HIV AIDS and STD

1. Sexually Transmitted
Diseases
Presented by Miss Sudipta Roy
Associate Professor
East Point College of Pharmacy
Bangalore

2. • The sexually transmitted diseases (STD) are a group
of communicable diseases which are transmitted
predominantly by sexual contact and are caused by
a wide range of bacterial, viral, protozoal, and
fungal agents and ectoparasites. Earlier, STDS were
termed as veneral diseases (VD) to compromise of
following the five types:
• 1. Syphilis
• 2. Gonorrhoea
• 3. Chancroid
• 4. Lymphogranuloma venereum

3. • These diseases are known to be caused by various
organism shown in Table No.1, Further diseases
caused by some of these organisms are listed.
• Classification of agents causing STDs.

4. Type of Agent Name of Agent
Bacterial Agents Neisseria gonorrhoeae
Chlamydia trachomatis
Treponema pallidium
Haemophilus ducreyi
Mucoplasma hominis
Ureaplasma urealyticum
Calymmotobacterium granulomatis
Shigella spp
Campylobacter spp
Group B Streptococcus
Bacterial vagiosis-associated organisms

5. Type of Agent Name of Agent
Viral Agents Human alpha herpes virus 1 or 2
(herpes simplex virus)
Human beta herpes virus 5
(cytomegalo virus)
Hepatitis virus B
Human papiilloma viruses
Molluscum contagiosum virus
Human immunodeficiency virus

6. Type of Agent Name of Agent
Protozoal Agents Entamoeba histolytica
Giardia lamblia
Trichomonas vaginalis

7. Type of Agent Name of Agent
Fungal Agents Candida albicans

8. Type of Agent Name of Agent
Ectoparasites Phthirus pubis
Sarcoptes scabiei

9. Important STDs and the causative
organisms
SL. No. Disease/Syndrome Pathogen
1 Gonorrhoea,
urethritis, cervicitis,
epididymitis,
salpingitis, neo-natal
conjunctivitis
Neisseria
gonorrhoeae
2 Syphilis Treponema pallidum
3 Chancroid Haemophilus ducreyi

10. Type of Agent Name of Agent
Urethritis, cervicitis, proctitis,
epididymitis, infant pneumonia,
Reiter's syndrome, neonatal
conjunctivitis
Chlamydia trachomatis

11. SL. No. Disease/Syndrome Pathogen
1 Donovanosis Calymmatobacterium
granulomatis
2 Genital herpes Herpes simplex virus
3 Acute and chronic
hepatitis
Hepatitis B virus
4 Genital and anal warts Human papilloma
virus

12. SL. No. Disease/Syndrome Pathogen
1 AIDS Human
immunodeficiency
virus
2 Genital molluscum
contagiosm
Molluscum
contagiosum
3 Vaginitis Candida albicans
4 Vaginitis Trichomonas vaginalis

13. Clinical Presentation.
• Role of Pharmacist in Education and Prevention:
• Preventive measures to control sexually
transmitted diseases are an effective way to deal
with them.
• The control can be effected in following ways:
• 1. Initial Planning:
• It involves following components:
• a. Problem definition:
• The problem in the community should be defined
in terms of prevalence, psycho-social consequences
and other health effects with the aid of population

14. • Eastablishing priorities:
• Based on health problem considerations
(magnitude, consequence) and feasibility of control
(availability of adequate resources, social and
political commitment), priority groups should be
unambiguous and quantifiable. Board coverage of
the population is crucial for effective STD control.
• Considering Strategies:
• Based on the local community, appropriate
strategies for control for STDs should be identified.

15. • Intervention Strategy.
• The intervention strategies are characterized as
follows:
• a. Case detection:
• Cases should be detected by screening, contact
tracing or cluster testing.
• Case holding and treatment:
• There is a tendency on the part of patients
suffering from STDs to disappear or drop out before
treatment is completed. It should be ensured that
every patient takes full treatment.

16. • Epidemiological treatment:
• It consists of administration of full therapeutic dose
of treatment to recently exposed patient while
awaiting for results of laboratory tests.
• Epidemiological treatment is not an end in itself. Its
effects are not long lasting, unless it is combined
with a venerological examination and tracing of
contacts revealed by the examination.

17. • Personal prophylaxis of STDs.
• Health education:
• The aim of educational intervention is to help
individuals to alter their behaviour in an effort to
avoid STDs. The target groups may include general
public, patients, priority groups, community leaders
etc.

18. • Support Componets.
• Following components are involved in the support.
• a. STD clinic: Eastablishing a special clinic for STD
patients is desirable.
• Laboratory services: Adequate laboratory facilities
and trained staff are essential for proper patient
management.
• Primary health care: Inegration of primary health
care services to include village health guides,
multipurpose workers is desirable.

19. • Information System:
• It should involve questions like number of cases,
number of villages and the number of examined
cultures. The system should provide information on
activities, resource utilization and task
accomplishment of programme personal.

20. • Legislation:
• A legislation "'The immoral traffic (prevention) Act, 1986
has been enacted to cover persons, who are exploited
sexually for commercial purpose.
• Social Welfare measures:
• The measures include:
• Rehabilitation of prostitutes.
• Provision of recreation facilities in the community.
• Provision of decent living conditions.
• Marraige counselling
• Prohobiting the sale of sexually stimulating literature,
pornographic books and photographic etc.

21. Monitoring and Evaluation.
• Monitoring of disease trends and evaluating
programme activities is necessary. Evaluation
shows whether the activity is performed in an
effective manner.
• AIDS: AIDS, the acquired immunodeficiency disease
is a fatal illness. Sometimes it is also termed as slim
disease.
• Causative Agent:
• The agent is Human Immunodeficiency Virus (HIV).
It breaks down the body's immune system, leaving
the victim vulnerable to a host of life-threatning
opportunistic infections.

22. • Once infected, it is probable that a person will be
infected for life. The virus replicates in actively
dividing T4 lymphocytes and can remain in
lymphoid cells in a latent state which can be
activated. The virus has the unique ability to
destroy human T4 helper cells, a sub-set of the
human T-lymphocytes.
• The virus is able to spread throughout the body. It
can pass through the blood-brain barrier and can
destroy some brain cells.

23. • This accounts for certain neurological and psychomotor
abnormalities observed in AIDS Patients. The virus
mutates rapidly. Two types of varieties HIV1 and HIV2
are known. The virus is easily killed by heat. It is readily
inactivated by ether, acetone, 20% ethanol and 1/400
dilution of beta propiolactone, but is relatively resistant
to ionizing radiation and ultra violet light. Since HIV
infection can take years to manifest itself , the
symptomless carrier can infect other people for years.
The virus can be found readily in blood, semen, and
CSF. Lower concentrations can be detected in tears,
saliva, breast milk, urine, cervical and vaginal
secretions. Only blood and semen have been
conclusively shown to transmit the virus.

24. • Cliical Presentation.
• Due to decreased immune resonse, the victim is
vulnerable to various life threatening opportunistic
infections, neurological disorders, or unusual
malignencies. The clinical manifestations of HIV
infection have been classified into four broad
categories.

25. • Initial infection with the virus and development of
antibodies:
• Initially, 70% of the patients are symptomless for
few weeks. HIV antibodies are raised during 2-12
weeks. This duration is termed as window period,
during which, although the person is infectious,
he/she will test negative on the standard antibody
blood test.

26. • Asymptomatic carrier state:
• Infected people have antibodies, but no signs of dosease
except persistent generalized lymphadenopathy. The
duration of this state is not certain.
• AIDS Related complex (ARC):
• A person with ARC has illness caused by damage to
immune system, but without opportunistic infections and
cancers associated with AIDS, but they exhibit one or
more of following clinical signs: unexplained diahorrea
lasting longer than a month, fatigue, malaise, loss of more
than 10% of body weght, fever, night swears or
opportunistic infections like oral thrush, generalized
lymphadenopathy or enlarged spleen.

27. AIDS.
• It is the end stage of HIV infection. A number of
opportinistic infections commonly occur at this stage
and or cancers that oocur in people with otherwise
unexplained defects.
• Tuberculosis and kaposi sarcoma are usually seen at an
early stage.
• Serious fungal infections such as Candida oesophagitis,
Cryptococcus meningitis and Penicillosis and parasitic
infections such as Pneumocystis carinni pneumonia or
Toxoplasma gondii encephalitis tend to occur , When T-
helper cell count has dropped to around 100. People
whose counts are below 50 have the late opportunistic
infections such as Ctyomegaloviral retinitis.

28. • An alarming factor in AIDS epidemic is the increasing
link between HIV infection and Tuberculosis.
Incidence of tuberculosis is further complicated due
to reduced immunity.
• The emergence of drug resistance makes it essential
that antibiotic sensitivity be erformed on all positive
cultures.
• Drug therapy should be individualized. Multidrug
resistant cases should receive at least three
antibiotics to which the organism issensitive.

29. • Role of Pharmacist in Education and Prevention.
• There are four basic approaches to control of AIDS.
• Prevention