HIV is caused by a retrovirus that weakens the immune system. It is transmitted through bodily fluids and from mother to child. There is a long asymptomatic period before AIDS symptoms appear. Diagnosis involves antibody screening and confirmation tests. Treatment involves antiretroviral drugs. STDs are transmitted diseases caused by viruses, bacteria, parasites through sexual contact. They have various clinical manifestations and are controlled through prevention, screening, treatment and health education programs.

1. HIV
• Acquired Immuno Deficiency Syndrome (AIDS)
• Fatal illness
• Caused by a retrovirus HIV
• It breaks down the body's immune system, leaving the patient
vulnerable to a host of life threatening opportunistic infections,
neurological disorders or unusual malignancies.

2. EPIDEMIOLOGY
• AGENT: HIV – HUMAN IMMUNO DEFICIENCYVIRUS
• AttacksT4 lymphocytes – Replicates inside it and destroy it
• Pass through blood brain barrier
• Two types – HIV1 and HIV2
• RESERVOIR: Cases and Carriers
• SOURCE:
• High concentration – blood, semen and CSF
• Lower concentration in other body fluids like saliva, urine etc

3. • HOST FACTORS:
• AGE – 20-49 most common
• SEX – more among homosexuals, Multiple partners,
Prostitutes

4. Mode of transmission
• SexualTransmission
• Blood contact – blood transfusion, needle injury like ear piercing,
tattooing etc
• Mother to child transmission

5. • INCUBATION PERIOD:
• Few months to 10 years or more
• CLINICAL MANIFESTATION:
• Initial Infection with virus and antibody development
• Asymptomatic carrier state
• AIDS –related complex (ARC)
• AIDS

7. DIAGNOSIS
• ELISA - Screening test for HIV – detect antibodies
• Western Blot test – Confirmatory – Detect more specific antibody
to viral core protein

8. CONTROL OF AIDS
• PREVENTION
1. Education
2.Combination HIV prevention
1. Biomedical
2.Behavioural
3. Structural interventions
3. Prevention of blood borne transmission

9. • ANTIRETROVIRAL TREATMENT:
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Nucleotide reverse transcriptase inhibitors (NtRTIs)
• Non-Nucleoside reverse transcriptase inhibitors (NNRTIs)
• Protease inhibitors (PPs)
• Integrase strand transfer inhibitors (INSTIs)

11. STD
• Group of communicable diseases
• Transmitted predominantly by sexual contact
• Caused by viral, bacterial, protozoan, fungi and ectoparasites
• Previously venereal disease (VD) – 5 diseases
• Syphilis, gonorrhea, chancroid, LGV and donovanosis
• Now STD – more than 20 agents

12. Epidemiological determinants
AGENT
• Nisseria gonorrhoeae
• Treponema pallidum
• Haemophilus ducreyi
• Chlamydia trachomatis
• Calymmatobacterium
granulomatis
• Herpes simplex virus
• Hepatitis B
• HPV
• HIV
• Molluscum contagiosum
• Candida albicans
• Trichomonas vaginalis

13. Host and demographic factors
• Age – 20-24 years
• Sex – morbidity male > female, severity female>male
• Marital status – single, divorced, separated
• SES – low SES
• Increased population – more younger population
• Rural to urban migration
• Delaying in female marriage

14. Social factors
• Prostitution
• Broken homes
• Sexual disharmony
• Easy money
• Emotional immaturity
• Urbanization
• Social disruption - war
• International travel
• Changing behavior pattern
• Social stigma
• Alcoholism

15. Clinical spectrum
• Gonococcal infection
• Inflammation – urethra and rectum in male, cervix and rectum
in female
• Complications – PID – ectopic pregnancy, infertility, chronic
pelvic pain
• In men – epididymis
• Treatment – cefixime, ciprofloxacin

16. Syphilis
• Ulceration of urogenital tract, mouth or rectum
• Skin eruptions, cardiovascular or neuro-syphilis – range of
infection
• Congenital syphilis – stillbirth
• Treatment – penicillin, erythromycin OR
doxycycline

17. Chlamydial infection
• Asymptomatic majority
• Symptoms and complications similar to gonorrhea
• Conjunctivitis - in newborn – vertical transmission
• Sterility in women
• Urethritis, epididymis – men
• Treatment – azithromycin or doxycycline

18. Trichomoniasis
• Parasitic infection
• Vaginitis and vaginal discharge
• Men – usually asymptomatic – urethritis
• Adverse outcome in pregnancy – low BW, premature rupture of
membrane
• Treatment – metronidazole or tinidazole

19. Chancroid
• Small papule at site of inoculation – 2 to 3
days – erodes –ulcer
• Extremely painful ulcer and deep
• 25% patients – inguinal lymph nodes
• Treatment – ciprofloxacin, erythromycin,
ceftriaxone, azithromycin

20. Lymphogranuloma venereum
• Swelling of lymph nodes in groin
• Small painless ulcer in genetalia -2 to 3 days – disappear
• Untreated –> lymphatic damage –> elephantiasis of genetalia
• Treatment – doxycycline, erythromycin, tetracycline
• Surgical correction for strictures

21. Donovanosis
• Small papules – ruptures to form granulomatous lesion – painless
• Bleeds on contact
• Treatment – azithromycin, doxycycline

22. Genital herpes
• Herpes simplex type 2
• Papular lesions – multiple blisters – ulcers –
painful
• No cure
• Antivirals like acyclovir to reduce the severity
and pain
• Four to five episodes per year
• Acyclovir, valaciclovir, famciclovir

23. Human papilloma virus
• Ano-genital warts
• Cervical cancer in female
• Treatment for large lesions
• Cancer screening for women – pap smear, colposcopy etc
• Prevention in sexually active younger population
• vaccination

24. Control of STDs
• AIM – prevention of ill health
• Primary prevention
• Secondary prevention
• Control depends on
• 1. Initial planning
• 2. Intervention strategies
• 3. Support components
• 4. Monitoring and evaluation

25. Initial planning
• Problem definition
• Establishment of priorities – age, sex, addiction
• Setting objectives
• Considering strategies

26. Intervention strategies
• Case detection
• Screening
• Contact tracing
• Cluster testing
• Case holding and treatment
• Epidemiological treatment – contact treatment
• Personal prophylaxis – contraceptives, vaccination
• Health education

27. Support components
• STD clinic – integrate with PHC, facility for treating women
separately
• Laboratory services
• Primary health care
• Information system
• Clinical/laboratory/sentinel notification needed

28. • Legislation – immoral traffic 1986 for both sex – exploited
sexually for commercial purpose
• Social welfare measures – rehabilitation of prostitutes, decent
living conditions, prohibition of pornographic books and pictures
etc.,

29. THANKYOU