Sexually transmitted infections

1. Sexually TransmittedSexually Transmitted
InfectionsInfections
Dr. Ashraf fouda
Ob/Gyn. SpecialistOb/Gyn. Specialist
Egypt – Domiatt General HospitalEgypt – Domiatt General Hospital

2. 2
The name of this groupThe name of this group
of diseases wasof diseases was
changed fromchanged from
“venereal diseases” to“venereal diseases” to
“sexually transmitted“sexually transmitted
diseases” or “STDs”diseases” or “STDs”
Now many persons callNow many persons call
them “sexuallythem “sexually

3. 3
Sexually TransmittedSexually Transmitted
InfectionsInfections
• A STI is an infection thatA STI is an infection that
is transmitted throughis transmitted through
sexually activitysexually activity

4. 4
Importance of STIsImportance of STIs
Most neglected area ofMost neglected area of
healthcare in developinghealthcare in developing
countriescountries ((vaginitis, cervicitisvaginitis, cervicitis
and PIDand PID))
Major cause of infertility in bothMajor cause of infertility in both
females and malesfemales and males
Source: Lande 1993; WHO 1996.

5. 5
• Account for up to 40% of
gynecologic hospital admissions
• Cofactor in HIV and HBV
transmission
• STDs are almost as common as
malaria: 333 million new cases
each year
Importance of STDsImportance of STDs

6. 6
STDs are a Significant
Problem
The consequences of untreated STDsThe consequences of untreated STDs
–Ectopic pregnancyEctopic pregnancy ((77--10 times10 times
increased risk in women with historyincreased risk in women with history
of PIDof PID))
–Increased risk ofIncreased risk of cervical cancercervical cancer
–Chronic abdominal painChronic abdominal pain ((18% of18% of
females with a history of PIDfemales with a history of PID))
Source: Lande 1993.

7. 7
STIs are a Significant
Problem
InfertilityInfertility::
– 2020--40% of40% of malesmales with untreatedwith untreated
chlamydia and gonorrheachlamydia and gonorrhea
– 5555--85% of85% of femalesfemales with untreatedwith untreated
PIDPID
((88--20% of females with untreated20% of females with untreated
gonorrhea develop PIDgonorrhea develop PID))
Increased risk of HBV andIncreased risk of HBV and
HIVHIV//AIDS transmissionAIDS transmissionSource: Lande 1993.

8. 8
STIs are a SignificantSTIs are a Significant
ProblemProblem
Infants canInfants can::
–Be infected at birth with blindingBe infected at birth with blinding
eye infections and pneumoniaeye infections and pneumonia
((chlamydia, genital herpes andchlamydia, genital herpes and
gonorrheagonorrhea))
–Suffer central nervous systemSuffer central nervous system
damage or diedamage or die ((syphilis or genitalsyphilis or genital
herpesherpes)) as a result of STDsas a result of STDs

9. 9
STIs -STIs -
classificationclassification
BACTERIALBACTERIAL
VIRALVIRAL
PROTOZOALPROTOZOAL
FUNGALFUNGAL
ECTOPARASITESECTOPARASITES

10. 10
BACTERIABACTERIA
Neisseria gonorrhoeaeNeisseria gonorrhoeae gonorrheagonorrhea
Chlamydia trachomatis chlamydiachlamydia
Treponema pallidum SyphilisSyphilis
Hemophilus ducreyi ChancroidChancroid
Calymmatobacterium granulomatis
Donovanosis (granuloma inguinale)Donovanosis (granuloma inguinale)
Gardnerella vaginalisGardnerella vaginalis Gardnerella-associatedGardnerella-associated
("nonspecific") vaginosis("nonspecific") vaginosis
OTHERRSOTHERRS :eg.:eg. Mycoplasma hominisMycoplasma hominis ,,UreaplasmaUreaplasma

11. 11
VIRUSESVIRUSES
Herpes simplex virusHerpes simplex virus
Human papilloma virusHuman papilloma virus
Hepatitis B virusHepatitis B virus
HIV (AIDS)HIV (AIDS)
CytomegalovirusCytomegalovirus
Molluscum contagiosumMolluscum contagiosum
virus

12. 12
PROTOZOALPROTOZOAL
Trichomonas vaginalisTrichomonas vaginalis
Trichomonal vaginitisTrichomonal vaginitis
Entamoeba histolyticaEntamoeba histolytica AmebiasisAmebiasis
in homosexual menin homosexual men
Giardia lambliaGiardia lamblia GiardiasisGiardiasis
in homosexual menin homosexual men

13. 13
FUNGIFUNGI
?Candida albicans?Candida albicans Vulvovaginitis,Vulvovaginitis,
balanitisbalanitis
ECTOPARASITESECTOPARASITES
Phthirius pubisPhthirius pubis Pubic lice infestationPubic lice infestation
Sarcoptes scabieiSarcoptes scabiei ScabiesScabies

14. BacterialBacterial
STDsSTDs

15. 15
ChlamydiaChlamydia
•• Bacteria -Bacteria - ChlamydiaChlamydia
trachomatistrachomatis
Unusual very small bacteriaUnusual very small bacteria
because it livesbecause it lives
inside cells that it infectsinside cells that it infects

16. 16
CHLAMYDIACHLAMYDIA
Most common STDMost common STD
Females outnumber males 6Females outnumber males 6
to 1to 1
Cervix is site of infectionCervix is site of infection
Most women areMost women are
asymptomatic until the painasymptomatic until the pain
and fever from PID occurand fever from PID occur

17. 17
CHLAMYDIA
If symptomatic - discharge,
painful urination, lower
abdominal pain, bleeding,
fever and nausea
Complications include;
cervicitis, infertility, chronic
pain, salpingitis, ectopic
pregnancies, stillbirths,
reactive arthritis.

18. 18
Chlamydia - consequencesChlamydia - consequences
20-40% of women infected with20-40% of women infected with
chlamydia will develop PIDchlamydia will develop PID
(Pelvic Inflammatory Disease)(Pelvic Inflammatory Disease)
–9%9% ectopic pregnancyectopic pregnancy
–20% will become20% will become infertileinfertile
–18% chronic18% chronic pelvic painpelvic pain

19. 19
ChlamydiaChlamydiaChlamydiaChlamydia
UrethritisUrethritis
EpididymitisEpididymitis
ProctitisProctitis
CervicitisCervicitis
EndometritisEndometritis
SalpingitisSalpingitis
PerihepatitisPerihepatitis
Otitis media
in infants
Inclusion
conjunctivitis
Sterility

20. 20
ChlamydiaChlamydia
1.1. Diagnostic MethodsDiagnostic Methods ::
2.2. Direct fluorescent antibodyDirect fluorescent antibody
3.3. Enzyme immunoassayEnzyme immunoassay
4.4. Nucleic acid hybridizationNucleic acid hybridization
(DNA probe)(DNA probe)
5.5. Cell cultureCell culture
6.6. DNA amplificationDNA amplification

21. 21
RecommendedRecommended
TreatmentTreatment
Doxycycline 100 mgDoxycycline 100 mg
orally 2 times a day for 7orally 2 times a day for 7
days ordays or
AzithromycinAzithromycin
(Zithromax) 1 g orally(Zithromax) 1 g orally

22. 22
ChlamydiaChlamydia
Azithromycin andAzithromycin and
doxycycline are equallydoxycycline are equally
effectiveeffective
abstain from sexualabstain from sexual
intercourse for 7 daysintercourse for 7 days
sex partners must besex partners must be
evaluated and treatedevaluated and treated

23. 23
Symptoms Among MalesSymptoms Among Males
Diagnosed With ChlamydiaDiagnosed With Chlamydia
Dysuria
16%
Discharge
13%
No Symptoms
71%

24. 24
Symptoms Among Females
Diagnosed With Chlamydia
No
Symptoms
86% Vaginal
Discharge
6%
Dysuria
2%
Abdominal
Pain
6%

25. 25
GonorrheaGonorrhea
–FemalesFemales::
gonococcal cervicitis slightgonococcal cervicitis slight
yellow-green discharge or vulvaryellow-green discharge or vulvar
irritationirritation
–MaleMale::
gonococcal urethritisgonococcal urethritis
odorous cloudy discharge;odorous cloudy discharge;
urinary burning; swollen, tenderurinary burning; swollen, tender
lymph glands in groinlymph glands in groin

26. 26

27. 27
GONORRHEA
Mucus membranes affectedMucus membranes affected
include: cervix, anus, throat,include: cervix, anus, throat,
eyeseyes
Bacteria neisseria gonorrheaBacteria neisseria gonorrhea
organism attacks cervix asorganism attacks cervix as
first site of infectionfirst site of infection

28. 28
GONORRHEA
Symptoms are thick discharge,Symptoms are thick discharge,
burning urination, and severeburning urination, and severe
menstrual or abdominal crampsmenstrual or abdominal cramps
10 to 40 percent women10 to 40 percent women
develop PIDdevelop PID
Untreated gonorrhea can resultUntreated gonorrhea can result
in arthritis, dermatitis, andin arthritis, dermatitis, and
tenosynivitistenosynivitis

29. 29
GonorrheaGonorrheaGonorrheaGonorrhea
UrethritisUrethritis
EpididymitisEpididymitis
ProctitisProctitis
CervicitisCervicitis
EndometritisEndometritis
SalpingititsSalpingitits
PerihepatitisPerihepatitis
PharyngitisPharyngitis
Conjunctivitis
(new born &
other)
Amniotic
infection
syndrome
Disseminated
gonococcal
infection

30. 30
GonorrheaGonorrhea
Consequences:Consequences:
–
FEMALEFEMALE :: PID with sterility;PID with sterility;
ectopic pregnancy, severe pelvicectopic pregnancy, severe pelvic
pain; infant conjunctivitis.pain; infant conjunctivitis.
– MALE:MALE: prostate abscesses withprostate abscesses with
fever, difficult urination;fever, difficult urination;
gonococcal epididymitis with ?gonococcal epididymitis with ?
sterilitysterility

31. 31
GonorrheaGonorrhea
–BothBoth: transmitted to eyes,: transmitted to eyes,
anus, throat; may enter theanus, throat; may enter the
bloodstream & invade joints,bloodstream & invade joints,
heart, liver, CNSheart, liver, CNS
–TreatmentTreatment: dual treatment for: dual treatment for
chlamydia & gonorrhea;chlamydia & gonorrhea;
resistant bacteria requireresistant bacteria require
special treatmentspecial treatment

32. 32
Gonorrhea
Treatment should include coverageTreatment should include coverage
against chlamydia as well asagainst chlamydia as well as
gonorrhea (e.g.gonorrhea (e.g. azithromycin orazithromycin or
doxycyclinedoxycycline to cover chlamydia)to cover chlamydia)
CefiximeCefixime - advantage can be given- advantage can be given
orally, but bactericidal levels lessorally, but bactericidal levels less
than ceftriaxonethan ceftriaxone
CeftriaxoneCeftriaxone - extensive clinical trials- extensive clinical trials
(99.1% cure)(99.1% cure)

33. 33
GonorrheaGonorrhea
Diagnostic MethodsDiagnostic Methods
Gram stain ofGram stain of
endocervical smearendocervical smear
CultureCulture
DNA probeDNA probe

34. 34
Recommended TreatmentRecommended Treatment
Ceftriaxone (Rocephin) 125 mg IM orCeftriaxone (Rocephin) 125 mg IM or
Cefixime 400 mg orally orCefixime 400 mg orally or
Ciprofloxacin (Cipro) 500 mg orally orCiprofloxacin (Cipro) 500 mg orally or
Ofloxacin (Floxin) 400 mg orallyOfloxacin (Floxin) 400 mg orally
Plus: (for chlamydia)Plus: (for chlamydia)
Doxycycline 100 mg 2 times a day forDoxycycline 100 mg 2 times a day for
7 days or azithromycin 1 g orally7 days or azithromycin 1 g orally

35. 35
Bacterial Infections -
NongonococalNongonococal
UrethritisUrethritis
– Female:Female: few or no symptoms;few or no symptoms;
may itch, urinary burning, mildmay itch, urinary burning, mild
vaginal discharge of pusvaginal discharge of pus
– Male:Male: penile discharge ,urinarypenile discharge ,urinary
burningburning

36. 36
Bacterial Infections -Bacterial Infections -
Nongonococal UrethritisNongonococal Urethritis
– Consequences:Consequences: inflamedinflamed
cervix or PID; spread tocervix or PID; spread to
prostate or epididymis; rareprostate or epididymis; rare
cases of arthritiscases of arthritis
– Treatment:Treatment: doxycycline ordoxycycline or
erythromycinerythromycin

37. 37
Spreads throughout the bodySpreads throughout the body
within hours of infectionwithin hours of infection
Caused by bacteria treponemaCaused by bacteria treponema
pallidumpallidum
Transmitted primarily throughTransmitted primarily through
sexual intercourse, but alsosexual intercourse, but also
from infected mother to fetusfrom infected mother to fetus
SYPHILISSYPHILIS

38. 38
SYPHILISSYPHILIS
Appearance of red orAppearance of red or
brown painless sore onbrown painless sore on
mouth, fingers,mouth, fingers,
reproductive organs inreproductive organs in
primaryprimary
syphilissyphilis(CHANCERS)(CHANCERS)

39. 39
SYPHILISSYPHILIS
Appearance of rash on palms,Appearance of rash on palms,
soles, looks like eczema,soles, looks like eczema,
psoriasis, measles or sunburnpsoriasis, measles or sunburn
and flu like symptoms orand flu like symptoms or
mononucleosis inmononucleosis in secondarysecondary
syphilissyphilis (maximum infectivity)(maximum infectivity)

40. 40

41. 41
SYPHILISSYPHILIS
Destructive lesions,Destructive lesions,
organorgan
destruction(Gumma),destruction(Gumma),
meningitis, and linkagemeningitis, and linkage
to HIV into HIV in tertiarytertiary
syphilis phasesyphilis phase

42. 42
SyphilisSyphilis
Diagnostic MethodsDiagnostic Methods
Clinical appearanceClinical appearance
Dark-field microscopyDark-field microscopy
Nontreponemal serologic testNontreponemal serologic test
Rapid plasma reaginRapid plasma reagin
VDRLVDRL
Treponemal testTreponemal test

43. 43
Recommended TreatmentRecommended Treatment
Primary and secondary syphilis and early latentPrimary and secondary syphilis and early latent
syphilis (<1 year duration):syphilis (<1 year duration):
benzathine penicillin G 2.4 million units IMbenzathine penicillin G 2.4 million units IM
in a single dose.in a single dose.
Late latent syphilis or latent syphilis of unknownLate latent syphilis or latent syphilis of unknown
duration and late syphilis (gumma or cardiovascularduration and late syphilis (gumma or cardiovascular
syphilis, but not neurosyphilis):syphilis, but not neurosyphilis): BenzathineBenzathine
penicillin G 7.2 million units total, as 3penicillin G 7.2 million units total, as 3
doses of 2.4 million units IM, at 1-weekdoses of 2.4 million units IM, at 1-week
intervalsintervals..
Neurosyphilis:Neurosyphilis:
Aqueous penicillin G, 18-24 million units aAqueous penicillin G, 18-24 million units a
day, as 3-4 million units IV q4h for 10-14day, as 3-4 million units IV q4h for 10-14
days.days.

44. Viral STDsViral STDs
Herpes simplexHerpes simplex
Genital WartsGenital Warts
(HPV)(HPV)
Hepatitis B virusHepatitis B virus
HIV ( AIDS virus)HIV ( AIDS virus)

45. 45
HerpesHerpes
Recurrent,Recurrent, incurableincurable
viral diseaseviral disease
HSV-2 -genital herpesHSV-2 -genital herpes
80% are asymptomatic80% are asymptomatic
or do not recognize theor do not recognize the
symptomssymptoms

46. 46
HERPES SIMPLEXHERPES SIMPLEX
VIRUSVIRUS
Contagious viral infection
that spreads from direct
skin to skin contact
particularly in the oral and
genital areas

47. 47
HERPES SIMPLEXHERPES SIMPLEX
VIRUSVIRUS
HSV-1 in form of cold
sores, fever blisters,
primarily around the mouth
affects @ 80 % of all
adults
HSV-2 genital herpes
infects 1 in 6 adults

48. 48
HSV 2
Symptoms vary from oneSymptoms vary from one
individual to anotherindividual to another
Active phase may includeActive phase may include
itching, burning, swelling, and fluitching, burning, swelling, and flu
like symptomslike symptoms
Appearance of small painfulAppearance of small painful
blisters on genitals rupture, crustblisters on genitals rupture, crust
over and healover and heal

49. 49
HSV 2
Virus travels down nerve toVirus travels down nerve to
ganglia near spine & remainsganglia near spine & remains
dormant until another outbreakdormant until another outbreak
and virus travels up nerve toand virus travels up nerve to
skinskin
Control efforts for HSV 2 areControl efforts for HSV 2 are
difficult because 75% aredifficult because 75% are
unaware they are infectedunaware they are infected

50. 50
HSV 2
There is no cure for HSV2,There is no cure for HSV2,
the drug acyclovir isthe drug acyclovir is
prescribed for minimizingprescribed for minimizing
the discomfortthe discomfort
Sexual activity should beSexual activity should be
avoided when sores areavoided when sores are
activeactive

51. 51
HSVHSV
Antiviral drugs neitherAntiviral drugs neither
eradicate latent viruseradicate latent virus
nor affect the risk,nor affect the risk,
frequency or severity offrequency or severity of
recurrencesrecurrences

52. 52
Recommended TreatmentRecommended Treatment
First clinical episodeFirst clinical episode::
Acyclovir 400 mg orally 5Acyclovir 400 mg orally 5
times a day for 7-10times a day for 7-10
daysdays, or famciclovir 250 mg, or famciclovir 250 mg
orally 3 times a day for 7-10orally 3 times a day for 7-10
days, or valacyclovir 1 gdays, or valacyclovir 1 g
orally 2 times a day for 7-10orally 2 times a day for 7-10
days.days.

53. 53
Recommended TreatmentRecommended Treatment
Recurrent episodesRecurrent episodes::
acyclovir 400 mg orally 3acyclovir 400 mg orally 3
times a day for 5 days, or 800times a day for 5 days, or 800
mg orally 2 times a day for 5mg orally 2 times a day for 5
days or famciclovir 125 mgdays or famciclovir 125 mg
orally 2 times a day for 5 daysorally 2 times a day for 5 days

54. 54
HUMAN PAPILLOMAHUMAN PAPILLOMA
VIRUSVIRUS
HPV refers to a group of overHPV refers to a group of over
70 different types of viruses70 different types of viruses
1/3 of which cause genital1/3 of which cause genital
problemsproblems
Found in @40% of sexuallyFound in @40% of sexually
active women in there 20’sactive women in there 20’s

55. 55
HUMAN PAPILLOMAHUMAN PAPILLOMA
VIRUSVIRUS
A small percentageA small percentage
develop genitaldevelop genital
warts which can leadwarts which can lead
to a precancerousto a precancerous
conditioncondition

56. 56
HUMAN PAPILLOMAHUMAN PAPILLOMA
VIRUSVIRUS
Genital warts or condyloma areGenital warts or condyloma are
usually spread by direct contactusually spread by direct contact
on vaginal and/or anal areason vaginal and/or anal areas
Warts remain undetected whenWarts remain undetected when
located inside vagina, cervix orlocated inside vagina, cervix or
anusanus

57. 57
Female HPVFemale HPV

58. 58
Human PapillomavirusHuman Papillomavirus
(HPV)(HPV)
More than 70 different types ofMore than 70 different types of
HPVHPV
30 types can infect the genital30 types can infect the genital
tracttract
Cervical CACER and HPVCervical CACER and HPV
– HPV-16HPV-16
– HPV-18, 31 and 45HPV-18, 31 and 45

59. 59
Human Papillomavirus (HPV)Human Papillomavirus (HPV)
75% of the reproductive-age75% of the reproductive-age
population has been infectedpopulation has been infected
withwith >> 1 sexually transmitted1 sexually transmitted
HPVHPV
Genital warts affect 1% ofGenital warts affect 1% of
sexually active adultssexually active adults

60. 60
HPVHPV
Warts can be small to large, raisedWarts can be small to large, raised
to flat, or single to clusteredto flat, or single to clustered
There is no cure for HPV althoughThere is no cure for HPV although
lesions can be removedlesions can be removed
Methods include: cryotherapy,Methods include: cryotherapy,
chemicals, and laser therapychemicals, and laser therapy

61. 61
HPVHPV
HPV is associated withHPV is associated with
cervical cancer or cervicalcervical cancer or cervical
dysplasiadysplasia
Early detection reducesEarly detection reduces
mortalitymortality
Also linked to cancers of theAlso linked to cancers of the
oral cavity.oral cavity.

62. 62
(HPV) - Goal of treatment(HPV) - Goal of treatment
SymptomaticSymptomatic
Decrease the bulk of the lesionDecrease the bulk of the lesion
Without treatment, warts mayWithout treatment, warts may
resolve on their own, remainresolve on their own, remain
unchanged or increase in sizeunchanged or increase in size
and/or numberand/or number
Often treatment is worse thanOften treatment is worse than
lesionlesion

63. 63
(HPV) - Treatments(HPV) - Treatments
Patient appliedPatient applied
– Podofilox 0.5% solution or gelPodofilox 0.5% solution or gel
Provider appliesProvider applies
–CryotherapyCryotherapy
–Podophyllin resin 10-25%Podophyllin resin 10-25%
–Surgery, intralesional interferon,Surgery, intralesional interferon,
laserlaser

64. 64
External warts:External warts:
Patient may applyPatient may apply podofilox 0.5%podofilox 0.5% solution or gel 2solution or gel 2
times a day for 3 days, followed by 4 days of notimes a day for 3 days, followed by 4 days of no
therapy, for a total of up to 4 cycles, ortherapy, for a total of up to 4 cycles, or imiquimodimiquimod
5% cream5% cream at bedtime 3 times a week for up to 16at bedtime 3 times a week for up to 16
weeks. Treatment area should be washed with mildweeks. Treatment area should be washed with mild
soap and water 6- 10 hours after applicationsoap and water 6- 10 hours after application
oror podophyllin resinpodophyllin resin 10-25% in compound tincture of10-25% in compound tincture of
benzoin in small amounts to each wart, repeat weeklybenzoin in small amounts to each wart, repeat weekly
if necessary;if necessary;
;; oror surgical removalsurgical removal..
Vaginal wartsVaginal warts::
cryotherapy with liquid nitrogen, or TCA 80-90%, orcryotherapy with liquid nitrogen, or TCA 80-90%, or
podophyllin 10-25%podophyllin 10-25%

65. 65
HEPATITIS B VIRUS
Transmission is similar toTransmission is similar to
HIVHIV
Through bloodborneThrough bloodborne
pathogens, unprotected SI,pathogens, unprotected SI,
Tattoos, ear piercings,Tattoos, ear piercings,
injections and acupunctureinjections and acupuncture

66. 66
HEPATITIS B VIRUS
HBV is more easily transmittedHBV is more easily transmitted
than HIVthan HIV
Nearly 95 % of persons with HBVNearly 95 % of persons with HBV
recoverrecover
Vaccination for HBVVaccination for HBV
recommended especially forrecommended especially for
health personnelhealth personnel

67. 67
HBVHBV
Persons at highest risk forPersons at highest risk for
contacting HBV include:contacting HBV include:
Hemodialysis patientsHemodialysis patients
Injectable drug usersInjectable drug users
Health care workersHealth care workers
Infants born to HBV infected mothersInfants born to HBV infected mothers
Gay menGay men
Sexually active heterosexualsSexually active heterosexuals

68. 68
HBVHBV
Hepatitis B virus is present inHepatitis B virus is present in
all body fluidsall body fluids
Severe HBV includesSevere HBV includes
jaundice and may result injaundice and may result in
prolonged illness or deathprolonged illness or death

69. 69
Human Immune DeficiencyHuman Immune Deficiency
Virus (HIV)Virus (HIV)
HIV - retrovirus thatHIV - retrovirus that
targets & destroystargets & destroys
helper T-4 cells thathelper T-4 cells that
assist the immuneassist the immune
response to diseaseresponse to disease

70. 70
ACQUIRED IMMUNEACQUIRED IMMUNE
DEFICIENCY SYNDROMEDEFICIENCY SYNDROME
AIDS is the third leading cause ofAIDS is the third leading cause of
death among all women betweendeath among all women between
15-4415-44
Worldwide, women constituteWorldwide, women constitute
@40% of all HIV positive cases@40% of all HIV positive cases
The majority of women whoThe majority of women who
contract AIDS are heterosexual,contract AIDS are heterosexual,
injecting drug users, hemophiliacsinjecting drug users, hemophiliacs

71. 71
DEFINING HIV/AIDSDEFINING HIV/AIDS
Human immunodeficiency virusHuman immunodeficiency virus
HIV is the organism that causesHIV is the organism that causes
AIDSAIDS
Majority of AIDS victims will dieMajority of AIDS victims will die
AIDS includes pulmonary TB,AIDS includes pulmonary TB,
recurrent pneumonia, andrecurrent pneumonia, and
invasive cervical cancerinvasive cervical cancer

72. 72
CONTRACTING AIDSCONTRACTING AIDS
HIV is carried from one person toHIV is carried from one person to
another through blood, semen andanother through blood, semen and
vaginal secretionsvaginal secretions
Transmitted through ::
sexual contactsexual contact
Sharing injecting drug needlesSharing injecting drug needles
From infected mother to infant duringFrom infected mother to infant during
childbirthchildbirth
HIV is not transmitted through causalHIV is not transmitted through causal
contact, tears or salivacontact, tears or saliva

73. 73
SYMPTOMS OFSYMPTOMS OF
HIVHIV
Symptoms of AIDS maySymptoms of AIDS may
be similar to otherbe similar to other
diseasesdiseases
Difference is that they takeDifference is that they take
longer to disappear or maylonger to disappear or may
recurrecur

74. 74
HIV(AIDS)HIV(AIDS)
1.1. Common early symptoms includeCommon early symptoms include ::
2.2. Night sweatsNight sweats
3.3. Rapid weight loss without diet or exerciseRapid weight loss without diet or exercise
4.4. Diarrhea lasting longer than severalDiarrhea lasting longer than several
weeksweeks
5.5. Thick white spots coating the mouthThick white spots coating the mouth
6.6. A dry cough and shortness of breathA dry cough and shortness of breath
7.7. Purple spots on skin, in mouth, andPurple spots on skin, in mouth, and
rectumrectum

75. 75
DIAGNOSIS OF HIVDIAGNOSIS OF HIV
Two tests are used forTwo tests are used for
diagnosisdiagnosis::
1.1. EEnzyme-nzyme-LLinkedinked IImmunommunoSSorbentorbent
AAssayssay
(E L I S A test):(E L I S A test): a general screeninga general screening
with a high sensitivitywith a high sensitivity
2. Western blot test, a less sensitive,2. Western blot test, a less sensitive,
more expensive but more specificmore expensive but more specific

76. 76
DIAGNOSIS OF HIVDIAGNOSIS OF HIV
A women must wait @ a month fromA women must wait @ a month from
the time of suspected exposurethe time of suspected exposure
before getting testedbefore getting tested
It takes @ 45 days between exposureIt takes @ 45 days between exposure
and body’s building enoughand body’s building enough
antibodies for detectionantibodies for detection
Experts recommend two sets of testsExperts recommend two sets of tests
@ 6 months apart@ 6 months apart

77. 77
TESTINGTESTING
PROCEDURESPROCEDURES
If a person tests positive for the HIVIf a person tests positive for the HIV
antibody with the ELISA test, aantibody with the ELISA test, a
second ELISA test is conducted onsecond ELISA test is conducted on
the same personthe same person
If the second test is positive, theIf the second test is positive, the
Western blot test is conductedWestern blot test is conducted
If the Western blot test is positive, theIf the Western blot test is positive, the
person is said to be HIV-positiveperson is said to be HIV-positive

78. 78
Symptoms of HIV & AIDSSymptoms of HIV & AIDS
Developing HIV antibodiesDeveloping HIV antibodies
Patterns of progressionPatterns of progression
–rapidly progressive (3 years)rapidly progressive (3 years)
–usual progression (8-11usual progression (8-11
years)years)
–long-term nonprogressionlong-term nonprogression
(> 10 yrs)(> 10 yrs)

79. 79
Symptoms of Full-Blown AIDSSymptoms of Full-Blown AIDS
Diagnosis of Opportunistic InfectionsDiagnosis of Opportunistic Infections
1.1. Pneumocystis carinii pneumoniaPneumocystis carinii pneumonia
2.2. Cytomegalovirus (CMV)Cytomegalovirus (CMV)
3.3. EncephalitisEncephalitis
4.4. MeningitisMeningitis
5.5. Tuberculosis & SalmonellaTuberculosis & Salmonella
6.6. ToxoplasmosisToxoplasmosis
7.7. Lymphomas, cervical cancer, Kaposi’sLymphomas, cervical cancer, Kaposi’s
sarcomasarcoma
* Death within 1-2 years* Death within 1-2 years

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TreatmentTreatment
NO CURENO CURE
Combination drug therapyCombination drug therapy
shows best results forshows best results for
slowing progressslowing progress
Prevention is the bestPrevention is the best
solutionsolution

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VAGINITISVAGINITIS
One in ten women who visit wheirOne in ten women who visit wheir
health-care provider complain abouthealth-care provider complain about
vaginal dischargevaginal discharge
Over 90% of vaginitis is classified as:Over 90% of vaginitis is classified as:
1. Trichomoniasis - caused by 1 celled1. Trichomoniasis - caused by 1 celled
protozoaprotozoa
2. Bacterial vaginosis2. Bacterial vaginosis
3. Candidiasis - yeast , fungus infection,3. Candidiasis - yeast , fungus infection,
monila usually not sexually transmittedmonila usually not sexually transmitted

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TRICHOMONIASISTRICHOMONIASIS
One celled parasiteOne celled parasite
Found in both men and womenFound in both men and women
Remains dormant in asymptomatic womenRemains dormant in asymptomatic women
Causes vaginal irritation, itching, and diffuseCauses vaginal irritation, itching, and diffuse
malodorous discharge in symptomatic womenmalodorous discharge in symptomatic women
Women may see red spots on the vaginalWomen may see red spots on the vaginal
wallswalls
Most men are a symptomaticMost men are a symptomatic
Both partnersBoth partners must be treated withmust be treated with
antibioticsantibiotics

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CANDIDIASISCANDIDIASIS
?Not a sexually transmitted disease?Not a sexually transmitted disease
Symptoms include itching, discharge,Symptoms include itching, discharge,
burning, or irritationburning, or irritation
Pregnant women commonlyPregnant women commonly
experience yeast infectionsexperience yeast infections
Factors most often associated withFactors most often associated with
repeat infections: diabetes, obesity,repeat infections: diabetes, obesity,
suppressed immunity, antibiotics,suppressed immunity, antibiotics,
corticosteroids, or birth control pillscorticosteroids, or birth control pills

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BACTERIAL VAGINOSISBACTERIAL VAGINOSIS
Discharge is white and ordorusDischarge is white and ordorus
Associated with:Associated with:
1. Cervicitis 2. PID1. Cervicitis 2. PID
3. Postpartum endometritis3. Postpartum endometritis
4. Premature labor4. Premature labor
5. Recurring urinary tract infections5. Recurring urinary tract infections
• TreatmentTreatment:: oral, cream or geloral, cream or gel
application of Flagylapplication of Flagyl
• male treated if infection recursmale treated if infection recurs

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Ectoparasitic InfectionsEctoparasitic Infections
Pubic LicePubic Lice:: transmittedtransmitted
through sexual contact orthrough sexual contact or
infected linen/clothinginfected linen/clothing
–SXSX: little to severe itchiness: little to severe itchiness
–TreatmentTreatment: prescribed: prescribed KwellKwell
; pyrinate.; pyrinate.
–launder linens & clothinglaunder linens & clothing

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Ectoparasitic InfectionsEctoparasitic Infections
ScabiesScabies: transmitted though close: transmitted though close
physical or sexual contact or fromphysical or sexual contact or from
infected linen orinfected linen or clothingclothing
SXSX: small, red rash around primary: small, red rash around primary
lesion; intense itching, esp. at nightlesion; intense itching, esp. at night
– TreatmentTreatment: topical scabicide: topical scabicide
launder or dry clean linens & clothinglaunder or dry clean linens & clothing

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Guidelines forGuidelines for ↓↓inging
RiskRisk
Always useAlways use
condoms &condoms &
spermicidesspermicides
Avoid multipleAvoid multiple

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PREVENTION
STRAGETIES
Sexual abstinence is the
only 100% effective method
to prevent sexually
transmitted diseases
Male condoms are one of
the most effective methods
for preventing STD’s

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STIs and Family PlanningSTIs and Family Planning ::
What Can Be DoneWhat Can Be Done
Most STIsMost STIs ((ee..gg.., gonorrhea,, gonorrhea,
syphilissyphilis)) can be treatedcan be treated..
All STIs can be preventedAll STIs can be prevented..
If not prevented, early diagnosisIf not prevented, early diagnosis
and treatment can decrease theand treatment can decrease the
possibility of serious complicationspossibility of serious complications
such as infertility in both womensuch as infertility in both women
and menand men..

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A Final Word on STI controlA Final Word on STI control
Contraceptive pills andContraceptive pills and
injections and surgery forinjections and surgery for
preventing pregnancypreventing pregnancy
DO NOT PREVENTDO NOT PREVENT
TRANSMISSION OF STIs !TRANSMISSION OF STIs !

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One of many reasons why STIOne of many reasons why STI
control is difficult is thatcontrol is difficult is that ::manymany
persons have thesepersons have these
infections or are carryinginfections or are carrying
the micro-organismsthe micro-organisms
without knowing itwithout knowing it

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SummarySummary
STDs are commonSTDs are common
STD infections can be present withoutSTD infections can be present without
symptomssymptoms
STDs can be costly in terms ofSTDs can be costly in terms of
personal health and health carepersonal health and health care
spendingspending
STDs need to be diagnosed andSTDs need to be diagnosed and
treated earlytreated early

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THANKTHANK
YOUYOU