptive overview of the prevalence and patterns of HIV exposure in adolescents, the extent of asymptomatic HIV infection remains largely unknown. Causes and Symptoms The chance for adolescents of getting and transmitting STDs is affected by complex interrelationships between key factors (sociodemographic, biologic, psychosocial, and behavioral). For example, many STD-related risk markers (e.g. age, gender, race/ethnicity) correlate with more fundamental determinants of risk status (e.g., access to health care, living in communities with high prevalence of STDs) to influence adolescents' risk for STDs. Developmental factors such as pubertal timing, self-esteem, and peer affiliation may also increase their risk of exposure to STDs. An assessment of these interrelationships is critical to preventing and controlling STDs in adolescents. Moreover, since behavior is the common means by which STDs occur, an important first step in fighting STDs is to understand the prevalence and patterns of risk behaviors as well as the psychosocial context in which these behaviors occur.
Behavioral Factors

Although biologic factors play an important role in the transmission of STDs, it is also the health-risking behaviors of adolescents that place them at increased risk for exposure to STDs. Behavioral risk factors include the age of sexual activity, number of sexual partners, use of contraceptives, and use of alcohol and drugs. SEXUAL ACTIVITY. Early initiation of sexual intercourse has been associated with high-risk sexual activities, including ineffective use of contraceptives, multiple sex partners over a short period of time, high-risk sex partners, and acquisition of STDs and their consequences of cervical cancer and dysplasia. The average age of first sexual intercourse is between 16 and 17 years for adolescent men and between the age of 17 and 18 years for adolescent women, and has been found to be as young as age 12 in some high-risk populations. Research on adolescents' decision to initiate sexual intercourse indicates an interaction between biological and social factors. However, much remains unknown about the interactions between hormones, behavior, and social factors. The Youth Risk Behavior Surveillance System (YRBSS), a self-reported survey of a national representative sample of high school students in grades nine to 12, indicated that in 2003, 46.7 percent of the students reported having had sex. By grade level, the rates were 32.8 percent for ninth grade, 44.1 percent for tenth grade, 53.2 percent for eleventh grade, and 61.6 percent for twelfth grade. Approximately 7.4 percent of students reported having sex for the first time before age 13. Prevalence rates of sexual experience differed by race/ethnicity and gender. African-American students were significantly more likely (73.8% of males and 60.9% of females) than Caucasian (40.5% of males and 43.0% of females) and Hispanic (56.8% of males and 46.4% of females) students to have engaged in sexual intercourse. Moreover, data from the National Survey of Family Growth (NSFG), a large-scale national survey of women ages 15 to 44 years, reveal that family income is associated with adolescents' protection against HIV and many other STDs; adolescents from poor and low-income families are more likely to report an earlier age of sexual experience than their counterparts from higher income families. In addition to early sexual activity, many adolescents have multiple sex partners within a short period of time in a pattern of serial monogamy which also increases their risk of acquiring STD for two important reasons: it increases the likelihood of being exposed to a sexually transmitted pathogen, and it may reflect poor choices of sexual partners. Among the sexually experienced high school students responding to the YRBSS, 14.4 percent reported having four or more sex partners. Multiple sex partners were noted more frequently among African-American students (41.7% of males and 16.3% of females), compared to Hispanic (20.5% of males and 11.2% of females) and Caucasian (11.5% of males and 10.1% of females) students. Involuntary sexual intercourse such as rape and sexual abuse may occur more commonly among adolescents, especially younger adolescent women, and often pose a potential risk for acquisition of STDs. A study on the effects of child abuse (i.e., incest, extra-familial sexual abuse, and physical abuse) on adolescent males showed a strong association between abuse and a number of risk-taking behaviors, such as forcing female sexual partners into having sexual intercourse and drinking alcohol prior to sexual intercourse. Moreover, when sexual intercourse is intermittent, as it is

with most sexually experienced adolescents, the adolescents are less likely to take proper measures to safeguard against STDs. CONTRACEPTIVE USE. Sexually experienced adolescents are also at risk for STDs because of their patterns of contraceptive use, especially their use of barrier-method contraceptives. Some data indicate that adolescents do not use effective methods to reduce their risk of STDs or unintended pregnancies. Sexual abstinence is the only sure method of eliminating risk for STDs. When used consistently and correctly, however, condoms offer the best protection against acquisition of STDs, including HIV. Even when condoms are used improperly they reduce the risk of acquiring infections by 50 percent. The overall reported use of contraceptives, particularly condoms, has increased among adolescents between 1994 and 2004. Data from the 2003 YRBSS reveal that 63.0 percent of the students who reported sexual activity in the three months prior to the survey also reported using condoms during their last sexual encounter; this behavior was more common among males of virtually all ages and racial/ethnic groups. In contrast, 20.6 percent of adolescent women ages 15 to 19 years reported use of birth control pills. It appears that while the use of oral contraceptives provides some protection against the development of gonococcal and nongonococcal forms of PID, it may increase the risk of chlamydial endocervical infections, and provides no protection against most STDs. Differences in the types and patterns of contraceptive use by race/ethnicity, age, and socioeconomic status have also been noted. Also, adolescent women of higher income are more likely than young women of lower income to use oral contraceptives. These factors are related to access and use of medical services for reproductive health care. Thus, providing all sexually experienced adolescents with reproductive health counseling and education about the importance of consistently and correctly using barrier-method contraceptives such as condoms may play a crucial role in reducing their risk of acquiring and transmitting STDs. ALCOHOL AND OTHER DRUG USE. Use of alcohol and other drugs is prevalent among adolescents and thus poses a significant threat to their health. About 40 percent of high school youth responding to the YRBSS have used marijuana at least once with 22.4 percent of these students reporting use of this substance within 30 days before the survey. Cocaine was used at least once by 8.7 percent of the students and by 4.1 percent within 30 days of the survey. The substance of choice, however, is alcohol: 74.9 percent of students had at least one drink at some point in time and nearly half (44.9%) consumed alcohol in the 30 days prior to the survey. Among the current alcohol users, 28.3 percent had five or more drinks on at least one occasion, suggesting that a sizeable proportion of the students are periodic heavy drinkers. Grade, age, and gender differences were noted for lifetime and current use of alcohol and other illicit substances. In general, students in higher grade levels (grades 11 and 12) and males were more likely to use all substances. Racial/ethnic differences in use of substances were also found. Heavy use of alcohol was most prevalent among Caucasian and Hispanic males and females, while marijuana use was most common among African-American and Hispanic males.

Although these data strongly suggest that adolescents are at increased risk for social and physical morbidities, and even premature mortality because of their use of alcohol and other illicit substances, they underrepresent the actual prevalence of substance use among all adolescents. Teens who have dropped out or who are repeatedly absent from school and those who are homeless or otherwise disenfranchised are not represented by the reported data; many of these teens are potentially at higher risk for STDs because of their substance use behavior. Substance use prior to sexual intercourse is likely to be related to a number of risktaking behaviors: sexual intercourse with a casual acquaintance, lack of communication about use of condoms or previous sexual experiences, and no use of condoms. This association remained significant regardless of demographic factors, sexual experience, and dispositional factors such as adventure and thrill seeking. It appears that early intervention to prevent the use and abuse of alcohol and other substances may significantly decrease their risk of acquiring STDs.
Psychosocial Factors

One study of college students examined the relationship between sexual behavior, substance use, and specific constructs from social cognitive theory (i.e., perceptions of self-efficacy, vulnerability to HIV risk, social norms, negative outcome expectancies of condoms, and knowledge of HIV risk and prevention). The results indicate that although young men expected more negative outcomes of condom use and were more likely to have sexual intercourse under the influence of alcohol and other drugs, young women reported perceptions of higher self-efficacy to practice safer sex. The study further revealed that perceptions of higher self-efficacy to engage in safer sexual behaviors, perceptions of fewer negative outcomes of condom use, and less frequent alcohol and drug use with sexual intercourse were the best predictors of safer sexual behaviors.
Evaluating Std Risk

The information, motivation, and behavioral skills (IMB) model is one method of evaluating risk for STDs. This model posits that information, motivation, and behavior are the primary determinants of AIDS-related preventive behavior. Specifically, the model asserts that information regarding the transmission of HIV and information concerning specific methods of preventing HIV (e.g., condom use, decreasing the number of partners) are necessary prerequisites of reducing risk behaviors. Motivation to change risk behaviors is another determinant of prevention and affects whether a person acts on his or her knowledge of the transmission and prevention of HIV. The IMB contends that motivation to engage in prevention behaviors is a function of one's attitudes toward the behavior and of subjective norms regarding prevention behaviors. Other critical factors which are hypothesized to influence motivation to engage in prevention behaviors are perceived vulnerability to acquiring HIV, perceived costs and benefits of engaging in prevention behaviors, intention to engage in prevention behaviors regarding HIV, as well as characteristics of the sex partner and/or the sexual relationship (e.g. primary vs. secondary partner).

Behavioral skills for engaging in specific prevention behaviors are a third determinant of prevention; it affects whether a knowledgeable, highly motivated person will be able to change his or her behavior to prevent HIV. Important skills required to engage in prevention behaviors include the ability to effectively communicate with one's sex partner about safer sex, refusal to engage in unsafe sexual practices, proper use of barrier-method contraceptives, and the ability to exit a situation when prevention behaviors are not possible. In addition, individuals who are able to practice prevention skills are presumed to have a strong belief in their ability to practice these prevention behavioral skills. Overall, the IMB asserts that information and motivation trigger behavioral skills to affect the initiation and maintenance of HIV prevention behaviors.
Symptoms of Common Stds

The symptoms of some STDs may seriously affect an infected individual's quality of life or eventually become fatal, while others are so mild as to go undetected. The symptoms of some of the more prevalent STDs include:
Gonorrhea: The most common symptoms among infected adolescent girls are vaginal discharge, bleeding between menstrual cycles, and painful urination. Among adolescent boys, common symptoms are burning or painful urination and pus-like discharge from the penis. Many infections, however, remain asymptomatic in both females (32%) and males (2%). Symptoms are similar among young children who have contracted gonorrhea from a sexual abuser. Chlamydia: Symptoms of chlamydia are similar to those of gonorrhea and sometimes difficult to differentiate clinically. Chlamydial infections are more likely to be asymptomatic than gonorrheal infections and thus are of longer duration on average. Syphilis: In primarily syphilis, the characteristic symptom is the appearance of a chancre (painless ulcer) at the site of initial exposure (e.g. external genitalia, lips, tongue, nipples, or fingers). In some cases, the infected individual will experience swollen lymph glands. In secondary syphilis, the infection becomes systemic and the individual experiences symptoms such as fever, headache, sore throat, rash, and swollen glands. During latent syphilis, symptoms go unnoticed. During the late stage of syphilis, the infection has spread to organ systems and may cause blindness, signs of damage to the nervous system and heart, and skin lesions. Herpes simplex virus: The symptoms of genital herpes include burning and itching of the genital area, blisters or sores on the genitals, discharge from the vagina or penis, and/or flu-like symptoms such as headache and fever. Human papillomavirus (HPV): The warty growths of HPV can appear on the external or internal reproductive organs of males and females but are commonly found on the labia minora and the opening to the vagina in females and the penis in males. They may be small and few or combine to form larger growths. Human immunodeficiency virus (HIV): Some persons who are newly infected with HIV have rash, fever, enlarged lymph nodes, and a flu-like illness sometimes called HIV seroconversion syndrome. This initial syndrome passes without intervention, and later symptoms, when T-cells become depleted, include weight loss,

chronic cough, fever, fatigue, chronic diarrhea, swollen glands, white spots on the tongue and inside of the mouth, and dark blotches on the skin or in the mouth.
When to Call the Doctor

If a child or adolescent develops any of the symptoms of STDs, he or she should be evaluated for possible infection. Routine pelvic exams are recommended for all sexually active females and all females over the age of 18. Diagnosis A history of sexual activity is collected from all individuals at increased risk of contracting an STD, including adolescents who admit to being sexually active or who are pregnant or have undergone therapeutic abortion, adolescents or children with symptoms indicative of infection with an STD, and adolescents or children suspected of being victims of sexual abuse or rape. The healthcare provider will take a complete medical history and perform a thorough physical examination. Depending on the STD in question, additional tests may be performed such as blood work, Papanicolaou (pap) smear, rectal swabs, or biopsy. Treatment The treatment of sexually transmitted diseases varies according to the diagnosed infection. Gonorrhea, chlamydia, and syphilis are curable in most cases with antibiotics, although antibiotic-resistant strains do exist. As viruses, HSV, HPV, and HIV are treatable but not curable. The frequency and duration of HSV lesions can be reduced with antiviral therapy, including acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). Common methods to reduce genital warts include application of a topical cream called imiquimod (Aldara), cryotherapy (freezing of the wart), elecrosurgery (applying an electrical current to the wart), and surgical removal. The course of HIV infection can be slowed with a number of different kinds of drugs, including reverse transcriptase inhibitors, protease inhibitors, nonnucleoside reverse transcriptase inhibitors, and fusion inhibitors.
Alternative Treatment

A number of different alternative therapies may be pursued to treat STDs, such as the use of herbs, homeopathy, acupuncture, and nutritional supplements, although minimal research has been done to establish their efficacy.
Nutritional Concerns

In some cases, supplementation with specific nutrients may enhance immunity and minimize outbreaks. Examples are vitamin C (to boost the immune system), zinc (to reduce the frequency of HSV outbreaks), aloe (a possible antiviral), lemon balm (to speed healing), and licorice (with anti-inflammatory and antiviral effects). Prognosis

Most STDs have excellent prognoses and respond well to treatment. While HSV and HPS are not curable, outbreaks can be managed and infection generally has little effect on quality of life. HIV, however, is a potentially fatal disease which can be treated but not cured. Prevention The prevalence data on STDs, HIV, and AIDS in adolescents indicate that younger women, gay and bisexual teens, and poor, urban and racial/ethnic minority young people have higher rates of STDs and HIV relative to their peers. Primary prevention of initial STD infections through prevention and risk reduction programs are essential for stemming the tide of these sexually acquired diseases. Moreover, secondary prevention through screening at risk adolescents for asymptomatic STD infections and effectively treating the index case and his or her sexual contact(s) are the most effective means of eliminating long-term medical and psychosocial consequences from STDs. Prevention of high risk sexual, contraceptive, and substance use behaviors through cognitive-behavioral skills training and prevention and risk reduction counseling programs is a key strategy for decreasing the high incidence of STDs in adolescents. Prevention and risk reduction strategies should be developed and implemented in settings in which most adolescents can be reached, including schools or communitybased programs in which there are multiple opportunities to intervene with adolescents or clinical settings where one-to-one risk reduction counseling can occur and actual risk can be assessed.
Cognitive-Behavioral Skills Building Interventions

In order to prevent new STD infections, adolescents must not only be informed about the risk and prevention of STDs, they must also have skills to resist peer pressure, negotiate the use of condoms, and project the future consequences of their behaviors. In addition, prevention of STDs in adolescents requires that they have the necessary means, resources, and social support to develop self-regulative skills and self-efficacy to effectively reduce their risk of disease transmission. Such cognitive-behavioral skills building programs have been shown to be effective in developing skills, delaying the onset of sexual activity, and changing high risk behaviors associated with pregnancy, STDs, and HIV infection. Moreover, cognitive-behavioral skills building programs should be immediate, sustained, and cost-effective. Specifically, these programs should be designed to increase knowledge about the prevention and transmission of STDs and their consequences; formulate realistic attitudes and perceptions about personal susceptibility to acquiring infections; enhance self-efficacy and self-motivation; monitor and regulate STD-related risk behaviors; address the role of social peer norms; and develop appropriate decision-making, problem-solving, and communication skills.
Prevention and Risk Reduction Counseling

Counseling strategies to prevent and reduce the risk of STDs should be conducted in a confidential and nonjudgmental manner that is both developmental and culturally appropriate for the adolescent. Counseling should focus on a number of key elements

such as maintenance and support of healthy sexual behaviors (e.g. delaying initiation of sexual intercourse, limiting the number of sexual partners), use of barrier-method contraceptives (e.g. condoms, diaphragms, spermicide), routine medical care and advice (e.g. seeking medical care if the adolescent has participated in high-risk behavior), compliance with treatment recommendations (e.g. taking all medications as directed), and encouraging sex partners to seek medical care. Adolescents should also be informed about the myths and misconceptions of acquiring STDs. Moreover, adolescents should receive anticipatory guidance to assist them in defining appropriate options and alternatives to engaging in high-risk behaviors. Parental Concerns Parents should be encouraged to talk to their children about sexually transmitted diseases and the risks of sexual activity. By asking preteens or teenagers questions about what they knows about STDs or by using cues from television shows or newspaper articles, parents can help make their children more comfortable talking about sex and the risks of infection, thereby opening the lines of communication. It is important that adolescents be provided accurate information, even if they already have some knowledge on the topic. Research has shown teens are not more likely to have sex if they are informed about safe sex practices, but they are more likely to practice safer sex. Resources
Books

Hammerschlag, Margaret R., Sarah A. Rawstron, and Kenneth Bromberg. "Sexually Transmitted Diseases." In Krugman's Infectious Diseases of Children, 11th ed. Edited by Anne A. Gershon, Peter J. Hotez, and Samuel L. Katz. New York: Mosby, 2004. Jenkins, Renee R. "Sexually Transmitted Diseases." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman, Robert M. Kliegman, and Hal B. Jenson. Philadelphia: Saunders, 2004. MacDonald, Noni E., and David M. Patrick. "Sexually Transmitted Disease Syndromes." In Principles and Practice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long. New York: Churchill Livingstone, 2003.
Periodicals

Department of Health and Human Services, Centers for Disease Control and Prevention. "Youth Risk Behavior Surveillance: United States, 2003." Morbidity and Mortality Weekly Report 53, no. SS-2 (May 21, 2004): 1220.
Organizations

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. Web site: www.cdc.gov.
Web Sites

Divisions of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention. "HIV/AIDS Surveillance in Adolescents." Centers for Disease Control and Prevention (CDC), August 25, 2004. Available online at www.cdc.gov/hiv/graphics/adolesnt.htm (accessed January 17, 2005). Divisions of STD Prevention, National Center for HIV, STD, and TB Prevention. "Sexually Transmitted Disease Surveillance 2002 Supplement: Syphilis Surveillance Report." Centers for Disease Control and Prevention (CDC), January 2004. Available online at www.cdc.gov/std/Syphilis2002/SyphSurvSupp2002.pdf (accessed January 17, 2005). Gearhart, Peter A., et al. "Human Papillomavirus." eMedicine, December 13,, 2004. Available online at www.emedicine.com/med/topic1037.htm (accessed January 17, 2005). Lamprecht, Catherine. "Talking to Your Child about STDs." Nemours Foundation, May 2001. Available online at (accessed January 17, 2005). [Article by: Stephanie Dionne Sherk]

Encyclopedia of Public Health:

Sexually Transmitted Diseases

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Sexually transmitted diseases (STDs) are caused by a group of infectious microorganisms that are transmitted mainly through sexual activity. These agents represent a costly, burdensome global public health problem. STDs can cause harmful, often irreversible, clinical complications, including reproductive health problems, fetal and perinatal health problems, and cancer, and they are also linked in a causal chain of events to the sexual transmission of human immunodeficiency virus (HIV) infection. Although STDs are largely preventable through behavior modification and sound primary health care, they are under-recognized and underappreciated as a public health problem by most healthcare providers, the general public, and healthcare policy makers. In 1997, the Institute of Medicine characterized STDs as "hidden epidemics of tremendous health and economic consequence" in the United States and advocated urgent national preventive action. An estimated 333 million curable STDs occur annually worldwide. In the United States, STDs are among the most frequently reported infectious diseases nationwide. Each year an estimated 15 million new cases of STDs occur in Americans, including nearly 4 million infections in U.S. teenagers. The annual direct and indirect costs of the principal STDs, including sexually transmitted HIV infection, and their complications are estimated at $17 billion.

More than twenty-five bacteria, viruses, protozoa, and yeasts are considered sexually transmissible. Bacterial STDs include those caused by Chlamydia trachomatis (chlamydia), Neisseria gonorrhoeae (gonorrhea), Treponema pallidum (syphilis), Haemophilus ducreyi (chancroid), and other common sexually transmitted organisms. Chlamydia and gonorrhea cause inflammatory reactions in the host. In women, these organisms can ascend into the upper reproductive tract where pelvic inflammatory disease (PID) can cause irreparable damage to the reproductive organs and result in infertility, ectopic pregnancy, and chronic pelvic pain. In its early stages, syphilis causes painless genital ulcers and other infectious lesions. Left untreated, syphilis moves through the body in stages, damaging many organs over time. Chancroid is associated with painful genital lesions. In pregnant women, acute bacterial STDs can cause potentially fatal congenital infections or perinatal complications, such as eye and lung infections in the newborn. Effective single-dose antimicrobials can cure chlamydia, gonorrhea, syphilis, and chancroid. Viral STDs include the sexually transmitted viral infections caused by human immunodeficiency virus (HIV infection), herpes simplex virus type 2 (genital herpes), and human papillomavirus (HPV infection). Initial infections with these organisms may be asymptomatic or cause only mild symptoms. Treatable but not curable, viral STDs appear to be lifelong infections. HIV is the virus that causes acquired immunodeficiency syndrome (AIDS). Herpes causes periodic outbreaks of painful genital lesions. Some strains of HPV cause genital warts, and others are important risk factors for cervical dysplasia and invasive cervical cancer. Hepatitis B virus (HBV) is another acute viral illness that can be transmitted through sexual activity. Most persons who acquire HBV infection recover and have no complications, but it can sometimes become a chronic health problem. Trichomonas vaginalis (trichomoniasis) is a common protozoal STD, and Candida species (candidiasis) are sexually transmitted yeasts. Both are frequently associated with vaginal discharge. Biological Factors in the Spread of Stds STDs are behavior-linked diseases that result from unprotected sex. Nonetheless, several biological factors contribute to their spread. These include the asymptomatic nature of STDs, the long lag time between infections and complications, the higher susceptibility of women to STDs, and the way that STDs facilitate the transmission of HIV infection. The silent nature of STDs represents their greatest public health threat. Most STDs cause some symptomatic illness, but many produce symptoms so mild or nonspecific that infected persons are not alerted to seek medical care. As many as one in three men and two in three women with chlamydia infection have no obvious signs of infection. Without treatment or other interventions, infected persons can continue to infect new sex partners. Moreover, serious complications that cause irreversible damage can occur "silently" before any symptoms are apparent. A related problem is the long interval that can elapse between acquiring an STD and recognizing a clinically significant health problem. Women can develop cervical cancer many years after infection with some strains of HPV. A woman may first suspect she had an asymptomatic infection with chlamydia or gonorrhea when she finds out later in life

that she is infertile or has an ectopic pregnancy. Because the original infection was likely to have been asymptomatic, there is frequently no perceived connection between the original sexually acquired infection and the resulting health problem. The lack of awareness of this connection leads people to underestimate their risk and to forego preventive precautions. Gender and age are also associated with increased risk for STDs. Women are at higher risk than men for most STDs, and young women are more susceptible to certain infections than older women. Due to cervical ectopy that is extremely common in adolescent females, the immature cervix of adolescent females is covered with cells that are especially susceptible to STDs such as chlamydia. The presence of other STDs, especially those that cause genital ulcers or inflammation, influences the sexual transmission and acquisition of HIV infection. Studies have repeatedly demonstrated that people are two to five times more likely to become infected with HIV through sexual contact when other STDs are present. In addition, dually infected persons (persons who are infected with both HIV and another STD) are more likely to transmit HIV infection during sexual contact. Conversely, effective STD detection and treatment can slow the spread of HIV infection at the individual and community levels. For example, in a study in Malawi in the mid-1990s, treatment of gonorrhea in HIV-infected men returned the frequency and concentration of HIV genetic material in semen to levels comparable to levels found in HIV-infected men who were not infected with other STDs. Similarly, a community trial in Tanzania in the mid-1990s demonstrated that treatment of symptomatic STDs resulted in a 42-percent decrease in new heterosexually transmitted HIV infections. Social Factors That Affect the Spread of Stds Some social factors directly affect STD spread especially in vulnerable populations. In addition, the stigma that continues to surround STDs in the United States indirectly interferes with establishing new social norms pertaining to sex and sexuality. When there are barriers to health care, it is difficult to detect and treat STDs early. Infected persons also miss an opportunity for behavioral change counseling. Health care access barriers keep infected persons in the community where they continue to spread STDs. In the United States, groups with the highest rates of STDs are the same groups in which access to health care services is limited or absent. Perhaps the greatest social factor contributing to the spread of STDs, and the factor that most significantly separates the United States from industrialized countries with low STD rates, is the stigma that continues to be associated with sexually transmitted infections. Although sex and sexuality pervade many aspects of American culture, most Americans are secretive and private about their sexual behavior. Talking openly and comfortably about sex and sexuality is difficult even in intimate relationships. This secrecy about sexuality and STDs adversely affects STD prevention in the United States by thwarting sexuality and STD education programs for adolescents, hindering communication between parents and children and between sex partners, promoting unbalanced sexual messages in the media, obstructing education and counseling activities, and impeding research on sexual behaviors.

Groups Disproportionately Affected By Stds All racial, cultural, economic, and religious groups are affected by STDs, and people in all communities and sexual networks are at risk. Nevertheless, some persons are disproportionately affected by STDs and their complications. STDs disproportionately affect disenfranchised persons and individuals who are in social networks characterized by high-risk sexual behaviors, substance abuse, and limited access to health care. Some notable disproportionately affected groups include sex workers, homeless persons and runaways, adolescents and adults in detention, and migrant workers. Many studies document the association of substance use, especially alcohol and drug use, with STDs. The introduction of illicit substances into communities can dramatically alter sexual behavior in high-risk sexual networks leading to epidemic spread of STDs. The national U.S. syphilis epidemic of the late 1980s was fueled by the effect of increased crack cocaine use, especially in minority communities. Crack cocaine led to increases in sex exchanged for drugs and in the number of anonymous sex partners and decreased health care-seeking behavior and motivation to use barrier protectionall factors that can increase STD transmission in a community. Other substances, including alcohol, can also affect a person's cognitive and negotiating skills before and during sex, lowering the likelihood that preventive action will be taken to protect against STDs and pregnancy. Gender disparities are an important aspect of the epidemiology of STDs. Compared to men, women suffer more frequent and serious STD complications, including PID, ectopic pregnancy, infertility, and chronic pelvic pain. Women are biologically more susceptible to infection when exposed to a sexually transmitted agent, and STDs are often more easily transmitted from a man to a woman than from a woman to a man. Given that some newly acquired STDs (and even some long-term complications) are only mildly symptomatic or completely asymptomatic in women, the combination of increased susceptibility and silent infection frequently results in delayed STD diagnosis and treatment. A further complication is that STDs are more difficult to diagnose in women due to the complex anatomy of the female reproductive tract and the frequent need for a speculum examination and diagnostic culture tests. In pregnant women, STDs can result in serious health problems or death to a developing fetus or newborn. Sexually transmitted pathogens can be transmitted across the placenta, resulting in congenital infection, or can reach the newborn during vaginal childbirth, resulting in perinatal infection. Regardless of the route of infection, these organisms can permanently damage the fetal or newborn brain, spinal cord, eyes, auditory nerves, or immune system. Even when the organisms do not reach the fetus or newborn directly, they can cause spontaneous abortion, stillbirth, premature rupture of the membranes, and preterm delivery. For a variety of behavioral, social, and biological reasons, STDs also disproportionately affect adolescents. In 1998, U.S. teenagers 15 to 19 years old had the highest reported rate of chlamydia and the second highest rate of gonorrhea. The herpes infection rate among white youth in the United States aged twelve to nineteen increased nearly fivefold from the late 1970s to the early 1990s. Because not all teenagers are sexually active, the actual rate of STDs among teens is even higher than the observed rates suggest. There are several contributing factors. Many teenagers are,

in fact, sexually active and at risk for STDs, and they are having sex with partners from sexual networks that are already highly infected with untreated STDs. In 1999, among U.S. high school youth interviewed for the Youth Risk Behavior Surveillance System survey, half (49.9%) indicated they had had sexual intercourse during their lifetimes. Early sexual activity and multiple sexual partners were commonly reported among American high school youth; 8.3 percent of students indicated they had first had sex before age thirteen, and 16.2 percent said they had four or more sex partners during their lifetime. Despite the supposedly easy access to condoms that can lower STD transmission risk considerably, only 58 percent of sexually active students said they used a condom the last time they had intercourse. Sexually active teenagers are often reluctant to seek STD services or face serious obstacles to obtaining such services. In addition, health care providers are often uncomfortable discussing sexuality and risk reduction with young persons. Some minority racial and ethnic groups (mainly black and Hispanic populations) in the United States have higher rates of STDs compared with rates for whites. Race and ethnicity in the United States are risk markers that correlate with other more fundamental determinants of health status such as poverty, access to quality health care, health care-seeking behavior, illicit drug use, and living in communities with high STD prevalence. Public health data may over-represent STDs among racial and ethnic groups who are more likely to receive STD services from public sector STD clinics characterized by timely and complete reporting of public health statistics. However, even when random sampling techniques are used to study health problems, higher rates of STDs are often found among African Americans and Hispanics compared with whites. Factors Important to the Prevention and Control of Stds The dynamics of how STDs spread in populations have been studied extensively to derive approaches to prevention and control. Three main factors predict how fast and at what level STDs will spread in a population: the nature of sexual relationships, the degree to which susceptibility to STDs can be modified, and the timeliness and completeness of treatment. The nature of sexual relationships refers to the decisions people make about when to become and remain sexually active and whom to select as sex partners. The earlier that vaginal, oral, or anal sexual intercourse begins and the greater the number of lifetime sex partners, the more likely a person is to acquire one or more STDs in a lifetime. Behavioral interventions that help delay the initiation of intercourse and reduce the lifetime number of sex partners will have a positive effect on slowing STD transmission. Susceptibility to STDs can be modified with vaccines or barrier contraceptives such as condoms. If uninfected persons are somehow immune to STDs, then no transmission will occur. The availability of effective vaccines against STDs could dramatically slow increases in or even eliminate some STDs. For example, there is an effective and widely available vaccine for hepatitis B, a viral STD. Current strategies to immunize all children against hepatitis B before they become sexually active could greatly reduce the societal burden of this disease. Susceptibility can also be altered each time sex occurs. The correct and consistent use of condoms can reduce the rate

of STD transmission in a population. Persons who choose to engage in sexual behaviors that place them at risk of STDs should use latex or polyurethane condoms every time they have sex. A condom put on the penis before starting sex and worn until the penis is withdrawn can help protect both the male and the female partner from most STDs. When a male condom cannot be used appropriately, sex partners should consider using a female condom. However, condoms do not provide complete protection from all STDs. Sores and lesions of STDs on infected men and women may be present in areas not covered by the condom, resulting in transmission of infection to a new person. This is common with genital warts and other genital HPV infections. Although condom use has been on the rise in the United States over the past few decades, women who use the most effective forms of contraception (sterilization and hormonal contraception) are less likely than other women to use condoms for STD prevention. The most effective methods of contraception are not the most effective methods of STD prevention; likewise, methods that give a considerable measure of protection against STDs are considered to be good, but not the most effective, methods of pregnancy prevention. This suggests that, especially for young women who are at highest risk for unwanted pregnancy and STDs, using dual protection (condoms and hormonal contraception) will offer the best overall protection against both. The third factor in STD prevention and control focuses on finding and treating infected persons and their sex partners. The longer someone has an untreated STD (especially if the person is asymptomatic), the longer that person can potentially infect others. If that interval can be shortened for the millions of persons who acquire STDs each year, then transmission would slow appreciably. Screening and treatment are the biomedical approaches that can be applied to this situation. For STDs that are frequently asymptomatic, screening and treatment also benefit those likely to suffer severe complications (especially women) if infections are not detected and treated early. For example, in the early 1990s, chlamydia screening in a large metropolitan managed-care organization reduced the incidence of subsequent PID in the screened group by 40 percent. Identifying and treating partners of persons with curable STDs has always been an integral part of organized control programs. Theoretically, this can break the chain of transmission in a sexual network. Early antibiotic treatment of a sex partner can interfere with an STD taking hold in a recently exposed person. Partner treatment benefits the original patient by reducing the risk of reinfection, and the partner benefits by avoiding acute infection and potential complications. Because future sex partners are protected by treating partners, this strategy also benefits the community. New screening tests (some of which can be performed on urine specimens) that facilitate STD screening in nontraditional settings are now available. Many examples demonstrate the effectiveness of organized approaches to STD prevention and control that incorporate these strategies on a large scale. When a sustained, collaborative, multifaceted approach to STD prevention and control is undertaken, dramatic results can be achieved. One need only observe the results of sustained STD prevention efforts in many countries in Western and Northern Europe, Canada, Japan, and Australia, where STD rates are many times lower than in the United States, to conclude that STD prevention programs can work on a national scale.

Bibliography American Social Health Association (1998). Sexually Transmitted Diseases in America: How Many Cases and at What Cost? Menlo Park, CA: Kaiser Family Foundation. Anderson, J.; Brackhill, R.; and Mosher, W. (1996). "Condom Use for Disease Prevention among Unmarried U.S. Women." Family Planning Perspectives 28:2528, 39. Anderson, R. M., and May, R. M. (1991). Infectious Diseases of Humans: Dynamics and Control. Oxford: Oxford University Press. Centers for Disease Control and Prevention (1998). "1998 Guidelines for Treatment of Sexually Transmitted Diseases." Morbidity and Mortality Weekly Report 47(RR1):1116. (1999). Sexually Transmitted Disease Surveillance, 1998. Atlanta, GA: Centers for Disease Control and Prevention, 1115. (2000). "Youth Risk Behavior Surveillance: United States, 1999." Morbidity and Mortality Weekly Report 49(SS-5). Cohen, M. S.; Hoffman, I. F.; Royce, R. A. et al. (1997). "Reduction of Concentration of HIV-1 in Semen after Treatment of Urethritis: Implications for Prevention of Sexual Transmission of HIV-1." Lancet 349:18681873. Fleming, D. T.; McQuillan, G. M.; Johnson, R. E. et al. (1997). "Herpes Simplex Virus Type 2 in the United States: 19761994." New England Journal of Medicine 337:11051111. Goldenberg, R. L.; Andrews, W. W.; Yuan, A. C. et al. (1997). "Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy." Clinics in Perinatology 24(1):2341. Grosskurth, H.; Mosha, F.; Todd, J. et al. (1995). "Impact of Improved Treatment of Sexually Transmitted Diseases on HIV Infection in Rural Tanzania: Randomised Controlled Trial." Lancet 346:530536. Gunn, R.; Montes, J.; Tomey, K. et al. (1995). "Syphilis in San Diego County, 1983 1992: Crack Cocaine, Prostitution, and the Limitations of Partner Notification." Sexually Transmitted Diseases 22:6066. Hillis, S.; Nakashima, A.; Amsterdam, L. et al. (1995). "The Impact of a Comprehensive Chlamydia Prevention Program in Wisconsin." Family Planning Perspectives 27:108111. Holmes, K.; Mardh, P.; Sparling, P. et al., eds. (1999). Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill.

Institute of Medicine. Committee on Prevention and Control of Sexually Transmitted Diseases (1997). The Hidden Epidemic: Confronting Sexually Transmitted Diseases, eds. T. R. Eng and W. T. Butler. Washington, DC: National Academy Press. Scholes, D.; Stergachis, A.; Heidrich, F. et al. (1996). "Prevention of Pelvic Inflammatory Disease by Screening for Cervical Chlamydial Infection." New England Journal of Medicine 334:13621366. St. Louis, M. E.; Wasserheit, J. N.; and Gayle, H. D. (1997). "Editorial: Janus Considers the HIV Pandemic: Harnessing Recent Advances to Enhance AIDS Prevention." American Journal of Public Health 87:1012. Tsui, A.; Wasserheit, J.; and Haaga, J. (1997). Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions. Washington, DC: National Academy Press. ALLISON L. GREENSPAN; JOEL R. GREENSPAN

US Military History Companion:

Sexually Transmitted Diseases

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Venereal diseases, or as the military currently defines them, sexually transmitted diseases (STDs), occur most often in sexually active people less than twentyfour years of age. Because military forces historically have consisted of mostly young people, predominantly young men, often sexually active, the incidence of STD in military personnel has always been two to three times that of a similar matched group of civilians. This rate can rise five to eight times higher during wartime. Some form of STDs seems to have plagued military forces from earliest recorded history. Herodotus in the fifth century B.C.E. wrote that Scythian soldiers who pillaged the Celestial Temple of Venus were infected with a female disease that afflicted all of their descendants. The first recorded cases of syphilis appeared in Europe in 1493 supposedly among Spanish sailors returning from the New World. Spanish and French armies soon spread what was called the Neapolitan disease or the French pox throughout Europe. Historically, two methods have been advocated for controlling rates of STDs in the U.S. military: punishment of soldiers and support for regulation of civilian conveyors of the disease through regular examination and treatment of prostitutes. Traditionally when rates became high, particularly in wartime, regulation was enforced; when rates returned to baseline levels, the military either ignored the problem or relied upon

punitive action. Such shifts in policy occurred during the Civil War, the Spanish American War, and World War I. The primary reason was that the methods of treatment, which consisted chiefly of local applications of antiseptics (containing arsenic, mercury, and bismuth), were only marginally effective. In addition, infected soldiers often did not develop a persistent and immediately debilitating illness, although they often became asymptomatic and infectious carriers. During World War I, the military public health authorities sought to eliminate prostitution in the areas around U.S. military and naval bases. During World War II, the public health authorities encouraged publicity about venereal disease, breaking a long taboo on public discussion. The advent of antibiotics, especially penicillin, had a dramatic impact on STDs, primarily gonorrhea and syphilis. Another effective preventive measure was the use of condoms, which were distributed to all members of the armed forces. STDs reemerged as a major problem in the military in the 1960s and 1970s as a result of several new developments. In the wider society, the sexual revolution in attitudes and behavior meant that sexual encounters were more readily accepted as a social norm. There was also indiscriminate use of antibiotics, thus reducing their effectiveness. And in 1976, new resistant strains of gonorrhea emerged first in the Far East, then in the United States which within a decade rendered many antibiotic treatments useless. Further, new sexuallytransmitted viral agents emerged: herpes; venereal warts (Papilloma virus); hepatitis B; and the deadly AIDS virus, HIV. STDs have always been a problem for the military. Attempts to control them by changing behavior have had a significant, if temporary, impact. But recent resistant microorganisms and new STDs threaten to bring back the high prevalence rate that existed before antibiotics. [See also Casualties; Demography and War.] Bibliography
U.S. Army, Medical Department, Preventive Medicine in World War II, Vol. V: Communicable Diseases, ed. John B. Coates, Ebbe C. Haff, and Phebe M. Hoff, 1960. Stanhope BayneJones, The Evolution of Preventive Medicine in the United States Army, 16061939, 1968. Edmund C. Tramont, AIDS and Its Impact on Medical Readiness, Military Review, 6 (1990), pp. 4858

US History Encyclopedia:

Sexually Transmitted Diseases

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Sexually transmitted diseases (STDs) are infections communicated between persons through sexual intercourse or other intimate sexual contact. In the early 1970s, as the

number of recognized STDs grew, the World Health Organization adopted the term to supersede the five diseases that collectively had been called venereal diseases (VD), chancroid, gonorrhea, granuloma inguinal, lymphogranuloma venereum, and syphilis. More than sixty other infections of bacteria, protozoa, fungi, and viruses that can be transmitted sexually have been added to the designation. Of the venereal diseases, gonorrhea and syphilis were the most prevalent in the United States before World War II. Because of the social stigma attached to the diseases and the difficulty in diagnosing them, statistics of their incidence are often unreliable when available at all. One 1901 study concluded that as many as eighty of every one hundred men in New York City suffered an infection of gonorrhea at some time. The same study reported 5 to 18 percent of all men had syphilitic infections. Progressive Era reformers and social critics pointed to the high incidence of venereal diseases and the moral and public health threats they posed to families and communities as evidence of a cultural crisis. Combating venereal diseases was an important component of the social hygiene movement during this period. The high rates of venereal diseases among military personnel also led the U.S. War Department to institute far-reaching anti-VD campaigns during World Wars I and II. Soldiers were told that VD, like the enemy on the battlefield, threatened not only their health but America's military strength. The reform impulse that began during the Progressive Era and World War I subsided until the 1930s, when the U.S. Public Health Service renewed efforts against syphilis and gonorrhea, resulting in the 1938 passage of the National Venereal Disease Control Act. Disease control efforts in the 1930s included requiring mandatory premarital tests for VD in many states. Widespread disease testing and the introduction of penicillin in 1943 contributed to declining VD rates after World War II. But by the late 1950s the rates began a steady increase that persisted with liberal sexual attitudes in the 1960s and 1970s. During the 1980s the global pandemic of Acquired Immune Deficiency Syndrome (AIDS) overshadowed other STDs. Between 1981 and 2000, 774,467 cases of AIDS were reported in the United States; 448,060 people died of AIDS. Nearly 1 million other Americans were also infected by the human immunodeficiency virus (HIV), the virus that causes AIDS. The development of powerful antiretroviral therapies during the 1990s prolonged the lives of many Americans infected by HIV or suffering from AIDS. In 2000, 65 million people in the United States were living with an incurable STD, and annually approximately 15 million new cases of STDs were diagnosed, of which nearly half were incurable. Of particular concern to public health officials was that nearly one-fourth of new STD infections occurred in teenagers. Also of concern was that STDs affected women and African Americans in disproportionately greater numbers and with more complications. The rates of gonorrhea and syphilis, for instance, were thirty times higher for African Americans than for whites. The most common STDs were bacterial vaginosis, chlamydia, gonorrhea, hepatitis B, herpes, human papillomavirus (hpv), syphilis, and trichomoniasis. Incidence and prevalence vary dramatically from disease to disease. The incidence of some diseases, such as syphilis, reached a historic low in the late 1990s, while those

of other diseases, such as chlamydia, genital herpes, and gonorrhea, continued to increase during the same period. STDs also pose an economic cost. The costs of the major STDs and their complications totaled almost $17 billion in 1994. With the emergence of antibiotic-resistant strains of once-treatable STDs, the problem has persisted as a major public health concern.
Bibliography

Brandt, Allan M. No Magic Bullet: A Social History of Venereal Disease in the United States since 1880. New York: Oxford University Press, 1985. National Center for HIV, STD, and TB Prevention, Division of Sexually Transmitted Diseases. Tracking the Hidden Epidemics, 2000: Trends in STDs in the United States. Atlanta: Centers for Disease Control and Prevention, 2001. Poirier, Suzanne. Chicago's War on Syphilis, 193740: The Times, The Trib, and the Clap Doctor. Urbana: University of Illinois Press, 1995. Shilts, Randy. And the Band Played On: Politics, People, and the AIDS Epidemic. New York: St. Martin's Press, 1987. Smith, Raymond A., ed. Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic. New York: Penguin, 2001.

Columbia Encyclopedia:

sexually transmitted disease

Top Home > Library > Miscellaneous > Columbia Encyclopedia sexually transmitted disease (STD) or venereal disease, term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, lymphogranuloma venereum, and chancroid. In the 1960s up to 20 other diseases were recognized as being transmitted by sexual contact, and the term "sexually transmitted disease" came into use. Some of the more common of these are AIDS, genital herpes (see herpes simplex), chlamydia, and human papillomavirus. Other diseases or infestations that can be transmitted sexually include giardiasis, amebiasis, scabies, pubic "crab" lice (see louse), hepatitis (A, B, and C), group B streptococcal infections (see streptococcus), cytomegalovirus infection, and the protozoan infection trichomoniasis.

STDs are generally graver in women, in whom diagnosis is often more difficult and treatment less available than for men; untreated they can lead to infertility or cause miscarriage, premature birth, or infection of the newborn. In some instances two or

more infections may be present concurrently. The spread of sexually transmitted AIDS increased dramatically during the 1980s and continued through the 1990s. Other STDs are often seen in tandem with AIDS, partly because open sores that they produce can provide an easy route for the AIDS virus to enter the body. In the 2007 it was estimated that 19 million new cases of STDs were contracted in the United States each year. Granuloma inguinale is caused by Calymmatobacterium granulomatis and is common in tropical and subtropical regions. Early lesions appear as painless, red, open sores on the skin of the genital and pelvic regions, succeeded by a spreading ulceration of the tissues. If not treated, the condition becomes chronic and may lead to death through anemia and general debility. Antibiotics such as tetracycline can eliminate the infection. Lymphogranuloma venereum, also common in tropical and subtropical regions, is caused by a strain of Chlamydia trachomatis, an organism classified as a bacterium but having some viral characteristics. The primary genital lesion is often overlooked. The lymphatic structures about the pelvic and rectal region then become involved; blockage of such structures may cause disfigurement and scarring of external genitals. Fever and headache are other constitutional symptoms. Severe involvement of the rectal mucosa may cause intestinal obstruction or stricture. Tetracycline is the drug of choice, although other antibiotics are effective. Chancroid is an acute localized infection caused by a bacterium called Hemophilus ducreyi. It can result in painful ulcerations of the skin, usually in the groin. In women symptoms may be absent or limited to painful urination, defecation, or intercourse. Involvement of the lymph nodes occurs in more than half the cases. Usually the disease is self-limited, but it may cause severe destruction of tissue. Antibiotics have been effective in treatment, but resistant strains are an increasing problem. In order to reduce ignorance and thereby decrease the risk of venereal infection, the U.S. government just before and after World War II encouraged publicity on the matter, for the taboo long associated with public discussion of these contagious diseases had given rise to serious public-health problems. A nationwide campaign was initiated in 1937 by Thomas Parran, then serving as U.S. surgeon general, to educate the public about the incidence, cause, and cure of venereal diseases. As a result, the number of new cases in the United States steadily declined each year until the 1950s, when a rise was noted, especially among teenagers and young adults. In 1998, concerned by high U.S. rates of such common STDs as human papillomavirus, genital herpes, and chlamydia, as well as local outbreaks of syphilis and gonorrhea, the Centers for Disease Control and Prevention began a new far-reaching campaign to combat STDs. Public authorities and private agencies coordinate their efforts to identify and isolate promptly all sources of infection. Worldwide, despite advances in diagnosis and treatment, the incidence of STDs has continued to rise and has reached epidemic proportions in many countries. Among the factors believed responsible for increases are changes in sexual behavior (e.g., the use of oral contraceptives), the emergence of drug-resistant strains, symptomless carriers, a highly mobile population, lack of public education, and the reluctance of patients to seek treatment.

Bibliography See T. Rosebury, Microbes and Morals (1971); K. L. Jones et al., VD (1974); J. Jacobson, Women's Reproductive Health (1991).
Health Dictionary:

sexually transmitted diseases

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Diseases that can be passed to other persons through sexual contact. AIDS, gonorrhea, herpes, and syphilis are examples of sexually transmitted diseases.
Wikipedia:

Sexually transmitted disease

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Sexually Transmitted Infections

Classification and external resources

Spanish Civil War poster, produced by the Republican government, saying "Avoid venereal diseases ... As dangerous as enemy bullets" ICD-10 ICD-9 DiseasesDB MeSH A64. 099.9 27130 D012749

A sexually transmitted disease (STD), also known as sexually transmitted infection (STI) or venereal disease (VD), is an illness that has a significant probability of transmission between humans or animals by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex. While in the past, these illnesses have mostly been referred to as STDs or VD, in recent years the term sexually transmitted infection (STI) has been preferred, as it has a broader range of meaning; a person may be infected, and may potentially infect others, without showing signs of disease. Some STIs can also be transmitted via the use of IV drug needles after its use by an infected person, as well as through childbirth or breastfeeding. Sexually transmitted infections have been well known for hundreds of years.
Contents [hide]

1 Classification and terminology o 1.1 Bacterial o 1.2 Fungal o 1.3 Viral

1.4 Parasites 1.5 Protozoal 1.6 Sexually transmitted enteric infections 2 Pathophysiology 3 Prevention o 3.1 Vaccines o 3.2 Condoms o 3.3 Nonoxynol-9 4 Diagnosis 5 Treatment 6 Epidemiology 7 History 8 See also 9 References
o o o

10 External links

Classification and terminology

Until the 1990s, STDs were commonly known as venereal diseases : Veneris is the Latin genitive form of the name Venus, the Roman goddess of love. Social disease was another euphemism. Public health officials originally introduced the term sexually transmitted infection, which clinicians are increasingly using alongside the term sexually transmitted disease in order to distinguish it from the former. According to the Ethiopian Aids Resource Center FAQ, "Sometimes the terms STI and STD are used interchangeably. This can be confusing and not always accurate, so it helps first to understand the difference between infection and disease. Infection simply means that a germvirus, bacteria, or parasitethat can cause disease or sickness is present inside a persons body. An infected person does not necessarily have any symptoms or signs that the virus or bacteria is actually hurting his or her body; they do not necessarily feel sick. A disease means that the infection is actually causing the infected person to feel sick, or to notice something is wrong. For this reason, the term STIwhich refers to infection with any germ that can cause an STD, even if the infected person has no symptomsis a much broader term than STD."[1] The distinction being made, however, is closer to that between a colonization and an infection, rather than between an infection and a disease. Specifically, the term STD refers only to infections that are causing symptoms. Because most of the time people do not know that they are infected with an STD until they start showing symptoms of disease, most people use the term STD, even though the term STI is also appropriate in many cases. Moreover, the term sexually transmissible disease is sometimes used since it is less restrictive in consideration of other factors or means of transmission. For instance, meningitis is transmissible by means of sexual contact but is not labeled as an STI because sexual contact is not the primary vector for the pathogens that cause meningitis. This discrepancy is addressed by the probability of infection by means

other than sexual contact. In general, an STI is an infection that has a negligible probability of transmission by means other than sexual contact, but has a realistic means of transmission by sexual contact (more sophisticated meansblood transfusion, sharing of hypodermic needlesare not taken into account). Thus, one may presume that, if a person is infected with an STI, e.g., chlamydia, gonorrhea, genital herpes, it was transmitted to him/her by means of sexual contact. The diseases on this list are most commonly transmitted solely by sexual activity. Many infectious diseases, including the common cold, influenza, pneumonia, and most others that are transmitted person-to-person can also be transmitted during sexual contact, if one person is infected, due to the close contact involved. However, even though these diseases may be transmitted during sex, they are not considered STDs.

Bacterial

Chancroid (Haemophilus ducreyi) Chlamydia (Chlamydia trachomatis) Granuloma inguinale or (Klebsiella granulomatis) Gonorrhea (Neisseria gonorrhoeae) Syphilis (Treponema pallidum)

Fungal
Tinea cruris "Jock Itch" (Trichophyton rubrum and others) Sexually transmissible Candidiasis or "yeast Infection"

Viral

Micrograph showing the viral cytopathic effect of herpes (ground glass nuclear inclusions, multi-nucleation). Pap test. Pap stain. Viral hepatitis (Hepatitis B virus)saliva, venereal fluids. (Note: Hepatitis A and Hepatitis E are transmitted via the fecal-oral route; Hepatitis C (liver cancer) is rarely sexually transmittable,[2] and the route of transmission of Hepatitis D (only if infected with B) is uncertain, but may include sexual transmission.[3][4][5])

Herpes simplex (Herpes simplex virus 1, 2) skin and mucosal, transmissible with or without visible blisters HIV/ AIDS (Human Immunodeficiency Virus) venereal fluids HPV (Human Papilloma Virus) skin and mucosal contact. 'High risk' types of HPV are known to cause most types of cervical cancer, as well as anal, penile, and vulvar cancer, and genital warts. Molluscum contagiosum (molluscum contagiosum virus MCV) close contact

Parasites

Crab louse, colloquially known as "crabs" (Phthirius pubis) Scabies (Sarcoptes scabiei)

Protozoal

Trichomoniasis (Trichomonas vaginalis)

Sexually transmitted enteric infections

Various bacterial (Shigella, Campylobacter, or Salmonella), viral (Hepatitis A, Adenoviruses), or parasitic (Giardia or amoeba) pathogens are transmitted by sexual practices that promote anal-oral contamination (fecal-oral). Sharing sex toys without washing or multiple partnered barebacking can promote anal-anal contamination. Although the bacterial pathogens may coexist with or cause proctitis, they usually produce symptoms (diarrhea, fever, bloating, nausea, and abdominal pain) suggesting disease more proximal in the GI tract.

Pathophysiology
Many STDs are (more easily) transmitted through the mucous membranes of the penis, vulva, rectum, urinary tract and (less oftendepending on type of infection) [citation needed] the mouth, throat, respiratory tract and eyes. The visible membrane covering the head of the penis is a mucous membrane, though it produces no mucus (similar to the lips of the mouth). Mucous membranes differ from skin in that they allow certain pathogens into the body.[6] Pathogens are also able to pass through breaks or abrasions of the skin, even minute ones. The shaft of the penis is particularly susceptible due to the friction caused during penetrative sex. The primary sources of infection in ascending order are venereal fluids, saliva, mucosal or skin (particularly the penis), infections may also be transmitted from feces, urine and sweat.[7] The amount required to cause infection varies with each pathogen but is always less than you can see with the naked eye. This is one reason that the probability of transmitting many infections is far higher from sex than by more casual means of transmission, such as non-sexual contact touching, hugging, shaking handsbut it is not the only reason. Although mucous membranes exist in the mouth as in the genitals, many STIs seem to be easier to transmit through oral sex than through deep kissing. According to a safe sex chart, many infections that are easily transmitted from the mouth to the genitals or from the genitals to the mouth, are much harder to transmit from one mouth to another.[8] With

HIV, genital fluids happen to contain much more of the pathogen than saliva. Some infections labeled as STIs can be transmitted by direct skin contact. Herpes simplex and HPV are both examples. KSHV, on the other hand, may be transmitted by deepkissing but also when saliva is used as a sexual lubricant. Depending on the STD, a person may still be able to spread the infection if no signs of disease are present. For example, a person is much more likely to spread herpes infection when blisters are present (STD) than when they are absent (STI). However, a person can spread HIV infection (STI) at any time, even if he/she has not developed symptoms of AIDS (STD). All sexual behaviors that involve contact with the bodily fluids of another person should be considered to contain some risk of transmission of sexually transmitted diseases. Most attention has focused on controlling HIV, which causes AIDS, but each STD presents a different situation. As may be noted from the name, sexually transmitted diseases are transmitted from one person to another by certain sexual activities rather than being actually caused by those sexual activities. Bacteria, fungi, protozoa or viruses are still the causative agents. It is not possible to catch any sexually transmitted disease from a sexual activity with a person who is not carrying a disease; conversely, a person who has an STD got it from contact (sexual or otherwise) with someone who had it, or his/her bodily fluids. Some STDs such as HIV can be transmitted from mother to child either during pregnancy or breastfeeding. Although the likelihood of transmitting various diseases by various sexual activities varies a great deal, in general, all sexual activities between two (or more) people should be considered as being a two-way route for the transmission of STDs, i.e., "giving" or "receiving" are both risky although receiving carries a higher risk. Healthcare professionals suggest safer sex, such as the use of condoms, as the most reliable way of decreasing the risk of contracting sexually transmitted diseases during sexual activity, but safer sex should by no means be considered an absolute safeguard. The transfer of and exposure to bodily fluids, such as blood transfusions and other blood products, sharing injection needles, needle-stick injuries (when medical staff are inadvertently jabbed or pricked with needles during medical procedures), sharing tattoo needles, and childbirth are other avenues of transmission. These different means put certain groups, such as medical workers, and haemophiliacs and drug users, particularly at risk. Recent epidemiological studies have investigated the networks that are defined by sexual relationships between individuals, and discovered that the properties of sexual networks are crucial to the spread of sexually transmitted diseases. In particular, assortative mixing between people with large numbers of sexual partners seems to be an important factor. It is possible to be an asymptomatic carrier of sexually transmitted diseases. In particular, sexually transmitted diseases in women often cause the serious condition of pelvic inflammatory disease.

Prevention
Main article: Safe sex

Prevention is key in addressing incurable STIs, such as HIV & herpes. The most effective way to prevent sexual transmission of STIs is to avoid contact of body parts or fluids which can lead to transfer with an infected partner. No contact minimizes risk. Not all sexual activities involve contact: cybersex, phonesex or masturbation from a distance are methods of avoiding contact. Proper use of condoms reduces contact and risk. Ideally, both partners should get tested for STIs before initiating sexual contact, or before resuming contact if a partner engaged in contact with someone else. Many infections are not detectable immediately after exposure, so enough time must be allowed between possible exposures and testing for the tests to be accurate. Certain STIs, particularly certain persistent viruses like HPV, may be impossible to detect with current medical procedures. Many diseases that establish permanent infections can so occupy the immune system that other diseases become more easily transmitted. The innate immune system led by defensins against HIV can prevent transmission of HIV when viral counts are very low, but if busy with other viruses or overwhelmed, HIV can establish itself. Certain viral STI's also greatly increase the risk of death for HIV infected patients.

Vaccines
Vaccines are available that protect against some viral STIs, such as Hepatitis B and some types of HPV. Vaccination before initiation of sexual contact is advised to assure maximal protection.

Condoms
Condoms only provide protection when used properly as a barrier, and only to and from the area that it covers. Uncovered areas are still susceptible to many STDs. In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin, thus properly shielding the insertive penis with a properly worn condom from the vagina and anus effectively stops HIV transmission. An infected fluid to broken skin borne direct transmission of HIV would not be considered "sexually transmitted", but can still theoretically occur during sexual contact, this can be avoided simply by not engaging in sexual contact when having open bleeding wounds. Other STDs, even viral infections, can be prevented with the use of latex condoms as a barrier. Some microorganisms and viruses are small enough to pass through the pores in natural skin condoms, but are still too large to pass through latex condoms. Condoms are designed, tested, and manufactured to never fail if used properly. There has not been one documented case of an HIV transmission due to an improperly manufactured condom

Proper usage entails:

Not putting the condom on too tight at the end, and leaving 1.5 cm (3/4 inch) room at the tip for ejaculation. Putting the condom on snug can and often does lead to failure. Wearing a condom too loose can defeat the barrier. Avoiding inverting, spilling a condom once worn, whether it has ejaculate in it or not, even for a second. Avoiding condoms made of substances other than latex or polyurethane, as they don't protect against HIV. Avoiding the use of oil based lubricants (or anything with oil in it) with latex condoms, as oil can eat holes into them. Using flavored condoms for oral sex only, as the sugar in the flavoring can lead to yeast infections if used to penetrate.

Not following the first five guidelines above perpetuates the common misconception that condoms aren't tested or designed properly. In order to best protect oneself and the partner from STIs, the old condom and its contents should be assumed to be still infectious. Therefore the old condom must be properly disposed of. A new condom should be used for each act of intercourse, as multiple usage increases the chance of breakage, defeating the primary purpose as a barrier.

Nonoxynol-9
Nonoxynol-9 a vaginal microbicide was hoped to decrease STD rates. Trials however have found it ineffective.[9]

Diagnosis
STI tests may test for a single infection, or consist of a number of individual tests for any of a wide range of STIs, including tests for syphilis, trichomonas, gonorrhea, chlamydia, herpes, hepatitis and HIV tests. No procedure tests for all infectious agents. STI tests may be used for a number of reasons:

as a diagnostic test to determine the cause of symptoms or

illness as a screening test to detect asymptomatic or presymptomatic infections as a check that prospective sexual partners are free of disease before they engage in sex without safer sex precautions (for example, in fluid bonding, or for procreation). as a check prior to or during pregnancy, to prevent harm to the baby as a check after birth, to check that the baby has not caught an STI from the mother to prevent the use of infected donated blood or organs

as part of the process of contact tracing from a known infected individual as part of mass epidemiological surveillance

Not all STIs are symptomatic, and symptoms may not appear immediately after infection. In some instances a disease can be carried with no symptoms, which leaves a greater risk of passing the disease on to others. Depending on the disease, some untreated STIs can lead to infertility, chronic pain or even death.[10] Early identification and treatment results in less chance to spread disease, and for some conditions may improve the outcomes of treatment. There is often a window period after initial infection during which an STI test will be negative. During this period the infection may be transmissible. The duration of this period varies depending on the infection and the test.

Treatment
High risk exposure such as what occurs in rape cases may be treated prophylacticly using antibiotic combinations such as azithromycin, cefixime, and metronidazole. An option for treating partners of patients (index cases) diagnosed with chlamydia or gonorrhea is patient-delivered partner therapy (PDT or PDPT), which is the clinical practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.[11]

Epidemiology

Age-standardized death from tuberculosis per 100,000 inhabitants in 2004.[12] no data less than 60 60-120 120-180 180-240 240-300 300-360 360-420 420-480 480-540 540-600 600-1000 more than 1000

STD incidence rates remain high in most of the world, despite diagnostic and therapeutic advances that can rapidly render patients with many STDs noninfectious and cure most. In many cultures, changing sexual morals and oral contraceptive use have eliminated traditional sexual restraints, especially for women, and both physicians and patients have difficulty dealing openly and candidly with sexual issues. Additionally, development and spread of drug-resistant bacteria (e.g., penicillin-resistant gonococci) makes some STDs harder to cure. The effect of travel

is most dramatically illustrated by the rapid spread of the AIDS virus (HIV-1) from Africa to Europe and the Americas in the late 1970s.[13] Commonly reported prevalences of STIs among sexually active adolescent girls both with and without lower genital tract symptoms include chlamydia (1025%), gonorrhea (318%), syphilis (03%), Trichomonas vaginalis (816%), and herpes simplex virus (212%).[citation needed] Among adolescent boys with no symptoms of urethritis, isolation rates include chlamydia (911%) and gonorrhea (23%).[citation needed] In 1996, the World Health Organization estimated that more than 1 million people were being infected daily. About 60% of these infections occur in young people <25 years of age, and of these 30% are <20 years. Between the ages of 14 and 19, STDs occur more frequently in girls than boys by a ratio of nearly 2:1; this equalizes by age 20. An estimated 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occurred throughout the world in 1999.[14][15]

History

American propaganda poster targeted at World War II soldiers and sailors appealed to their patriotism in urging them to protect themselves. The text at the bottom of the poster reads, "You can't beat the Axis if you get VD." Images of women were used to catch the eye on many VD posters.

Prior to the invention of modern medicines, sexually transmitted diseases were generally incurable, and treatment was limited to treating the symptoms of the disease. The first voluntary hospital for venereal diseases was founded in 1746 at London Lock Hospital.[16] Treatment was not always voluntary: in the second half of the 19th century, the Contagious Diseases Act was used to arrest suspected prostitutes.

The first effective treatment for a sexually transmitted disease was salvarsan, a treatment for syphilis. With the discovery of antibiotics, a large number of sexually transmitted diseases became easily curable, and this, combined with effective public health campaigns against STDs, led to a public perception during the 1960s and 1970s that they have ceased to be a serious medical threat. During this period, the importance of contact tracing in treating STIs was recognized. By tracing the sexual partners of infected individuals, testing them for infection, treating the infected and tracing their contacts in turn, STI clinics could be very effective at suppressing infections in the general population. In the 1980s, first genital herpes and then AIDS emerged into the public consciousness as sexually transmitted diseases that could not be cured by modern medicine. AIDS in particular has a long asymptomatic periodduring which time HIV (the human immunodeficiency virus, which causes AIDS) can replicate and the disease can be transmitted to othersfollowed by a symptomatic period, which leads rapidly to death unless treated. Recognition that AIDS threatened a global pandemic led to public information campaigns and the development of treatments that allow AIDS to be managed by suppressing the replication of HIV for as long as possible. Contact tracing continues to be an important measure, even when diseases are incurable, as it helps to contain infection.

See also

Bugchasing and giftgiving Microbicide STD Wizard Transmission (medicine) Zoophilia and health A