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KIN 140

Section 4

I. Sexually Transmitted Diseases (STDs) (parts of Chap 13)

STDs include acquired immunodeficiency syndrome (AIDS), chlamydia, gonorrhea,
pelvic inflammatory disease (PID), genital warts, genital herpes, hepatitis B, syphilis, and
others.
Unfortunately you can have more than 1 STD at a time and the same one can reoccur
many times. Little immunity is imparted to the host and therefore you can get the disease
more than once. Having an STD can also lead to other diseases, so there is not a lot of
upside.
Another problem is that STDs can be asymptomatic for long periods while the host
remains infectious. This leads to 6 degrees of copulation. It takes between 3 and 7
sexual contacts to be linked to the sexual partners of everyone else. The spread of an STD
is magnified when some individuals have a large number of sexual contacts. In the case
of AIDS, a Canadian flight attendant was responsible for 40 of the first 248 cases
identified in 8 different cities in the world.
II. HIV (human immunodeficiency virus)/AIDS
Evolution
It is believed a monkey became infected with two different simian immunodeficiency
viruses (SIV). The RNA of these two viruses fused to create a hybrid SIV. This hybrid
infected a human. It turns out people eat monkey meat and can cut themselves while
butchering the monkey, thus creating a portal of entry for bodily fluid (blood) exchange.
This occurred in the 1920s most likely in Cameroon Africa. Humans were immune to
SIV, so the SIV had to mutate to overcome the natural immunity of humans. Now it is
HIV. It spread via the proliferation of towns in Africa with an increase in sexual contacts
and red light districts. Some believe it also spread was the massive reuse of cheap needles
in the 1950s that were used to control/eradicate diseases such as polio, smallpox and
malaria. While HIV has mutated numerous time since, the most common form is HIV-1
group M. It accounts for about 98% of the HIV cases worldwide.
Structure
As mentioned in a previous lecture, in general, there are DNA and RNA viruses, both
single and double stranded. HIV is a single-stranded RNA virus and is also known as a
retrovirus. It has two copies of single-stranded RNA and is retro because it also has the
enzyme, reverse transcriptase, which enables the virus to make DNA copies of its RNA
inside its host cell. The RNA molecule has 9 or 10 genes that in turn encode 19 proteins.
It is surrounded by a protein coat and then again by a lipid membrane which has surface

glycoproteins for recognition of specific cells in which to bind. It is about 60x smaller
than a red blood cell.
A lot of controversy surrounds HIV identification and the cause of AIDS. Below is the
mass-combined version.

A. HIV Attack
HIV is a very effective pathogen because it attacks the immune system that defends the
body. The retrovirus attacks the T4 helper cells. Thus it attacks the bodys ability to kill
the virus and depresses our amplification mechanisms as well. With the immune system
depressed, the infected person is also vulnerable to many other diseases.
Once infected it may take as long as 3 months, while the virus is replicating, before there
are detectable levels of antibodies (made by the body) to HIV to make a positive
confirmation of the infection. At this time the virus can be transmitted the easiest.
It may take from 1-20 years before the infected person shows symptoms. At this time the
person can still transmit the virus.
In the symptomatic period the normal count of T helper cells (aka T4 or CD4 cells) falls
from 800-1000 per microlitre to below 200 per microlitre and the patient is now
considered to have AIDS (Fig 13-3).
Once the patient becomes symptomatic, this phase can last 6 months to 10+ years. This
duration is quite drug effectiveness dependent.
AIDS kills only a fraction of the people that cars, tobacco, heart disease etc kills. So why
are we so concerned?
We have no vaccine and no cure. It is the most infectious disease since the Black Plague.
AIDS is mostly a disease of the young and 58 million people worldwide are infected.
B. HIV Transmission
At any stage of HIV infection, the carrier is infectious. The virus is transmitted through
some of the bodys fluids:
vaginal
semen
blood
breast milk

HIV is not transmitted through saliva (as long as the oral lining is intact), sweat, or tears.
Blood to blood and semen to blood are the most effective ways to transmit the virus. It is
easier to get HIV via unprotected anal or vaginal intercourse rather than the oral route.
At the end of 2014, an estimated 21 per cent of the 75,500 individuals living with HIV in
Canada were unaware of their infection, according to the Public Health Agency of
Canada.
The chance of infection increases if tissue linings are irritated (e.g., enemas,
spermaticides, or flossing).
For heterosexual activity, HIV is 12x more readily transmitted from male to female than
the reverse because HIV is more concentrated in semen than it is in vaginal fluids.
Outside of the body, HIV is easily destroyed with hot soapy water or dilute bleach. It also
cannot survive on a toilet seat.
C. AIDS Treatment
There is no cure for AIDS, so prevention is critical to prevent its spread.
Currently, the best treatments available attempt to reduce or stop the virus from
multiplying. These drugs are protease inhibitors and reverse transcriptase inhibitors.
Protease inhibitors stop virus replication by inhibiting the cleaving of large proteins into
smaller viral building blocks. Reverse transcriptase inhibitors try to block the initial
process of making DNA from the viral RNA.
Often these treatments last only days or weeks because the virus adapts. Because of this,
the patient is often given a cocktail of both types of drugs.
These cocktail treatments are known as Highly Active Antiretroviral Therapy, or
HAART. These different drugs have many side effects, with severe nausea being common
to virtually all of them. This requires anti-nausea medication to be taken concurrently.
A vaccine is the only long term and economical solution to the spread of HIV. But
vaccination against HIV is not possible because the virus mutates too often for a standard
vaccine to be successful. The mutation rate is so high that HIV surface molecules are a
moving target. Furthermore, on its antigenic site, its conserved region, is hidden and its
variable region is exposed. This means that our immune system and vaccine developers
cannot keep up.

One possible novel vaccine is to introduce modified CD8+ lymphocytes. This treatment
reduces the HIV replication rate inducing a much more reduced viral load in a treated
individual. This in turn will reduce the transmission rate of HIV.
D. AIDS Mortality
The person with AIDS (PWA) will most likely die from Pneumocystis carnii pneumonia,
Kaposis sarcoma (a skin cancer), or brain infection.
Lets take a closer look at the induced encephalitis. The JC virus is present and dormant in
about 70 % of the population. When the immune system is weakened, the JC virus can
multiply and cause encephalitis as well as destroy myelin.
Gastrointestinal problems arise because the particular type of CD4 lymphocyte that HIV
attacks is present in a much greater amount in intestinal mucosa than in blood for
example.

E. AIDS in Canada
There are over 60,000 Canadians suffering from AIDS and the median age of symptoms
is now 24 rather than 30 as it was in the 1980s.
In the late 80s mostly gay men were infected. Currently, 25 % of AIDS cases are
women. AIDS rates are increasing most in woman, young gay men, aboriginals, and
injecting drug users (IDU).
The treatment is not user friendly. You have to take 30 pills/day: some with food and
some without. Some need refrigeration.
The costs are in excess of $1500/month. Because of this, many of those infected quit their
jobs so they can get on a government-assisted plan to pay for the drugs.
With IDU taking 20 injections of cocaine/day, sticking to the proper regime of AIDS pills
and paying for them is unlikely. This leads to extra transmission in the population: 2/day
in the Vancouver IDU population.
F. AIDS in the World
There are over 60 million cases in the world of which 95 % are in the developing world
and 70 % in sub-Saharan Africa.
AIDS develops because of ignorance, fear, and poverty. In many countries, there is a lack
of education: how does it spread and how can one protect themselves? Sometimes one is

not allowed to protect oneself. Women marry older men that have had many sexual
contacts. Machismo is often compounding the problem.
There is also a drug patent controversy in which the AIDS drugs of multinational
companies cost about $10,000/year whereas similar generic drugs may only cost
$280/year.
III. Meningitis
Meningitis is an inflammation of the membranes surrounding the central nervous called
the meninges. Many types of bacteria as well as viruses and fungi can cause it. It is
characterized by fever, headache, nausea, vomiting, stiff neck, sensitivity to light, and
mood changes.
Viral meningitis is the most common in Canada. Fortunately the symptoms are not
usually severe.
Bacterial meningitis, while less common, is deadly, with fatality being the highest in the
teenage group.
The type of meningitis that is causing the problems in Abbotsford and the Fraser Valley is
the meningococcus bacterium. It is found in the back of throats in about 1 out of every 5
people and is not a problem. The subpopulations at highest risk are babies less than a year
old and young adults, 18-27.
Transmission
Kissing, sharing water bottles, or lipstick etc can transmit the bacterium from one person
to another. The bacterium does not live long outside of the body. Therefore, transmission
by swimming pools or restaurants does not occur. We do not know why the bacterium
suddenly puts on a growth spurt. The normal incidence is about 1/100,000 people which
means 35-50 cases per year in BC. A carrier is infectious 7 days BEFORE showing
symptoms and up to 2 days after serious antibiotic treatment.
Treatment
Treatment is a bit of a crap shoot. Initial symptoms are generic making diagnosis
difficult. Just because a person does not feel well and has a headache, does not justify a
lumbar puncture to sample cerebral spinal fluid. Yet meningitis is a medical emergency.
Because mortality can occur within a few hours, broad spectrum antibiotics may be
started before confirmation of a bacterial cause. Byproducts of the destroyed bacteria
may increase the inflammation.
Prevention is usually done with a vaccine after an outbreak has occurred to contain it. All
children receive a vaccine to what used to be a very common form of meningitis: H flu b.
Thanks to the vaccine, it is now very rare. In the United Kingdom, they recently

vaccinated 18 million people between the ages of 2 months to 19 yr to control the strain
of meningitis seen in Abbotsford.