20/20 Research project 2007/8

Global Infectious Diseases

Sexually Transmitted Diseases

Introduction

Girls Preparatory School from Chattanooga, TN is studying infectious diseases with three other schools from around the world. The focus of Project 20/20 is to create global awareness about critical issues facing our world. The class goals are to study the causes of infectious diseases and to come up with possible solutions. The three other schools with whom the class will be working with are The Christ Church High School of Lahore, Pakistan, The St. Alban’s College of Pretoria, South Africa, and The Walker School of Marietta, Georgia.

Girls Preparatory School studied the Sexually Transmitted Diseases (STD’s) chlamydia, gonorrhea and HIV/AIDS by looking at the background of these diseases in order to understand origination. Another important part of the project was to determine the impacts of disease in our state and in the world. The Chattanooga Health Department provided statistics from our local community such as the number of new cases appearing in Chattanooga and across the state every month. The causes of the diseases as well as explanations of the impact of spreading helped the class derive possible solutions to drastically reduce the number of infections. Research determining treatment options and affordability was conducted in conjunction with a closer look at the current practices involving distribution and containment both locally and globally. Governmental and non-governmental agencies were included in the research of current practice, prevention, and solutions.

CHLAMYDIA

Background

Chlamydia is a bacterial infection called Chlamydia trachomatis (Background 1). It is a sexually transmitted disease – the most common in the US (Background 1). “It is an intracellular parasite that has specific requirements for Adenosine Triphosphate (ATP) and amino acids. In stage one, the infective stage, the elementary body attaches to the host cell and is ingested by phagocytosis. In stage two, the elementary body undergoes metamorphosis to become a reticulate or initial body, this is the metabolic phase of the life cycle. The initial body duplicates by binary fission and changes into the elementary body” (Phipps 1865).

In the US, 10% of adolescent females are infected (Chlamydia 1). For women, if symptoms occur they include “bleeding after intercourse or between periods, lower abdominal pain, or discharge from the vagina” (Chlamydia 3). In men, “25- 50% show no symptoms but when they do occur they include discharge from penis, pain or burning during urination, inflammation or infect of a duct in the testicles, or tenderness of pain in the testicles” (Chlamydia 3).

In 2004, 929,462 new cases of chlamydia were reported in the US but it is predicted that there are about 2.8 million cases new each year because of all the un-reported cases (Background 1). “The rate of chlamydial infection among African American women is more than seven and a half times the rate of white women” (Background 1). Also, the rate of chlamydial infection among African American males was eleven times that among white males” (Background 1). “These statistics are in such disparity probably because of variations in reporting” (Background 1).

Chlamydia is more common in “incarcerated populations, army recruits, and patients at public STI clinics.” Other risk factors include “multiple sexual partners, having a new sexual partner or an infected sexual partner, inconsistently using barrier contraceptives, and having a history or previous or coexistent STIs” (Background 1).

Chlamydial infection can also be passed along during birth (Chlamydia 2). This can cause “conjunctivitis and pneumonia in many newborns” (Phipps 1865). In fact, it is the “leading cause of pneumonia in infants under 6 months old” (Phipps 1865).

Causes

Chlamydia trachomatis is one of three bacterial species in the genus chlamydia family. It is also a gram negative bacterium meaning that it does not retain the crystal violet dye in gram staining protocol. Also, in 1907, it was the first chlamydia agent discovered by humans. Chlamydia trachomatis can be recognized by monoclonal antibodies.

One can transmit chlamydia sexually by the following ways: vaginal sex, oral sex, and anal sex. It can also be transmitted from a mother who is infected to her baby during vaginal childbirth. When this happens, the baby usually contracts an eye infection called a trachoma, which can lead to blindness, or the baby can contract pneumonia as well (EMedicine Health 1).

When one contracts chlamydia the symptoms are usually mild and sometimes even absent. This is a major problem because when chlamydia is left untreated, it can lead to serious complications (CDC 1).

In a woman infected with chlamydia, the following can occur: cervicitis, the inflammation of the tissues of the cervix; pelvic inflammatory disease, the infection of the female uterus, fallopian tubes, and/or ovaries as it adheres to nearby tissues; ectopic pregnancy, a complication of pregnancy in which the fertilized ovum is implanted in any other tissue other than the uterine wall; pelvic pain; and premature birth (CDC 2).

In a man infected with chlamydia, the following can occur: prostatitis, the inflammation of the prostate; and epididymitis, inflammation of the epididymis

In both males and females, the following can occur: urethritis, the inflammation of the urethra; infertility; proctitis, inflammation of the anus and the lining of the rectum; reactive arthritis, an autoimmune condition that develops in response to an infection in another part of the body; and trachomas, which is an infectious eye disease that can lead to blindness (CDC 2).

Local Impact

Chlamydia has quickly risen to the most common sexually transmitted disease in the United States. In fact, an estimated three million people transmit it every year and the numbers are growing. Since there are no symptoms, chlamydia is easily passed from partner to partner with no one knowing. The following chart is the number of chlamydia cases reported in the United States from 1996 to 2006 (STD Statistics for the USA 1).

In the state of Tennessee, there are an estimated 25,000 new cases every year. The number has risen dramatically since 1993. The following chart shows the increase (Reported Chlamydia Cases Among TN Residents, 1993-2006).

The following is the most recent report of cases in the state of Tennessee. It is through the week of November 10, 2007 (Weekly Surveillance Reports TN Department of Health).

It is assumed that the main reason cases are increasing over the years is because chlamydia shows no symptoms, but with the awareness today, more people should be getting tested and cured, but they aren’t.

The region that affects our school the most is the Hamilton County region. Hamilton County has the second highest number of cases in the entire state of Tennessee, the average being around 1,600 new cases every year. In fact, since 1993 the number of chlamydia cases has quadrupled, with the maximum number occurring in 2004. The following chart explains in more detail (Reported Chlamydia Cases Among TN Residents, 1993-2006).

Global Impact

Global statistics show that there are roughly 92 million chlamydia cases each year. This 92 million includes 50 million women and 42 million men. Chlamydia, the ‘silent’ disease, leaves 70-75% of the 50 million women infected with chlamydia asymptomatic. Men tend to be asymptomatic, but show symptoms more often than women (www.avert.org/chlamydia.htm 1).

Below are statistics on the global impacts of chlamydia from different sources.

(http://www.eurosurveillance.org/eq/2004/04-04/pdf/eq_10_2004_68-70.pdf 1).

Chlamydia is the most common treatable bacterial STD. In the period 1995 to 1999 there was an estimated worldwide increase in prevalence of 2.8 million people. The frequency of chlamydia varies worldwide. In the 1990s, rates amongst pregnant women in Europe ranged from 2.7% in Italy to 8.0% in Iceland, while studies in South America found rates of 1.9% amongst teenagers in Chile and 2.1% amongst pregnant women in Brazil. In Asia rates among pregnant women tend to be much higher: up to 17% in India and 26% in rural Papua New Guinea. In Africa, studies amongst pregnant women have revealed rates from 6% in Tanzania to 13% in Cape Verde. The following table shows that rates of infection fell in some regions while rising in others. (http://www.avert.org/stdstatisticsworldwide.htm 2)

The following data include trends in the US and surrounding areas based on information from (http://www.cdc.gov/std/Chlamydia2004/ctsupplement_2004FINAL.pdf. 1).

Treatments

The chlamydia infection can be cured with oral antibiotics, most commonly tetracycline and erythromycin. The treatment normally lasts from seven to twenty days (Little 2). Chlamydia may be treated with a single dose of antibiotics (Mader 454). Some of the most common antibiotics given to chlamydia patients are azithromycin, also known as Zithromax, and doxycycline, also known as Vibramycin (Chlamydia Treatment 1). Both of these prescriptions are in the pill form and are taken by mouth. Around 95% of people taking these antibiotics will be cured of chlamydia after one round (Chlamydia Treatment 2). All sexual contact should be avoided until the infection has been completely taken out of the body (Little 2).

Azithromycin is a “semi-synthetic macrolide antibiotic” related to erythromycin and clarithromycin (Medications 1). In addition to being an antibiotic for chlamydia, it can also be used to treat Hemophilus influenze, Streptococcus pneumoniae (strep virus), and many other viruses. Disease infected patients are able to take only one pill a day because the medication lasts a longer period of time, allowing the treatment to be shorter as well. Azithromycin prevents bacteria from growing by interfering with the bacteria’s ability to make proteins, not with the human’s ability to make proteins. The antibiotic should be taken one to two hours after all meals to keep the medication from binding to the food molecules and not being absorbed. Most infections only require one dose of Azithromycin per day. The first dose can sometimes be doubled up to get the treatment started and then the last four to five days will require single doses only. Very few side affects are found when taking Azithromycin. The most common effects are diarrher, nausea, abdominal pain, and vomiting. These effects can be found in one in every twenty patients treated with Azithromycin. The more rare side effects include abnormal liver tests, allergic reactions, and nervousness (Medications 1).

Doxycycline is “a synthetic broad spectrum antibiotic” originating from the antibiotic tetracycline, which is used to treat gonorrhoea (Marks 1). Doxycycline is used to fight off a variety of bacteria such as Streptococcus pneumoniae, Chlamydia psittaci (bacteria causing chlamydia), and Chlamydia trachomatis, and Lymphogranuloma venereum. Respiratory tract infections or sexually transmitted diseases are the most common infections Doxycycline treats. In contrast to Azithromycin, Doxycycline must be taken once or twice a day for seven to fourteen days and it can be taken along with meals. Pregnant or nursing mothers must refrain from taking thing antibiotic while carrying or breast feeding because this drug has toxins that have major effects of the development of fetus’ bones or cause decreased bones in new born babies (Marks 1). Similar to Azithromycin, Doxycycline is normally well accepted. Its side effects are those of Azithromycin’s, but in addition to those, children under the age of eight may have some discoloration in their teeth, and bad sunburn may arise due to the tetracyclines found in the Doxycycline antibiotic (Marks 1).

Practices

When sexually transmitted diseases are considered, chlamydia is not one of the most common to be discussed among young men and women in their late teens and early to mid twenties. Because it has no symptoms until it’s a relatively serious condition, many don’t get help for the disease until it’s too late. And as an unfortunate result, the commonality of this disease has risen. For example, between 1986 and 2005 the number of reported cases per 100,000 people rapidly rose in the United States, from approximately 32.5 cases to 332.5 (Refer to graph at the end of this section) (CDC 1). This has caused many in the medical profession to realize the general negligence of realization to the disease and has forced them to take measures outside the clinic in order to increase awareness of the dangers of chlamydia. In areas where chlamydia awareness has been promoted certain techniques such as “STD’s are discussed in school-based sex education programmes, chlamydia tests are widely available, there are high profile public education campaigns, attention has been paid to educating the practitioners who deal with the consequences of chlamydial infection” have proven to be successful (Robinson 1). Females in their late teens and early to mid twenties are most commonly targeted for screening because they tend to be more prone to the infection (Health Policy Guide 1). It is important to not only advocate awareness for the disease but also to provide screening tests for the disease to the targeted age groups, because it has no symptoms. Many screening programs have been successful. For example, a “decline in chlamydia prevalence was seen in other regions where large-scale screening programs had been fully implemented. In Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia there was a 31% decline in chlamydia infection among females under age 20 after screening program had been in place for about two years” (Health Policy Guide 1). In other countries outside the USA, chlamydia awareness has increased and become successful. “The National Chlamydia Screening Programme was launched in England in 2003 and has screened around 18,000 young men and women in its first year, and 60,698 in its second year” (BBC 1). To completely remain free of the disease of course it is highly recommended to refrain from sexual intercourse, but to those who are sexually active in order to abstain from getting Chlamydia it is best to use a condom.

The news of chlamydia is starting to spread beyond the U.S. and Great Britain. In Australia, many conferences are starting to be held in order to find a way to deal the rising problem. Between 1999 and 2004, the number of chlamydia cases found doubled in Australia (Turtle 1). A news interview presented that young Australians were embarrassed to be tested for STD’s because they were afraid that their results would come back positive. As a result, much of the efforts in Australia have been convincing teens and young adults that being tested is simply a safety precaution and not a scarlet letter.

Solutions

Since chlamydia is the most common sexually transmitted disease in the world, solutions to the disease are necessary. Antibiotics are currently used to treat chlamydia. They are very effective in the United States and Europe, where antibiotics are readily available. Antibiotics, such as 100 mg of Doxycycline can be taken twice a day to clear up chlamydia infections in about one weeks time (Chlamydia 1). Another antibiotic option for treating chlamydia is one dose of azithromycin (Chlamydia - CDC Fact Sheet 1 ). A vaccine for the disease is currently under development (Chlamydia Vaccine 1 ). Some effective solutions for chlamydia are as follows: correct condom use, safe sex education, annual testing if you are sexually active, notifying all recent sex partners if you test positive for the disease, abstaining from sex until treatment for chlamydia is complete, and screening all pregnant women for the disease (Chlamydia 1 ). If all of these are implemented, chlamydia can effectively be prevented and/or treated. It is crucial that a person infected with chlamydia abstain from sexual activities until the infection is totally gone and they have finished the course of antibiotics (Chlamydia-CDC Fact Sheet 1 ). The only true solution to chlamydia is to have one partner.

Works Cited

"Background." Health Services/Technology Assessment Text. 10 Jan. 2007. National Library of Medicine. 17 Nov. 2007 <http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat3.section.32418>.

Boyles, Salynn. "CDC: 2 Million in U.S. Have Chlamydia." WebMD. July 2007. 14 Dec. 2007 http://www.webmd.com/sex/news/20070717/cdc-2-million-in-us-have-chlamydia.

"Chlamydia Awareness on the Rise." BBC News | Health. 24 Oct. 2006. BBC. Nov. 2007 <http://news.bbc.co.uk/2/hi/health/6080228.stm>.

Chlamydia." Campaign for Fighting Diseases. 2008. 16 Nov. 2007 <http://www.fightingdiseases.org/main/disease.php?disease_id=36>.

Chlamydia Causes." EMedicineHeath. 7 May 2007. 13 Nov. 2007 <http://www.emedicinehealth.com/chlamydia/page2_em.htm>.

"Chlamydia - CDC Fact Sheet." Centers for Disease Control and Prevention. 20 Dec. 2007. 13 Nov. 2007 <http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm>.

"Chlamydia." CDC. 16 Nov. 2007 <http://www.cdc.gov/std/Chlamydia2004/ctsupplement_2004FINAL.pdf>.

“Chlamydia." EMedicine Health. 7 May 2007. WebMD. 16 Nov. 2007 <http://www.emedicinehealth.com/chlamydia/article_em.htm>.

"Chlamydia Facts." Region | Infertility Prevention Program. JSI Research & Training Institute, Inc. Nov. 2007 <http://ipp.jsi.com/Chlamydia_Facts/Facts.htm#Listen%20Up>.

"Chlamydia." Library of the National Medical Society. The National Medical Society. 4 Dec. 2007 <http://www.medical-library.org/journals2a/clamidia.htm>

 "Chlamydia — Rates: Total and by Sex: United States, 1987–2006." Division for STD Prevention. 13 Nov. 2007. Centers for Disease Control. Nov. 2007 <http://www.cdc.gov/std/stats/figures/figure1.htm>.

“Chlamydia.” Revolution Health. 18 April 2007. 11 Dec 2007. <http://www.revolutionhealth.com/conditions/stds/chlamydia/chlamydia?section=section_07>.

"Chlamydia." Sexually Transmitted Diseases. 13 Nov. 2007. Centers for Disease Control. Nov. 2007 <http://www.cdc.gov/std/stats/chlamydia.htm>.

“Chlamydia Trachomatis." Wikipedia. 21 Dec. 2007. 13 Nov. 2007 <http://en.wikipedia.org/wiki/Chlamydia_trachomatis>.

“Chlamydia Vaccine – Product Candidate.” Emergent Biosolutions. 11 Dec 2007. <http://www.emergentbiosolutions.com/Chlamydia/>.

 Cooper, Susan R. "Weekly Surveillance Reports." Tennessee.Gov: Department of Health. 14 Dec. 2007 http://health.state.tn.us/CEDS/WeeklyReports/WeeklyReports.asp.

"Current Status of Chlamydia Screening in Europe." EuroSurveillance. 07 Oct. 2004. 16 Nov. 2007 <http://www.eurosurveillance.org/eq/2004/04-04/pdf/eq_10_2004_68-70.pdf>.

Hill-Jones, Ben, and Rob Noble. "STD Statistics Worldwide." Avert. 09 Jan. 2008. 16 Nov. 2007 <http://www.avert.org/stdstatisticsworldwide.htm>.

 Magee, James. "Chlamydia: Symptoms, Treatment & Prevention." Avert. 21 Dec. 2007. 16 Nov. 2007 <www.avert.org/chlamydia.htm>. 

Phipps, Wilma J., Frances D. Monahan, Judith K. Sands, Jane F. Marek, and Marianne Neighbors. Medical-Surgical Nursing: Health and Illness Perspectives. Ed. Carol J. Green. 7th ed. St. Louis: Mosby, 2003. 1865-1866.

 "Preventing Chlamydia Through Education, Screening, and Treatment." Health Policy Guide. 2004. Center for Health Improvement. Nov. 2007 <http://healthpolicyguide.org/doc.asp?id=6424>.

"Reported Chlamydia Cases Among Tennessee Residents, 1993-2006." Tennessee.Gov: Department of Health. 14 Dec. 2007 <health.state.tn.us/STD/93-06%20County-level%20Data/CT10yr.pdf>.

"STD Statistics for the USA." AVert. Nov. 2008. 14 Dec. 2007 http://www.avert.org/stdstatisticusa.htm.

Turtle, Michael. "Chlamydia Infections on the Rise." The World Today. 8 Oct. 2007. Australian Broadcasting Corporation. Nov. 2007 <http://www.abc.net.au/worldtoday/content/2007/s2053611.htm>.

GONORRHEA

Background

Gonorrhea is an extremely contagious, yet curable, sexually transmitted disease. The term gonorrhea originates from the Greek word “gono” which means “seed” and “rrhea” which means “to flow.” This can be accredited to, “the flow of discharge from the penis caused by gonorrhea in men” (Helping Gonorrhea 1). This disease is most common in young adults, specifically African Americans and it is considered one of the most common sexual transmitted infections in the world. Gonorrhea is reported more often in urban than in rural areas. “Historically, gonorrhea was long misunderstood and seen as a something of a mysterious disease. However, it has long been associated with sexually transmitted diseases, and treated along with other common STD’s like chlamydia and syphilis” (Helping Gonorrhea 1).

Gonorrhea is caused by a gram-negative bacterium called Neusserua gonorrheae spread through sexual contact with an infected person. This sexual contact leads to infection of the cervix, urethra, and vagina. Gonorrhea can also be transmitted from mother to child during the birthing process. Infrequently the bacteria can spread to the newborn’s eyes causing a severe infection called gonococcal ophthalmia (Everyday Health 1).

The slang term for gonorrhea is “the clap,” and it has several disputed origins. One idea proposes that when men or women urinate, there is a clapping sensation that suddenly stings the genitals. A second theory suggests that a technique “to remove the puss from the male's penis was to vigorously clap the penis on both sides in an attempt to remove the entirety or puss from the urethra.” The third belief connects the clap to a famous French term for brothel, "clapier," where gonorrhea may have been scandalously widespread” (Helping Gonorrhea 1).

This STD can easily be treated if diagnosed early. However, if left untreated gonorrhea can cause serious health problems, especially in women. Women with the disease can become sterile, develop pelvic inflammatory disease, have ectopic pregnancies, or chronic pelvic pain. In men, untreated gonorrhea can cause prostatitis (prostate inflammation, and epididymo-orchitis (inflammation of the epididymis and testes). For people who practice anal intercourse gonorrhea can also cause gonococcal proctitis (inflammation of the anus and rectum). For people infected with gonorrhea who practice oral sex, gonorrhea can infect the throat, causing gonococcal pharyngitis (Everyday Health 1). In less common instances, gonorrhea can spread to other parts of the body through the bloodstream which may result in fevers, rashes or arthritis.

Approximately 600,000 people in the United Sates are diagnosed with gonorrhea each year (Every day Health 1). However, this statistic is only a slight indication of the real number because many people with gonorrhea do not seek treatment. Overall, the increase of gonorrhea cases is due to people not using safer sex methods. As a result, drug-resistant strands of gonorrhea are emerging across North America (The CDC 1).”

Causes

Reports show that over one million new cases of gonorrhea occur in the United States each year. Also, public health experts stated that an additional one million gonorrhea infections are not reported each year. Gonorrhea often occurs simultaneously with chlamydia and is very similar. “Between 25 and 40 percent of women who have gonorrhea also have chlamydia” (Grapes 17). The microorganism Neisseria gonorrhoeae was identified in 1879, more than 25 years before the bacteria that causes syphilis, another sexually transmitted disease, was found. Gonorrhea is commonly spread by vaginal, anal, and oral intercourse. Contact with infected body fluids such as blood, semen, and vaginal secretions cause the infection to spread. Also, mucous membranes that line the mouth, vagina, and rectum can cause the infection to spread if they come in contact with another individual. Ideal points for the disease to enter the body include the cervix, the urinary tract, the mouth, and the rectum. “In women, the most common site of infection is the cervix. In men, it is the urethra” (Little 47). The infection can easily be spread from a man’s penis to his partner’s throat but it is very unlikely that a man will contract or spread the disease by performing oral sex on his female partner. Gonorrhea, along with chlamydia, can also be spread from a mother to a baby during a vaginal childbirth. This can cause eye infections and chronic pneumonia in newborns. That is why it is so important for a pregnant woman to obtain prenatal testing and care. Contrary to what some people may think, it is impossible to contract an STD from a toilet seat or anything else that has been touched by an infected person. Although gonorrhea is originally caused by one microorganism, it can be spread in many different ways.

Local and Global Impact

Gonorrhea Rates in the United States increased steadily from 1970-1995, reaching approximately 475 cases of gonorrhea per 100,000 population. Over 20 years, the rates have decreased to 150 cases of gonorrhea per 100,000 populations. From 1996 to 1999, the rates have slightly increased.

Of all the states, Wyoming had the greatest decrease of gonorrhea rates from 1997 to

1998, 33.7%, whereas Nevada had the greatest increase of gonorrhea rates from 1997 to 1998, 74.5%.

Gonorrhea — Rates by state: United States and outlying areas, 2005

Gonorrhea is the most prevalent STD in the southern United States. The greatest rate of gonorrhea is found in Louisiana which has 247 cases of gonorrhea per 100,000 people. Only six states of the U.S., Idaho, Wyoming, Montana, Maine, Vermont, and New Hampshire, had less than 19 reported rates of gonorrhea per 100,000 population (Sexually Transmitted Disease 5).

Gonorrhea — Rates by county: United States, 2005

As shown by the graph, the rates of gonorrhea are most prevalent in the southern counties. Mississippi and its counties contain the greatest number of gonorrhea infected persons and Idaho contains the fewest. (Sexually Transmitted Disease 6).

Gonorrhea — Age- and sex-specific rates: United States, 2005

This graph illustrates that women are more likely to be infected with gonorrhea than men. Females and males from ages 15-29 have the highest number cases of gonorrhea. As men and women approach 30, the rates of gonorrhea decrease. As aging continues, sexual activity decreases among both males and females and the rates of gonorrhea continue to decrease. Thus, the smallest number of gonorrhea cases is reported in both males and females ages 65 and older (Sexually Transmitted Disease 9).

Gonorrhea — Age-specific rates among women 15 to 44 years of age:
United States, 1996–2005

From the years 1996 to 2005, the rates of women infected with gonorrhea decrease as age increases. Thus, the highest rates of gonorrhea are reported in women aged 15-19 and the lowest rates of gonorrhea are reported in women aged 35-44 (Sexually Transmitted Disease 10).

Gonorrhea — Positivity among 15- to 24-year-old women tested in family planning clinics by state: United States and outlying areas, 2005

As shown by the previous graphs, women aged 15-24 had the highest rates of gonorrhea. The 15-24 year-old women who tested positive for gonorrhea in family planning clinics were scattered around the nation. The highest rates of infected women were from Michigan, Wisconsin, Mississippi, Georgia, and South Carolina. The lowest rates of infected women were from Oregon, Idaho, North Dakota, South Dakota, Pennsylvania, West Virginia, Massachusetts, Rhode Island and Maryland (Sexually Transmitted Disease 12).

Gonorrhea — Age-specific rates among men 15 to 44 years of age: United States, 1996-2005

Men aged 40-44 have had the lowest rates of gonorrhea from 1996-2005. As the men aged from 30-34 years old to 35-39 years old and to 40-44 years old, the rates of gonorrhea decreased, respectively. Men aged 20-24 have the highest rates of gonorrhea from 1996-2005. From 1996-1999, the rate of 15-19 year-old men infected with gonorrhea was greater than 25-29 year-olds. The rate of 25-29 year-old men infected with gonorrhea increased in 1997 and surpassed the rate of 15-19 year-old men infected with gonorrhea in 1999. The rate of 25-29 year-old men infected with gonorrhea continued to be greater than the rate of 15-19 year-old men infected with gonorrhea through 2005 (Sexually Transmitted Disease 11).

Gonorrhea— Cases by reporting source and sex: United States, 1996-2005

Gonorrhea — Reported cases by reporting source: United States, 1984-2003

These two graphs shown above, illustrate the socio/economic status non-STD clinic males and females versus STD clinic males and females. The rates for non-STD clinic males and females are higher than those of STD clinic males and females. It can be inferred that the people who go to general non-STD specific clinics are of a lower socio/economic status than those who can afford to go to an STD clinic (Sexually Transmitted Disease 7).

Gonococcal Isolate Surveillance Project (GISP) — Percent of Neisseria gonorrhoeae isolates with resistance to ciprofloxacin by sexual behavior, 2001-2005

This graph shows that, on average, homosexual men are more likely to show resistance to ciprofloxacin then heterosexual men (Sexually Transmitted Disease 16).

Gonorrhea — Rates by race/ethnicity: United States, 1996–2005

This graph compares gonorrhea rates by ethnicity/race. It shows than African-Americans are most likely to contract gonorrhea than whites, Hispanics, Asian/PI, or AI/AN (Sexually Transmitted Disease 8).

Gonorrhea — Rates by region: United States, 1981–2003 and the Healthy People 2010 target

Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

This graph breaks down rates of reported gonorrhea by regions. The South was the region with the most cases of gonorrhea as compared to the West, Midwest, and Northeast (Sexually Transmitted Disease 4).

Gonorrhea — Rates: Total and by sex: United States, 1986–2005 and the
Healthy People 2010 target

This graph shows that from 1986 to 1996, men were more likely than women to be infected with gonorrhea. However, from 1996 to 2005, women and men were about the same on overall rates of gonorrhea reported (Sexually Transmitted Disease 3).

Gonorrhea — Rates: United States, 1941–2005 and the Healthy People 2010 target

The rates of gonorrhea have fluctuated from 1941-2005. The rate per 100,000 population of gonorrhea spiked in 1970 and continued to increase until 1976. From 1976 to1996, the rates of gonorrhea have decreased. It is to be noted that the rates of gonorrhea infected persons from 1941-2005 has never been below 100 cases per 100,000 population. The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population (Sexually Transmitted Disease 2).

Estimated new cases of gonorrhea infections (in million) in adults, 1995 and 1999

Region	1995			1999
	Female	Male	Total	Female	Male	Total
North America	0.92	0.83	1.75	0.84	0.72	1.56
Western Europe	0.63	0.60	1.23	0.63	0.49	1.11
North America & Middle East	0.77	0.77	1.54	0.68	0.79	1.47
Eastern Europe & Central Asia	1.16	1.17	2.32	1.81	1.50	3.31
Sub-Saharan Africa	8.38	7.30	15.67	8.84	8.19	17.03
South & Southeast Asia	14.55	14.56	29.11	15.09	12.12	27.20
East Asia & Pacific	1.47	1.80	3.27	1.68	1.59	3.27
Australia & New Zealand	0.07	0.06	0.13	0.06	0.06	0.12
Latin America & Caribbean	3.67	3.45	7.12	4.01	3.26	7.27
Total	31.61	30.54	62.15	33.65	28.70	62.35

This table shows the estimated new cases of gonorrhea infections broken down by global regions. South and Southeast Asia were the areas most infected by cases of gonorrhea in 1995 and 1999.

Treatments

Gonorrhea is treated in a few different ways, usually depending on the country. In the United States, gonorrhea is treated with an assortment of antibiotics. One of the most common antibiotics, Penicillin, has been used to treat gonorrhea until now, when we are faced with resistant strains of gonorrhea that do not respond to Penicillin treatments (Treatments for Gonorrhea 1). Ciprofloxacin, an oral antibiotic, is used against serious bacterial infections of the skin. It is also used for treating anthrax, cystic fibrosis, and Tularemia (Treatments: Ciprofloxacin 1). A third generation cephalosporin antibiotic, Cefixime is stable to hydrolysis by betalactamases (Treatments: Cefixime 1). Another commonly used antibiotic, Ceftiaxone is a cephalosporin antibiotic with a very long half-life and high penetrability to meninges (Treatments: Ceftiaxone 1). Also, synthetically produced antibiotics can be used, such as Tetracyclines, which is derived from microorganisms of the genus Strepomyces (Treatments: Tetracyclines 1). Because gonorrhea is so commonly coincided by chlamydia, they are usually treated at the same time by the same antibiotics or a combination of antibiotics. These are basic medical treatments for gonorrhea. Other precautions include refraining from sexual activity until a doctor has made sure the disease has been cured (Gonorrhea 2).

Practices

The United States and many other countries around the world are making great efforts to cure and stop the spread of gonorrhea. The practice of Field-Delivered Therapy all the way to simply, trials and studies of the sexual transmitted disease, these measures are significantly helping and advancing our treatments for Gonorrhea.

FDT or Field-Delivered Therapy for gonorrhea is one treatment that is practiced to increase treatment's affectivity. In 1998, treatments assigned for follow-up treatments for gonorrhea and chlamydia were rarely ever completed as reported by the San Francisco Department of Public Health (Steiner). FDT is designed to be a one-time treatment, effective and convenient for people who won't return for a follow-up treatment.

The United States has through the years and increasingly supported scientists who study and continue to learn more about what causes gonorrhea and possible cures to this horribly common disease. National Institute of Allergy and Infectious Diseases has supported scientists to research the bacterium which causes gonorrhea and conduct studies to improve the overall health care of the public (Wrong Diagnosis). Each clinical trial tests the affectivity and safety of new drugs and procedures. These tests also evaluate risks and side-effects of these treatments. The resistant strains also give scientist a more important reason to discover better treatments for gonorrhea as well.

Many problems arise with the antibiotic-resistant strain of Gonorrhea. These strains are "plasmid-mediated" resistant to penicillin and tetracycline, and "chromosomally mediated" resistant to penicillins, tetracyclines, spectinomycin, and fluoroquinolones (Centers…). The fear and danger of drug-resistant bacteria is that it might be treated and the patient might think it’s cured and unknowingly pass it on. Just like this resistant strain, gonorrhea in pregnant women is also very dangerous.

Gonorrhea in a pregnant woman may cause problems with the pregnancy and with the health of the baby. Untreated gonorrhea can cause miscarriage or premature birth. There is also a risk of passing the disease onto the baby as the baby passes through the birth canal. "This can cause blindness, joint infection, or a life-threatening blood infection in the baby” (Women’s Health).

These problematic situations and resistant strains have complicated the study of practices for gonorrhea around the world.

Solutions

The treatments for the STD, gonorrhea, are pretty straight forward—take all of the prescribed medication, and you are cured. However, this straight path can have many curves and hidden obstacles which can inhibit the recovery from gonorrhea.

The treatment for gonorrhea is usually very effective. By taking the prescribed cocktail of antibiotics Cefixime, Ceftriaxone, Ciprofloxacin, Ofloxacin, and Doxycycline, a patient should recover from the STD after they have finished the medications. These antibiotics clear up the STD in a matter of weeks (CDC, Updated recommended treatment regimens for gonococcal infections and associated conditions - United States, April 2007 1)

The treatment becomes ineffective when the patient isn’t persistent about taking the medications because they start to feel better. They figure, “if I feel better, my STD must be cleared up.” However, that is not the case. The medicine must be taken to its completion in order for the STD to be completely cleared up

(TheHealthCentralNetwork 1).

There are several reasons that a patient’s treatment may not be effective. The most common reason that a patient’s gonorrhea would return would be from re-infection, rather than treatment failure. This is due to having sex with a partner who already has gonorrhea or not following the medication regiment (TheHealthCentralNetwork 1). Another setback is that, as of early 2006, there's now a fluorquinolone-resistant strain of gonorrhea that's rapidly spreading across the United States (CDC, Control of Neisseria Gonorrhoeae Infection in the United States 16). Also, the treatment of gonorrhea can become difficult if the patient has monetary difficulty. Ranging anywhere from five dollars to fifty dollars per dosage, the costs of treating gonorrhea can become a hefty expense. The problem is amplified because, usually, if a person is being treated for gonorrhea, they are also being treated for chlamydia. Therefore, they have to pay for even more medications (CDC, Control of Neisseria Gonorrhoeae Infection in the United States 13). Otherwise, gonorrhea is not difficult to cure.

Just because gonorrhea is easily treated medically, it does not mean that everyone is cured. Problems with educating certain communities on the awareness and treatment of gonorrhea are very prevalent. In order for people to know how to treat this STD and know how to prevent its spread, they must be educated. A program must be set up that addresses the problem within a community. The public must know there are the obvious solutions to not obtaining gonorrhea, like abstaining from sex and by using condoms. The program must be more intensive than this, however (Kimberly A. Workowski and Stuart M. Berman 1). Therefore, those who are educating must take in the following accounts: You must consider the audience—where they live, what they can afford, and how they feel about the subject. Determine the health communication objectives—for example, simply to raise awareness about the STD. However simply saying “use condoms,” is not every effective because that may not get through to the audience (Kimberly A. Workowski and Stuart M. Berman 1). Get people involved in the education that has a significant role in the community, so that more people are likely to listen and take note. And finally, find out why current efforts are not working to stop the STD and strategies that have not been thought of yet (CDC, Control of Neisseria Gonorrhoeae Infection in the United States 6).

Works Citied

American Public Health Association.

15 Nov. 2007 <http://www.pubmedcentral.nih.gov>.

"Antibiotic-Resistant Gonorrhea." 12 Apr. 2007. Centers for Disease Control and Prevention. 17 Nov. 2007 <http://www.cdc.gov>.

CDC. Control of Neisseria Gonorrhoeae Infection in the United States. <http://www.cdc.gov/std/GCmtgreport.pdf>.

"Cure Research for Gonorrhea." Wrong Diagnosis. 13 Nov. 2007. 17 Nov. 2007

<http://www.wrongdiagnosis.com>.

"Gonorrhea - CDC Fact Sheet." Center for Disease Control and Prevention. 19 Dec. 2007. Department of Health and Human Services. 20 Nov. 2007 http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm.

"Gonorrhea." STD Facts. 19 Dec. 2007. Center for Disease Control and Prevention. 15 Nov. 2007 http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm#treatment.

"Gonorrhea Sexually Transmitted Disease Surveillance 2005." Center for Disease Control and Prevention. Department of Health and Human Services. 20 Nov. 2007 http://www.cdc.gov/std/stats/slides/SurvReportSlides2005.ppt#13.

"Gonorrhea Tables." Center for Disease Control and Prevention. 13 Nov. 2007. Department of Health and Human Services. 20 Nov. 2007 http://www.cdc.gov/std/stats/tablesgon.htm.

"Gonorrhea --- United States, 1998." Center for Disease Control and Prevention. 23 June 2000. Department of Health and Human Services. 20 Nov. 2007 http://www.cdc.gov/mmwR/preview/mmwrhtml/mm4924a5.htm.

"Gonorrhea." Womenshealth .Gov. May 2005. The National Women's Health Information Center. 17 Nov. 2007 <http://www.4women.gov>.

Grapes, Bryan J. Sexually Transmitted Diseases. San Diego: Greenhaven P, 2001. 17-18.

"History of Gonorrhea." Helping Gonorrhea. 9 Nov. 2007 <http://www.helpinggonorrhea.com/History+of+Gonorrhea.494.htm>.

"It's Your Health- Gonorrhea." http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/gonorrh_e.html. July 2004. 9 Nov. 2007 <http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/gonorrh_e.html>.

Kimberly A. Workowski, MD and MD Stuart M. Berman. STD Treatment Guidlines 2006. 2006. 16 January 2008 http://www.cdc.gov/STD/treatment/2006/toc.htm.

Little, Marjorie. Sexually Transmitted Diseases. Philadelphia: Chelsea House. 2000. 48-49.

"STD Surveillance 2005." The CDC. 23 Dec. 2006. 29 Oct. 2007 http://www.cdc.gov/std/stats/gonorrhea.htm.

Steiner, Katherine C., Veronica Davila, and Charlotte Kent. "Field-Delivered Therapy Increases Treatment for Chlamydia and Gonorrhea." Pubmed Central. June 2003.

"Treatments for Gonorrhea." Wrong Diagnosis. 10 Dec. 2007. Adviware Pty Ltd. 13 Nov. 2007 <http://www.wrongdiagnosis.com/g/gonorrhea/treatments.htm#treatment_list>.

"Treatments: Sulphonamides." Wrong Diagnosis. 10 Dec. 2007. Adviware Pty Ltd. 13 Nov. 2007 <http://www.wrongdiagnosis.com/treat/sulphonamides.htm>.

"Treatments: Tetracycline." Wrong Diagnosis. 10 Dec. 2007. Adviware Pty Ltd. 14 Nov. 2007 <http://www.wrongdiagnosis.com/treat/tetracycline.htm>.

"Treatments: Cetriaxone." Wrong Diagnosis. 10 Dec. 2007. Adviware Pty Ltd. 14 Nov. 2007 <http://www.wrongdiagnosis.com/treat/ceftriaxone.htm>.

"Treatments: Cefixime." Wrong Diagnosis. 10 Dec. 2007. Adviware Pty Ltd. 14 Nov. 2007 <http://www.wrongdiagnosis.com/medical/cefixime.htm>.

"Treatments: Ciprofloxacin." Wrong Diagnosis. 10 Dec. 2007. Adviware Pty Ltd. 14 Nov. 2007 <http://www.wrongdiagnosis.com/treat/ciprofloxacin.htm>.

"Trends in Reportable Sexually Transmitted Diseases in the United States, 2006." Center for Disease Control and Prevention. 13 Nov. 2007. Department of Health and Human Services. 20 Nov. 2007 http://www.cdc.gov/std/stats/trends2006.htm#gonorrheatrends.

Updated recommended treatment regimens for gonococcal infections and associated conditions - United States, April 2007. April 2007. 10 November 2007 <http://www.cdc.gov/std/treatment/2006/updated-regimens.htm>.

"What is Gonorrhea?" Everyday Health. 2006. Harvard Health Publications. 10 Nov. 2007 <http://www.everydayhealth.com/sexual-health/STDs/what-is-gonorrhea.aspx>.

HIV/AIDS

Background

The AIDS epidemic was first recognized on June 5, 1981. In the early years of the AIDS breakout, the World Health Organization (WHO) failed to understand why this new disease received so much media attention. Despite this misunderstanding, AIDS quickly became the most destructive disease in recorded history. In 1980, a 33 year old male from Los Angeles was diagnosed with PCP, a type of pneumonia typical to infants, elderly, and those with the weakened immune systems. “Within a year, the patient was dead (Hoff 39).” In the same year, there were five other reported cases of patients showing similar symptoms, all five died within the same year. At the same time the breakout was occurring in Los Angeles, New York was experiencing a break out of Kaposi’s sarcoma, a skin cancer that is very rare in the United States. A New York dermatologist noticed similarities between the Los Angeles patients diagnosed with PCP and those from New York, diagnosed with Kaposi’s. An interesting similarity among the cases was determined. All of the recorded patients were homosexual males. The Center for Disease Control, or the CDC, then declared this disease as “gay-related immunodeficiency disease (Hoff 39),” or, GRID.

In early 1982, another group of patients began contracting GRID. This time, they were not strictly homosexuals, but they were drug users. Later in the year, 3 heterosexuals with hemophilia, a disease that keeps blood from clotting, were diagnosed with GRID also. It was then that the CDC recognized this as not just a sexually transmitted disease, but a disease that could also be passed through infected blood. The disease name was changed from GRID, to acquired immunodeficiency disease, or AIDS (Hoff 40).

Drug users often sold their blood to support their habits, and it was quickly found that the American blood supply was tainted. The National Hemophilia Foundation (NHF) tried to persuade executives from the national blood industry to clean their supply of tainted blood, but their request was refused. As a result, AIDS began to spread through the country. Today the AIDS epidemic has killed 25 million people since first recognized in 1981 and in 2006 alone, an estimated 2.8 million people died of the virus, with increasing numbers through 2007 (Hoff 39-42).

Causes

Until 1983, the cause of AIDS was unknown. Now, with the advancement of technology and scientific study, HIV, human immunodeficiency virus, has been coined as the cause. Learning about the cause of AIDS included research on the affects that it has on the body, internally and externally, along with how it is spread.

When infected with HIV, CD4 + T cells are killed during infection. The end stage of AIDS is characterized by a count of or below 200 where the average healthy person has about 800-1200 CD4 + T cells. Symptoms of AIDS include of the intestinal tract, lungs, brain, eyes and other organs, weight loss, diarrhea, neurologic conditions and cancers (Majure 15). HIV is like other viruses in that it replicates inside cells only and different in that, like other retroviruses, convert its RNA to DNA by using the enzyme reverse scriptase which are than incorporated into the host cell’s genes. The infection of HIV begins when one of more of its gp120 molecules binds tightly to CD4 molecules that are found on the cell’s surface (What Causes AIDS 1). Fusion of the virus membranes and the cell occur, which then causes the RNA, proteins, and enzymes of the virus to be released (Majure 25)

AIDS is spread by sexual intercourse, blood transfusions, and the sharing of unsterilized needles. It is common among people living in cramped and unsanitary conditions that have lifestyles that are more heavily exposed to multiple, repeated, and chronic actions of immunological stressor agents. HIV, the cause of AIDS, is carried in blood, breast milk, semen, and vaginal secretions (Giraldo 1).

Hopefully, one day there will be a vaccine or cure for HIV and AIDS, but until then people will have to suffer from this and take a regimen of pills daily.

Local Impact

Due to recent research, the numbers of HIV cases have been increasing since 2001, and they are suspected to continue rising. These HIV and AIDS cases are occurring in older populations, including the teenager population. In Tennessee, statistics are held that African Americans make up about 20% of the population in Hamilton County, however, about half the cases of HIV and 44% of the cases of full blown AIDS are said to be in the African American community. With statistics from the Chattanooga-Hamilton County Health Department, there are specific trends over the years for the people who have HIV/AIDS.

Statistics are known that at the end of 2003, there was an 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS, with 24-27% undiagnosed and unaware of their HIV infection (A Glance at the HIV/AIDS Epidemic.) The estimated amount of individuals with AIDS in the United States in 2005 was 40,608. There were a total of 40,540 with 29,766 cases in males and 10,774 cases in females. 68 cases were estimated in children under the age of thirteen years. The cumulative estimated number of diagnoses of AIDS through 2005 in the United States was 952,629. In the 50 states and District of Columbia, adult and adolescent AIDS cases totaled 943,525 with 761,723 cases in males and 181,802 cases in females, and 9,101 cases estimated in children under age 13. (A Glance at the HIV/AIDS Epidemic)

AIDS Cases by Age. Of the estimated number of AIDS cases in the United States and the District of Columbia, the individual’s age at time of the diagnoses were distributed.

Age	Estimated # of AIDS Cases in 2005	Cumulative Estimated # of AIDS Cases, Through 2005*
Under 13:	68	9,112
Ages 13-14:	86	1,065
Ages 15-19:	447	5,289
Ages 20-24:	1,836	34,795
Ages 25-29:	3,407	114,141
Ages 30-34:	5,122	193,926
Ages 35-39:	7,246	208,505
Ages 40-44:	8,210	164,697
Ages 45-49:	6,418	102,732
Ages 50-54:	3,935	56,950
Ages 55-59:	2,064	30,424
Ages 60-64:	967	16,493
Ages 65 or older:	801	14,503

*Includes persons with a diagnosis of AIDS from the beginning of the epidemic through 2005.

Graphs show that African Americans have the highest estimated number of AIDS cases in the United States. In 2005, African Americans had the estimated total of 397,548. American Indians/Alaskan Natives had the lowest estimate, being 3,238.

AIDS Cases by Race/Ethnicity

Race or Ethnicity	Estimated # of AIDS Cases in 2005	Cumulative Estimated # of AIDS Cases, Through 2005*
White, not Hispanic	11,780	385,537
Black, not Hispanic	20,187	397,548
Hispanic	7,676	155,179
Asian/Pacific Islander	483	7,659
American Indian/Alaska Native	182	3,238

*Includes persons with a diagnosis of AIDS from the beginning of the epidemic through 2005.

Race/ethnicity of persons (including children) with HIV/AIDS diagnosed during 2005

Note. Based on data from 33 states with long-term, confidential name-based HIV reporting.

In 2005, male-to-male sexual contact was the highest transmission category being 452,111 estimated cases. The next highest transmission category consisted of injection drug use, with the estimate being 241,364 individuals.

AIDS Cases by Transmission Category

Transmission Category	Estimated # of AIDS Cases, Through 2005*
	Adult and Adolescent Male	Adult and Adolescent Female	Total
Male-to-male sexual contact	452,111	-	452,111
Injection Drug Use	168,314	73,050	241,364
Male-to-male sexual contact and injection drug use	65,881	-	65,881
High-risk heterosexual contact**	61,438	102,171	163,609
Other^***	13,978	6,582	20,560

*Includes persons with a diagnosis of AIDS from the beginning of the epidemic through 2005.
**Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
*** Includes hemophilia, blood transfusion, perinatal, and risk not reported or not identified.

Transmission categories of adults and adolescents with HIV/AIDS diagnosed during 2005

Note. Based on data from 33 states with long-term, confidential name-based HIV reporting.

In the United States and Dependent Areas, the top ten states/areas that had the number of cumulative AIDS cases through 2005 were New York, California, Florida, Texas, New Jersey, Illinois, Pennsylvania, Georgia, Maryland, and Puerto Rico.

Top 10 AIDS Cases by State/Dependent Area

State/Dependent Area	# of Cumulative AIDS Cases Through 2005*
	Adults or Adolescents	Children (<13)	Total
New York	170,035	2,342	172,377
California	138,361	658	139,019
Florida	99,290	1,519	100,809
Texas	66,836	391	67,227
New Jersey	47,659	772	48,431
Illinois	32,314	281	32,595
Pennsylvania	31,619	358	31,977
Georgia	30,179	226	30,405
Maryland	28,804	312	29,116
Puerto Rico	28,693	399	29,092

*Includes persons with a diagnosis of AIDS from the beginning of the epidemic through 2005.

In the United States, the estimated total number of people living with AIDS is 418,084 adults and teenagers, and 3,787 children under the age of thirteen. The estimated death count in people with AIDS throughout 2005 is 550,394. This death estimate consists of 525,442 adults and teenagers, with 4,865 under the age of thirteen.

The estimated numbers of AIDS diagnoses, deaths, and people living with AIDS is increasing almost each year. This graph shows from 2001-2005, the rate of AIDS is slowly increasing.

Estimated numbers of AIDS diagnoses, deaths, and persons living with AIDS, 2001–2005

		2001		2002		2003		2004		2005		Cumulative (1981-2005)
AIDS diagnoses		38,079		38,408		39,666		39,524		40,608		952,629
Deaths of persons with AIDS		16,980		16,641		17,404		17,453		16,316		530,756
Persons living with AIDS		331,482		353,249		375,511		397,582		421,873		NA
NA, not applicable (the values given for each year are cumulative).

Global Impacts

“Internal and external are ultimately one. When you no longer perceive the world as hostile, there is no more fear, and when there is no more fear, you think, speak and act differently. Love and compassion arise, and they affect the world,” so says writer Eckhart Tolle. Ideally, we would live in such a world. However, in many developing nations today, thousands of women, children and families live daily in fear- fear of violence, fear of starvation, and fear of disease. Today, about 33.4 to 46 million people suffer from AIDS (Acquired Immunodeficiency Syndrome). About 64% of those people live in Sub-Saharan Africa. 6.1 Million of those live in South Africa. This dire problem has affected millions of people. To them, it is more than just numbers and statistics on a page- it is a dying mother, an infected orphan, or even a wiped out community. The way to reach a solution is through international aid, which is what WHO, UNAIDS, and other NGO’s (Non-governmental organizations) are providing

Current ways the world is dealing with the AIDS epidemic: In 2005, The United States set aside $8.3 million to go towards researching and developing a response to HIV/AIDS. According to the 2006 UNAIDS Global Report, the number of people who use HIV tests and counseling increased in over 70 countries. It also states that by 2015, the total population of countries most affected by AIDS will drop by about 115 million people. This is shown in the following chart:

They have attempted to set up hospitals for victims of AIDS and have started educating people in other countries about the proliferation of the epidemic. Although it is a step, there is still a long way to go for doctors around the world. The following graphs show how much AIDS as proliferated around the world:

The region shown in red faces the most dire conditions.

PAKISTAN

II. HIV AND AIDS ESTIMATES

Number of people living with HIV ................................................................................................. 85 000 [46 000 – 210 000]

Adults aged 15 to 49 HIV prevalence rate .................................................................................................... 0.1 [0.1 – 0.2%]

Adults aged 15 and over living with HIV ...................................................................................... 84 000 [45 000 – 210 000]

Women aged 15 and over living with HIV ......................................................................................... 14 000 [6600 – 36 000]

Deaths due to AIDS ................................................................................................................................ 3000 [1700 – 4900]

GENERALIZED EPIDEMICS

Children aged 0 to 14 living with HIV .................................................................................................................................... –

Orphans aged 0 to 17 due to AIDS ....................................................................................................................................... –

SOUTH AFRICA

II. HIV AND AIDS ESTIMATES

Number of people living with HIV ................................................................................... 5 500 000 [4 900 000 – 6 100 000]

Adults aged 15 to 49 HIV prevalence rate ............................................................................................... 18.8 [16.8 – 20.7%]

Adults aged 15 and over living with HIV .......................................................................... 5 300 000 [4 800 000 – 5 800 000]

Women aged 15 and over living with HIV ........................................................................ 3 100 000 [2 800 000 – 3 400 000]

Deaths due to AIDS ................................................................................................................. 320 000 [270 000 – 380 000]

GENERALIZED EPIDEMICS

Children aged 0 to 14 living with HIV ......................................................................................... 240 000 [93 000 – 500 000]

Orphans aged 0 to 17 due to AIDS .................................................................................... 1 200 000 [970 000 – 1 400 000]

This chart shows the number of deaths in each country affected by AIDS. It can be seen that AIDS has impacted Asia and Africa the most. That is where most interventional help is needed. The following graphs also show the increase in death rates due to AIDS:

As the number of infected persons increases, the number of workers and students decreases.

Furthermore, the problem of dealing with global AIDS is exacerbated by a high number of refugees in Sub-Saharan Africa who flee from their homes but are not given necessary HIV-treatment in refugee camps. They are no longer guaranteed the protection of their country of origin, they often do not have the assistance of the country of asylum and they go without the HIV-related services which they need and to which they are entitled under international human rights instruments. This failure to provide HIV prevention and care to refugees not only undermines effective HIV prevention and care efforts, it also hinders effective HIV prevention and care for host country populations (2006 UNAIDS Report 1).

AIDS has also caused an increase in the proliferation of tuberculosis. The UNAIDS report states “that HIV infection impairs anti-malarial immunity. In areas where malaria is endemic, HIV infection increases the risk that an individual over five years of age will become infected with malaria and experience malaria-related diseases. In five southern African countries, the WHO estimates that high HIV prevalence in rural areas increased malaria incidence by 28% and more than doubled the malaria death toll.” This is shown in the following graph:

In this graph, it is shown that as HIV prevalence increases, TB notification increases.

The prevalence of AIDS worldwide has impacted thousands of innocent people, including women, kids, and refugees. It has increased TB rates, death rates, and reduced the number of workers and students.

Treatments

The treatment for AIDS is not perfected and there is no permanent cure for HIV/AIDS, however, if HIV/AIDS is contracted, scientists use antiretroviral or anti-HIV drugs to treat it. The term Highly Active Antiretroviral Therapy (HAART) is used to describe a combination of three or more anti-HIV drugs. HAART is what doctors will prescribe in order for the drugs to be effective for a long time. There are many different types of antiretroviral drugs, four of which are listed below (Avert 1).

All four types of antiretroviral drugs all function to reduce HIV symptoms.The first group of antiretroviral drugs are the Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (aka NRTIs, aka nucleoside analogues, aka nukes), which were the first available for use of drug available to treat HIV infection in 1987. The second group of antiretroviral drugs are the Non-Nucleoside Reverse Transcriptase Inhibitors (aka NNRTIs, non-nucleosides, aka non-nukes), which started to be approved in 1997. The third group of antiretrovirals is the protease inhibitor (PI) group. The first protease inhibitor was approved in 1995. The fourth group of antiretrovirals is comprised of entry inhibitors, including fusion inhibitors. Entry inhibitors prevent HIV from entering human immune cells (Avert 1).

One fusion inhibitor - commonly called T-20 - has been licensed both in the US and in Europe since 2003, but only for use by people who have already tried other treatments. T-20 differs from the other antiretrovirals in that it needs to be injected (otherwise it would be digested in the stomach.) (Avert 1).

A new type of entry inhibitor known as maraviroc was licensed in 2007. This drug is known as a CCR5 inhibitor. The final group of antiretrovirals currently consists of just one drug, raltegravir, which was approved in the US in October 2007

Functions of Drugs:

Entry Inhibitors: Entry inhibitors do just that. They keep the HIV virus from entering/infecting a healthy cell (Avert 1). They attach onto proteins on the surface of HIV and prevent the virus from entering a cell. Entry inhibitors prevent the outer coat from binding to the surface of a healthy cell.

Nucleoside Reverse Transcriptase Inhibitors: Nucleoside Reverse Transcriptase Inhibitors interfere with the reverse transcriptase enzyme that the HIV virus uses to replicate itself inside a healthy cell. Inhibitors prevent T cells from becoming infected with HIV so that they can continue to try and fight off other smaller infections like pneumonia. When entering a cell, HIV needs to replicate its RNA to DNA to fully infect the cell. Nucleosdie Reverse Transcriptase Inhibitors mess up this process and cause the DNA to be copied incorrectly, causing fewer cells to be infected with HIV (Avert 1).

Non-Nucleoside Reverse Transcriptase Inhibitors: In contrast to the nucleoside reverse transcriptase inhibitors, the non-nucleoside version does not mess up the conversion from RNA to DNA. It actually stops the process from occurring, hopefully, putting the RNA conversion to a complete stop. The inhibitors do this by attaching themselves to the HIV’s reverse transcriptase and halting the process.

Protease Inhibitors: When the HIV virus has entered a cell, it uses a reverse transcriptase enzyme to convert RNA to DNA. While this process is going on, the strands are copied and are “cut” and “pasted” together (Avert 1). The protease inhibitors block the protease enzyme and stop the DNA from being put together.

Practices

AIDS is a virus that only originated in the second half of the twentieth century, yet it has been the cause of millions of deaths around the world. The virus first originated in Africa, later spreading to Europe and North America. The most recent statistics show that AIDS has killed 21.8 million, but the death toll increases daily. Currently over 34.7 million adults and 1.4 million children are living with AIDS, but again the number of people infected with the virus grows everyday (Mader 460). More is known about the virus than before and drugs have been developed that combat AIDS, however, there is still no cure. Although these drugs have resulted in a decrease of overall deaths from AIDS, in many places the rate of infection is on the rise (Mader 462). What used to be known in the United States as a virus that infected only homosexuals, the rate of infection for heterosexuals and minorities is drastically increasing (Mader 464). In many Sub-Saharan countries in Africa where AIDS was not a huge threat it has become the leading cause of death. In 1990 only 1% of the population was infected with HIV AIDS, however, today about 20% of the population is infected (Mader 463). AIDS is a virus that is not specific to one country or one population, it affects everyone and anyone can be infected. In reality very little progress has been made to find a cure or prevent the virus from spreading. In fact, Teens and young adults are now becoming the prime sufferers of AIDS (Mader 466). Although AIDS in present around the world, the African continent still remains the overwhelmingly largest population infected with AIDS.

Many African countries do not have the means to prevent the spread of the AIDS virus from person to person and many people lack the education to know what causes and how to prevent the virus. Governments throughout Africa do not have the funds to provide education and protection for the millions of individuals and often they do not understand what causes the virus in the first place. Aside from education, abstinence and condoms are the best methods to check the spread of AIDS, but many African couples do not understand how to use condoms and sometimes they cannot afford them. Furthermore, rape is a common occurrence in Africa, so it is often impossible for the women to know when they are going to be engaged in sexual activity. In order to decrease the spread of AIDS in Africa it is necessary for the United Nations and organizations such as the Red Cross to provide protection and education for millions of individuals in Africa.

Solutions

There is no cure for AIDS. There are, however, various treatments that reduce the effects of the disease. Scientists like “Dr. Robert Gallo, director of the Institute of Human Virology at the University of Maryland and co-discoverer of HIV” focus on better understanding the human immune system and how it responds to the virus. Gallo and others like him are working towards creating a vaccine for AIDS, which is believed to be “the only way to stop the virus from spreading.” (Check 1) Today, treatment for AIDS involves mainly pain medications such as morphine and related drugs.

Around the world, people are seeking spread AIDS awareness and prevention. Some billboards in Africa read, “‘AIDS does not discriminate,’ with blood dripping down, another ‘if you want to get it on, get with it and put it on, condoms.’” Educational organizations like high schools and colleges pass out pamphlets about AIDS prevention and awareness and condoms to their students. (AIDS African Solutions 1) Organizations like UNAIDS and the International Conference on AIDS and fundraisers such as AIDS Awareness Days and the HIV/AIDS quilt are means make aware and gather support from the public (Reed 36).

In June 1987, “President Reagan issued a directive that all immigrants and federal prisoners be tested.” He also strongly encouraged those applying for marriage licenses are tested. In Georgia, judges can order prostitutes to be tested. Some people also want doctors and nurses tested. Most doctors want their patients tested before surgery, so some hospitals begun routine HIV testing of the patients undergoing surgery. (Check 61) In May 1995, Norway passed the Communicable Diseases Control Act, which makes it required for a physical to inform a third party if the physician notices that an HIV-positive patient is putting other at risk for contracting HIV. The law also requires the physician to attempt multiple times to get the patients consent before breaking the confidentiality law. (Check 61) In the US by 1990, the doctors were required to report all AIDS cases to the Department of Health Services, although the patient’s identity is protected. The physician who reported the case was now permitted to inform the patient’s sexual partner of the HIV case. Doctors are not legally required to inform the third party, but if the patient shows “manic- depressive or reckless tendencies,” the doctor is legally required to warn others, especially if the patient might purposely and knowingly infect others. If the patient’s partner contracts HIV and the patient wasn’t notified, the doctor could be sued for “failing to provide a warning.” Because the drugs for HIV and AIDS are so expensive, there are two different worlds of AIDS patients. (Check 57)

Works Cited

“2007 AIDS Epidemic Update.” December 2007. United Nations. 19 January, 2008.

http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf

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Conclusion

The students at Girls’ Preparatory School undertook this Global Infectious Disease project in an effort to educate themselves and others about chlamydia, AIDS, and gonorrhea. Beginning in September, students spent four months researching and collaborating to produce this final report on the background, treatment, solutions, and impacts of all three of these infectious diseases. Through our efforts, we hope we are able to increase the knowledge about and awareness of chlamydia, AIDS, gonorrhea in this global society.

In the United States, chlamydia is the most common sexually transmitted disease. Unfortunately, most symptoms of this disease go unnoticed, leaving those infected at a greater risk for pelvic inflammatory disease, ectopic pregnancy, infertility, or prostatitis. Because of the mild symptoms of chlamydia, it is commonly passed from partner to partner at an astonishing rate, leading to almost three million new cases in the US every year. Ninety-two cases of chlamydia were reported in the world in 2007, with frequencies varying from country to country. Luckily, if chlamydia is diagnosed in time, it can be completely cured by a course of oral antibiotics. While many don’t have access to these antibiotics, some screening and/or treatment facilities have been opened to provide aid to those who cannot afford it. Through treatment and prevention education, chlamydia can become of a disease of the past. It is up to the citizens of the world to have the wherewithal to partake in safe sex, have annual screenings for STDs, and be open and honest with partners about their sexual history.

We saw the beginning of the AIDS epidemic in the early 1980s and soon after the world bore witness to the rapid decline and eventual death of those infected with this dangerous disease. Originally believed to be a “gay disease,” acquired immunodeficiency syndrome soon became a scourge that lead to the deaths of over 20 million people. It began in Africa, where it still thrives today, and later spread to Europe and North America. No cure currently exists for AIDS, although, those living with the disease have access to several treatment options. Protease and Reverse Transcriptase Inhibitors work to delay the spread of the disease throughout the body. While these drugs do not cure AIDS, the often extend the life expectancy of those infected. Unfortunately, access to these medicines is basically limited to wealthier areas like Europe and North America. An overwhelming 20% of the population of Africa is currently infected with the disease, yet they still have little to no access to AIDS related healthcare. Hopefully through safe sex practices and education, the spread of the disease can be limited until a cure can be found.

Gonorrhea is one of the most prevalent STDs in the world today and over 600,000 people in the US are diagnosed each year. Gonorrhea is spread through sexual contact, but like chlamydia, it can be cured with antibiotics like Penicillin. Unlike chlamydia, gonorrhea has several side effects including but not limited to genital pain and discharge. If left untreated, gonorrhea can lead to pelvic inflammatory disease, prostate inflammation, ectopic pregnancies, and/or infertility. Through the efforts of several programs and governments, knowledge about gonorrhea has spread throughout the world. With it have come better treatment options to those in developing countries as well as an overall global initiative to try and slow the spread of all STDs. Like chlamydia and AIDS gonorrhea can be prevented through safe practices and prevention education.

We encourage all to take part in this global initiative to reduce the rates of all STDs, deadly or otherwise, throughout the world. The combined efforts of everyone involved can lead to a happier, healthier world for generations to come. We, the students at Girls Preparatory School, present this report as our contribution to achieving a safer, healthier, and more knowledgeable society.