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Sexually transmitted diseases
This document discusses sexually transmitted diseases (STDs) and their epidemiological determinants and clinical presentations. It notes that over 20 pathogens can be spread through intimate sexual contact, including Neisseria gonorrhoeae, Treponema pallidum, Chlamydia trachomatis, herpes simplex virus, HIV, and Trichomonas vaginalis. The highest incidence of STDs is in people aged 20-24 years old. Syndromic management and treatment options are provided for common STDs like gonorrhea, chlamydia, syphilis, and genital herpes. Control of STDs requires initial planning, intervention strategies like screening and contact tracing, support components like STD clinics and
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Sexually transmitted diseases
- 1. Sexually Transmitted Diseases Mrs.Namita Batra Guin Associate Professor Dept. of Community Health Nursing
- 2. Introduction • Transmitted bywide range of bacteria, viral, protozoal and fungal agents and ectoparasites. • STI’s are infections that are spread from person to person through intimate sexual contact. • STI’s are dangerous because they are easily spread and it is hard to tell just by looking who has an STI.
- 3. Epidemiological determinants • Agentfactor: over 20 pathogens are found to be spread by sexual contact. ▫ Neisseria gonorrhoeae – gonorrhoea ▫ Treponema pallidum- syphilis ▫ Chlamydia trachomatis- urethritis, cervicitis. ▫ Herpes simplex virus- genital herpes ▫ HIV- AIDS ▫ Trichomonas vaginalis – vaginitis.
- 4. Epidemiological determinants • Hostfactor: ▫ Age: highest incidence in 20-24 years followed by 25-29 and 15-19 years ▫ Sex: morbidity is higher in men but is much more severe in women. ▫ Marital status: higher among singles, divorced and separated persons. ▫ Socio-economic status: low socio-economic have high morbidity rates.
- 5. Epidemiological determinants • Demographicfactors: ▫ Population explosion ▫ Marked increase in young people ▫ Rural to urban migration ▫ Increasing educational opportunities for women for delaying their marriage and increasing STD risks.
- 6. Epidemiological determinants • Socialfactors: ▫ Prostitution: major factor in the spread of STD. Acts as reservoir of infection. ▫ Broken homes: promiscuous women are withdrawn . Home is unhappy and children reared in such an atmosphere are likely to go astray in search of other avenues of happiness. ▫ Sexual disharmony: married people with strained relation, divorced and separated persons. ▫ Easy money: prostitution is a reflection of poverty. It provides an occupation for earning easy money
- 7. Epidemiological determinants • Socialfactors: ▫ Emotional immaturity: often stressed as a social factor in acquiring STDs ▫ Urbanization and industrialization: conductive type of lifestyles leads to high levels of infections since long working hours, relative isolation from the family and social mobility causes causal sexual relationships. ▫ Social disruption: caused by disasters, wars and civil unrest ▫ International travel: travellers import and export the infection
- 8. Epidemiological determinants • Socialfactors: ▫ Changing behaviour patterns: more relaxation to moral and cultural values in present day society provides the young people opportunity to break away from the traditional ways of life ▫ Social stigma: stigma attached to STD accounts for non- detection of the cases, not disclosing the source of contact etc. ▫ Alcoholism: effects of alcohol seems to be more indirect than direct.
- 9. Common STD’s are: •Chlamydia • Gonorrhea • Genital Herpes (HSV-2) • Genital Warts (HPV) • Hepatitis B • HIV and AIDS • Pubic Lice • Syphilis • Trichomoniasis
- 10. Clinical spectrum • Gonococcalinfection: ▫ Causes inflammation of genital tract, cervix and rectum in women ▫ Pharyngitis ▫ Possible complication – PID in women, epididymis in men ▫ Can cause sub-fertility and urethral strictures ▫ ‘serious consequences in infants- eye infection leading to blindness if not treated ▫ Antibiotics of choices are: - Ciprofloxacin, ceftriaxone, cefixime or spectinomycin
- 11. Clinical spectrum • Syphilis: ▫Causes ulceration of the uro-genital tract, mouth or rectum ▫ Other signs occur in later stages ranges from skin eruption to cardiovascular and nervous system complications ▫ Congenital syphilis is important to cause stillbirths ▫ Antibiotics – penicillin, doxycycline and erthromycin.
- 12. Clinical spectrum • Chlamydialinfection: ▫ A high % of people doesn’t have any clinical manifestations ▫ If they occur they are similar to gonorrhoea. ▫ Complications can result in sterility in women and vertical transmission during childbirth leading to conjuctivitis or eye inflammation ▫ In men – epididymis and urethritis ▫ Antibiotics – doxycycline or azithromycin, alternative can be – amoxycilin, ofloxacin, erthromycin or tetracycline
- 13. Clinical spectrum • Trichomoniasis: ▫Parasitic infection leading to vaginitis and vaginal discharge in women ▫ Usually there are no symptoms ▫ In men- urethritis ▫ T. vaginalis can cause adverse outcomes in pregnancy- low birth weight PROM ▫ Treatment- metronidazole or tinidazole
- 14. Clinical spectrum • Chancroid: ▫After infection, small papule develops at the site of inoculation, within 2-3 days ▫ Lesion erodes into deep ulcer that is extremely painful ▫ Painful swelling in inguinal lymph nodes ▫ Antibiotics: - ciprofloxacin, erythromycin, ceftriaxone and azithromycin
- 15. Clinical spectrum • Lymphogranulomavenereum: ▫ Present with swelling of lymph nodes in the groin ▫ 3-30 days after exposure it may pass unrecognised and resolve spontaeneously ▫ Untreated may cause lymphatic damage resulting in elephantiasis of genitalia ▫ Antibiotics used are: doxycycline, erythromycin and tetracycline
- 16. Clinical spectrum • Donovanosis: ▫First manifestation is small papule which ruptures to form granulomatous lesion that is pain free and bleeds readily on contact. ▫ Antibiotics used- doxycycline, azithromycin. Alternatives- erythromycin, tetracycline, trimethoprim –sulphamethoxale.
- 17. Clinical spectrum • Genitalherpes: ▫ HSV-2 causes genital herpes ▫ Typical papular lesions that progress to multiple blisters and ulcers ▫ First episode is frequently associated with prolonged course of ulceration lasting up to 3-4 weeks. ▫ HSV infection is life long. Subclinical infections also occur. ▫ There is no cure for HSV-2 infection ▫ Antivirals reduce the severity and duration of lesions
- 18. Clinical spectrum • Humanpapilloma: ▫ HPV causes genital warts which vary from common soft, flesh coloured protuberances which may become cauliflower like to papular flat warts on drier areas ▫ Seen in any part of genitalia including perianal region ▫ Manifestation- cervical cancer caused by sub- types. ▫ Treatment generally reserved for large lesions
- 19. Syndromic approach toSTD • Common syndromes and sequelae: ▫ Male urethritis ▫ Lower genital syndrome in women ▫ Genital ulceration ▫ Prostitis/colitis ▫ Salphingitis ▫ Epididymis/orchitis ▫ Infertility/ ectopic pregnancy ▫ Postnatal and perinatal morbidity ▫ Hepatitis/hepatic carcinoma ▫ Genital carcinoma ▫ AIDS
- 20. Syndromic management ofurethral discharge Treatment for gonorrhea and chlamydial infection. Health education and counseling Examine and treat partners Follow up, 7- 14 days after treatment Discharge persists Assess: treatment compliance good and reinfection unlikely Urethral discharge confirmed by clinician Clinical cure Assess: treatment compliance bad and/or reinfection likely Start protocol again Refer Laboratory investigations: Gram stain exam of urethral smear- shows Gram –ve intracellular diplococci in case of gnorrhoea In non- gonococcal urethritis more than 5 neutrophils/ oil immersion field are observed
- 21. Syndromic management ofgenital ulcer Vesicular lesion present or history of vesicular lesions often recurrent ? Follow up, after 7 days Improving? Refer Genital ulcer Herpes management Clinical cure
- 22. Control of STDs •Initial planning • Intervention strategies • Support component • Monitoring and evaluation
- 23. Initial planning • Problemdefinition: define disease problem in terms of prevalence, psychosocial consequences and other health effects by geographic areas and population groups with aid of surveys. • Establishing priorities: rational planning requires establishment of priorities. Depends on magnitude, feasibility of control. • Setting objectives: priorities must be converted to discrete, achievable and measurable objectives. • Considering strategies: variety of strategies must be planned.
- 24. Intervention strategies • Casedetection: • Screening: testing for apparently healthy persons from general population. High priority is given to special groups i.e. pregnant women, blood donors industrial workers etc. • Contact tracing: sexual partners of diagnosed patients are identified, located, investigated and treated. • Cluster testing: partners are asked the name of other persons of either sex who move in same socio-sexual environment. They are screened. • Case holding and treatment: tendency of drop out is very common. Therefore every effort should be made to ensure complete and adequate treatment. • Epidemiological treatment: also known as contact treatment. Consists of full therapeutic dose of treatment to persons recently exposed to STD while awaiting the results of laboratory tests. Should be combined with venereal examination and tracing of contacts revealed by the examination
- 25. Intervention strategies • Personalprophylaxis: contraceptives, maintenance of hygiene of the private parts, vaccines like hepatitis B. • Health education: principle aim to avoid STDs, to minimize disease acquisition and transmission.
- 26. Support components • STDclinic: for consultation, investigations and treatment, contact tracing and other relevant services. STD clinics should maintain the anonymity. Center should be housed adjacent to other medical facilities and training centers • Laboratory services: for correct diagnosis and treatment decisions, for contact tracing, surveillance and detection of resistance • Primary health care: integrate STD control activities with primary health care system.
- 27. Support components • Informationsystem: data required for STD control activities are: clinical notification, laboratory notification and sentinel and adhoc surveillance. • Legislation: to encourage to seek early treatment and name their sexual contacts, to screen high risk groups, to improve notification by general practitioners, health education of public. • Social welfare measures: STDs are social problems, so there is need of social therapy. • Measures include: rehab of prostitutes, provision of recreation facilities in the community, provision of decent living conditions, marriage counseling, prohibiting the sale of sexually stimulating literature, pornographic books or photographs.
- 28. Monitoring and evaluation •Ongoing evaluation of disease trends provides more direct measure of program effectiveness • It may be used to determine the appropriateness of the selected intervention.
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