Sexually Transmitted Diseases

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Sexually Transmitted Diseases

  1. 1. 1 Sexually Transmitted Infections (STI) SAgun PAudel Shima Kunwar Lila Kumari Sharma Health Assistant Staff Nurse Staff Nurse EIHS, Naulo Ghumti Nepal 08/01/2014
  2. 2. Sexually Transmitted Infections (STI) 2 Sexually Transmitted Infections (STI) are illnesses that predominantly transmitted by means of sexual behavior, including vaginal intercourse, anal sex and oral sex. 08/01/2014
  3. 3. Classification of STIs 3  1. 2. 3. 4. 5. Bacterial Chancroid (Haemophilus ducreyi) Chlamydia (Chlamydia trachomatis) Gonorrhea (Neisseria gonorrhoeae) Syphilis (Treponema pallidum) Donovanosis 08/01/2014
  4. 4. 4 Parasites  Crab louse pubic lice" (Pthirus pubis)  Scabies (Sarcoptes scabiei) Protozoal Trichomoniasis (Trichomonas vaginalis Viral 1. Viral hepatitis (Hepatitis B virus 2. Herpes simplex (Herpes simplex virus 3. HIV 4. HPV 5. Molluscum contagiosum 08/01/2014
  5. 5. Mode of Transmission 5    Sexual contact: from one infected person to another primarily by Sexual contact- Anal, Vaginal or oral From Mother to child: during Pregnancy and child birth Occasionally through contaminated fingers, blood and blood products, organ transplants, contaminated needles and fomites such as towels, sex toys. 08/01/2014
  6. 6. Sign and symptoms of STIs 6 Male • Urethral discharge • Burning and pain during urination • Pain of itch in and around genitalia, perineum and anus/rectum • Papules, vesicles, erosion/ulcers or fleshy growths in and around genitalia, perineum and anus/rectum, oral cavity and occasionally on other sites. • Swelling in inguinal, anal region and of scrotum. 08/01/2014
  7. 7. 7 Female  abnormal vaginal discharge  Burning and/or increased frequency of urination  Lower abdominal pain • Pain, itch, Papules, vesicles, erosion/ulcers or fleshy growths in and around genitalia, perineum and anus/rectum, oral cavity and occasionally on other sites. • Swelling in inguinal, anal region and of scrotum. 08/01/2014
  8. 8. 8 08/01/2014
  9. 9. Possible complications related to STIs 9 Male  urethral stricture  Epididymo-orchitis  Penile and anal cancer  Rarely disseminated infections 08/01/2014
  10. 10. 10 New born (from mother) • congenital syphilis and neonatal conjunctivitis • Premature and low birth weight • Herpetic/HPV infection 08/01/2014
  11. 11. 11 Female  Pelvic inflammatory disease  Cervical and cancer  Ectopic pregnancy  Abortion, still birth STI increases risk of HIV infection 08/01/2014
  12. 12. Common complications in male and female 12        infertility Scarring, distortion and mutilation of the genitalia Systemic infection Anxiety depression Social rejection by community member, family members Stigma and discrimination Intra-marital discord and divorce etc 08/01/2014
  13. 13. STI risk factors 13 health care related behaviors  Lack of willingness to seek medical advice and choice of health care  Lack of compliance with therapy  Lack of partner’s referral for therapy  Practice of vaginal cleaning of douching, enema 08/01/2014
  14. 14. 14 Sexual behaviors  sexual contact with multiple partners  Sexual contact without using protective barriers  Sexual contact with causal partners  Sexual contact with high possibilities of trauma – anal Other factors  age, socioeconomic status, drug and alcohol use etc. 08/01/2014
  15. 15. STIs management strategy 15 STIs management program should be comprehensive It should be designed in such a way that:  identification of maximum number of symptomatic and asymptomatic individuals.  provide effective on-the-spot treatment  Identify those who have increased risk behavior for contracting STIs  Promote positive behavior change and maintenance to reduce sexual and other risks through appropriate health education and communication program. 08/01/2014
  16. 16. Epidemiology 16 Estimated annual Incidence WHO: 1999  340 million new cases (syphilis, gonorrhea, chlamydial and trichomoniasis primarily occurring in men and women aged 15-49 years)  Syphilis: 12 million  Gonorrhea: 62 million  Chlamydial infection: 92 million  Trichomoniasis: 173 million 08/01/2014
  17. 17. 17 According to HMIS 2064/65 BS;  28,2229 STIs Research by Zeeb (1996) estimated a total of 6,000 to 8,000 annual STIs client in kaski District. IBBS, 2008 in pokhara 30% of FSW reported at least one symptom of STIs. 08/01/2014
  18. 18. Public health aspect 18 General population High Risk population Bridge population 08/01/2014
  19. 19. Approaches of STIs Diagnosis and management 19     Clinical Etiological Syndromic Enhanced syngromic 08/01/2014
  20. 20. Clinical approach 20  Based on clinical findings 08/01/2014
  21. 21. Etiological approach 21  identification of causative organisms or their antibodies through laboratory testing. 08/01/2014
  22. 22. Syndromic approach 22   Identification of consistent STI-related groups of symptoms and clearly recognized signs are called STI syndromes. The provision of clinical care which will cure the majority of organisms responsible for producing each syndrome is called syndromic case management. 08/01/2014
  23. 23. Enhanced syndromic 23  An approach that aims toward reducing the prevalence of STIs through a single round of presumptive treatment of cervicitis, with subsequent monthly clinical care through an enhanced syndromic management protocol on risk assessment and laboratory tests. 08/01/2014
  24. 24. Main STI syndromes 24        UDS SSS GUDS IBS VDS LAPS NCS 08/01/2014
  25. 25. 4Cs of Syndromic management 25     Compliance with treatment Counseling Contact tracing Correct and consistent condom use. 08/01/2014
  26. 26. Activities inside Clinic 26 STI COUNSELING STI EXAMINATION STI MANAGEMENT AND POST TEST COUNSELING 08/01/2014
  27. 27. FAMILY PLANNING SERVICE 27 FP COUNS ELING FP SERVICE PROVISION (IF CLIENT WANTS) Post service Counse ling 08/01/2014
  28. 28. Problems 28    Client do not easily agree for STI examination especially for PV examination. Irregular client flow. acceptance of dual methods. 08/01/2014
  29. 29. References 29  National Training Manual on the Management of Sexually Transmitted Infection. (Training manual) updated: 2011 08/01/2014
  30. 30. Do not forget to suggest 30    mail4sagun@gmail.com www.facebook.com/preventionisbest www.facebook.com/sagun.paudel 08/01/2014
  31. 31. 31 Thankyou 08/01/2014
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