This document discusses reproductive tract infections (RTIs) and sexually transmitted infections (STIs), their causes, symptoms, and relationship to HIV/AIDS. It notes that many STIs are RTIs that can infect the genital tract and other areas. Left untreated, RTIs in women can spread from the lower to upper reproductive tract and cause pelvic inflammatory disease. The document outlines prevention methods and treatment for STIs/RTIs and explains how STIs increase HIV transmission by enhancing viral shedding and increasing target cells. Treating STDs reduces HIV levels in infected individuals.

1. Reproductive Tract Infections(RTI)
& Sexually Transmitted Infections or
Diseases ( STI/STD)
Dr.S.I.Ahmed
AIDS Prevention Society ( APS)

2.  RTIs- Bacterial,Viral.Protozoal inf. Of lower +
upper RT of both sexes
 RTIs- many sexually transmitted
 STIs –most are RTIs , also systemic like
Syphilis,AIDS,Hep B
 STIs – also affect mouth,rectum,urinary tract(part
of RT in males not in females)
 Female RTIs – originate LRT (Externals,
genitals,vagina,cervix)
 Female RTIs-without treatment can spread to
URT( Uterus,Fallopian Tubes,ovaries)
 LRT & URT inf. Can ascend to cause PID
 Risk of Inf IUD insertion,Abortion,Child
Birth when instruments are introduced thro,Cx

3. Common Causes of RTIs :
Iatrogenic Infections – inadequate
medical procedure- unsafe
abortions
Endogenous Infections- Inadequate
personal, sexual & menstrual
hygiene
Sexually Transmitted Infections
( STIs)

4. Mode of Transmission : Same like HIV/AIDS
 Symptoms in Women – discharge,foul smell
from vagina,burning or itching,pain in
lower abdomen,deep pain during sex
 Symptoms both in Men & Women-
sores,bumps,blisters or rashes in sex organs
or mouth,burning pain during urination or
defaecation,swelling redness in
throat,fever,chill aches-flu like,swelling in
the groin
 Symptoms in Men- Discharge from Penis,
Ulcer

5. SYNDROMES of STDs :
 STD Syndromic Management: Identification of
consistent group of symptoms and easily recognised
signs (Syndromes)
 Discharge-Urethral Discharge ( N.Gonorrhoea,
Chlamydia Trachomatis)Vaginal Discharge-
N.Gonorrhoea, C.Trachomatis, Candida Albicans,
Gardnerella Vaginalis, Trichomonas Vaginalis)
 Ulcer(T.Pallidum,H.Ducreyi,C.trachomatis,Herpes
Simplex)
 Inguinal Gland Enlargement-inguinal bubo(H.Ducreyi,
C.Trachomatis)
 Lower Abdominal Pain(N.Gonorrohea,C .Trachomatis,
anaerobic bacteria
 Scrotal Swelling (N.Gonorrhoea, C.Trachomatis,
viruses, surgical conditions)
 Ophthalmia Neonatorum- N.Gonorrhoea,
C.Trachomatis

6. CONSEQUENCES of RTIs :
 Serious threat to health & well being of men &
women
 Pain,discomfort,acute illness
 Infertility,hepatitis,dementia
 Ectopic pregnancy
 Cervical Cancer
 Congenital Syphilis ,Foetal Death, pre mature
delivery,infection, low birth weight infants
 Infants- blindness,conjunctivitis,pneumonia
 Psychological distress,family disruption

7. Prevention and Treatment of STDs :
 Abstinence – difficult
 Avoid sex with partners who have genital
rashes,redness,sores or foul smelling or
blood mixed discharge
 Stay away from casual relationship
 Reduce the number of your partners as
much as possible
 Use condom
 Wash the genital area after intercourse
 Prevention of STDs would also reduce the
risk of HIV transmission

8. THE STD-HIV RELATIONSHIP
Numerous epidemiologic
and biologic studies now
support the fact that STDs,
both ulcerative and non-
ulcerative, enhance HIV
acquisition & transmission.

9. THE STD-HIV RELATIONSHIP
* In addition, it appears
that HIV alters the natural
history of some STDs.
*Those with Genital Ulcers
more prone to HIV infection

10. THE STD-HIV RELATIONSHIP
HIV has been identified in
the genital tract of both
males and females and
found to be both cell-
associated and cell-free.

11. THE STD-HIV RELATIONSHIP
HIV has also been
isolated from the
exudates of both male
and female genital
ulcers.

12. THE STD-HIV RELATIONSHIP
Increasing evidence
suggests there is
increased severity of
manifestations &
infectivity of STDs in
HIV infected persons

13. THE STD-HIV RELATIONSHIP
It appears that HIV alters the natural
history of some STDs.
For example in Syphilis/T.Pallidum infection
following variations were observed in a HIV
infected person :
1.limited or absent antibody(ab)response -ve
reagin & treponemal ab testing
2.Increased severity of clinical manifestation
3.Painless chancre of Primary Syphilis –
painful - sec inf.

14. THE STD-HIV RELATIONSHIP
(cont’d)……
4.Latency period for development of
meningovuscular syphilis shorter
5.Rapid progression to Tertiary
Syphilis(within 1st yr of inf)
6.Lack of response to Penicillin
7.Relapse without exposure
8.Syphilitic lesion lasts longer

15. THE STD-HIV RELATIONSHIP
The shedding of HIV in genital fluids is
increased by STD-related inflammatory
responses and exudates from lesions,
making men and women who are STD-
infected and HIV-positive more
infective.
Those with HIV & STD shed increased
number of HIV infected cells compared
to those with HIV infection alone .

16. THE STD-HIV RELATIONSHIP
Furthermore, it has been found
that when women have
gonorrhea or chlamydial
infection there is a
disproportionate increase in
CD4 lymphocytes, the HIV
target cell, in the endocervix.

17. THE STD-HIV RELATIONSHIP
Studies have shown that
treating STDs reduces
the percentage of men in
whom HIV is detected
and the amount of HIV

18. THE STD-HIV RELATIONSHIP
In a recent community-based,
randomized trial in the Mwanza
district of rural Tanzania,
treating STD-symptomatic
individuals using the syndromic
approach reduced HIV
incidence in the study
population by 42 percent.

19. THE STD-HIV RELATIONSHIP
-The Predominant mode of transmission of both
HIV infection and other STDs is same including
sexual transmission
-Preventive measures for sexual transmission of
HIV/STDs are same
-STD clinical services –entry point for both
diagnosis, treatment & education on prevention
-Evidence show that prevention,early diagnosis and
treatment of STDs can be important HIV prevention strategy
-Trends in STD incidence and prevalence can be
useful indicators to monitor trends in HIV sero-
prevalence & to assess impact of HIV/AIDS control
programme