Dr. Faika Khan is the founder of UrgentWay. She completed her medical degree at New York College of Osteopathic Medicine and is board certified in family medicine. Currently, she is a faculty member at NYU Langone and Nassau University Hospital. She also works as a hospitalist at Long Island Jewish Hospital and serves as an urgent care specialist, civil surgeon, and DOT physician.

1. Dr. Faika Khan CEO of UrgentWay
Dr. Faika Khan is a founder of UrgentWay. She completed her degree as
a Doctor of Osteopathic from New York College of Osteopathic
Medicine.
She is certified by American Board of Family Medicine. Currently she is
a faculty member at NYU Langone and Nassau University Hospital.
Dr. Faika Khan is also a hospitalist at Long Island Jewish Hospital, New
York as well as a civil surgeon, urgent care specialist and DOT certified
physician.

2. Sexually Transmitted Disease

3. WHAT IS STD?
➢Sexually Transmitted Diseases (STDs) are infections that are passed from
one person to another through sexual contact.
➢Most STDs affect both men and women, but in many cases the health
problems can be more severe for women as untreated STDs can lead to
pelvic inflammatory disease (PID).

4. STATISTICS
➢According to the Center for Disease Control
and Prevention, approximately 20 million new cases of sexually
transmitted diseases occur each year in the United States, and one
half are among 15 to 24 years old.
➢According to WHO report of 2007 approximately 33.0 million people
worldwide are living with HIV/AIDS out of which 5 million are in Asia.
➢As per Pakistan Global AIDS Response Progress Report, Pakistan’s
HIV epidemic started in the 1980s when cases surfaced mostly
amongst migrant workers employed abroad.

5. STATISTICS
➢In Pakistan, 75-80% of the citizens in case of illness, visit a general
practitioner (GP), who can be the main educators for prevention of any
disorder including HIV/AID.
➢Though statistics show that HIV is a grave problem, the ban placed on
condom advertisements in 2014 depicts how reluctant the government of
Pakistan is to address this serious issue.
➢The government had registered 14,705 HIV carriers across Pakistan till
December 2015 but fighting cultural ignominy is still a serious challenge.

6. WAYS IN WHICH STDS CAN BE TRANSMITTED?
➢ Vaginal sex
➢ Anal sex
➢ Oral sex
➢ Skin-to-skin contact
➢ Infected Mother to child

7. SYMPTOMS OF STDS IN MEN
➢Pain or discomfort during sex or urination
➢Sores, bumps or rashes on or around the genital area
➢Unusual discharge or bleeding from the penis
➢Painful or swollen testicles

8. SYMPTOMS OF STDS IN WOMEN
➢Pain or discomfort during sex or urination
➢Sores, bumps, or rashes on or around the genital area
➢Unusual discharge or bleeding from the vagina
➢Itchiness in or around the vagina

9. TYPES OF STDS
➢Chlamydia Bacterial (infection of genital areas)
➢Gonorrhea (A bacterial infection of the genital areas)
➢HPV (usually harmless and goes away by itself, but some types can lead to
genital warts or cervical carcinoma)
➢Syphilis (Infection caused by bacteria that can spread throughout the body)

10. TYPES OF STDS
➢HIV (Human immunodeficiency virus)
➢Trichomoniasis (Parasitic infection of the genital areas)
➢Herpes (A viral infection of the genital areas)

11. CURABLE STD DISEASES
➢Chlamydia
➢Syphilis
➢Gonorrhea
➢Trichomoniasis

12. INCURABLE SEXUALLY TRANSMITTED DISEASES
➢HPV
➢HIV
➢Herpes

13. WHAT IS CHLAMYDIA?
➢Chlamydia is a bacterial infection that is easily cured with antibiotic medicine.
It’s one of the most common STDs, and many people who have chlamydia are
carriers and don’t show any symptoms.
➢Chlamydia is spread through vaginal, anal, and oral sex. The infection is
carried in semen and vaginal fluid.

14. ➢The “USPSTF” strongly recommends screening of all women age 25 or
younger and other asymptomatic women at risk for chlamydia infection.
➢These recommendations are based on epidemiologic data showing that
prevalence and risk of chlamydia infection is greater in women age 25 years
or younger as well as evidence from community based screening.
➢As chlamydial infection is often asymptomatic, screening based on
symptoms & signs alone is inadequate.
CONTINUED…

15. HOW CAN CHLAMYDIA BE DIAGNOSED?
➢Swab
For women, the doctor takes a swab of the discharge from the cervix for
culture, sensitivity or antigen testing for Chlamydia.
➢Urine Test
Now Chlamydia can also be diagnosed through urine sample, it is easier to
sample and it usually takes 48-72 hours to report results.

16. CHLAMYDIA TREATMENT
➢Chlamydia trachomatis is treated with antibiotics, usually sensitive to Macrolides
(azithromycin 1g orally in a single dose or doxycycline 100mg orally twice a day for 7
days).
➢Patient with chlamydial infection is treated for both Chlamydia and N. Gonorrhea
because co-infection is very common. For that reason we also treat patients with
Ceftriaxone125mg IM in a single dose or cefixime 400mg orally in a single dose.
➢After treatment patient should be re-tested to confirm eradication of infection.
➢Having chlamydia or having been treated for it in the past provides no immunity against
reinfection in the future.

17. WHAT IS GONORRHEA?
➢Gonorrhea is a sexually transmitted disease (STD) that can infect both men and women
caused by bacteria “Neisseria Gonorrhea”. It is a very common infection, especially
among young people of ages 15-24 years.
➢Symptoms: dysuria, postcoital bleeding, vaginal discharge.
➢Signs: cervical bleeding upon contact, cervical erythema, mucopurulent discharge,
tender cervix.
➢You can get gonorrhea by having vaginal, anal, or oral sex with someone who has
gonorrhea. A pregnant woman with gonorrhea can pass on the infection to her baby
during childbirth.

18. CONTINUED…
➢People with multiple sexual partners, inconsistent use of barrier contraceptives
and prior history of STD/PID are at increased risk of getting the infection.
➢For gonorrhea screening, the “USPSTF” recommends that all sexually active
women, including pregnant women, be screened if they are at risk of infection.
➢Patients must be tested for both N. gonorrhea and chlamydia to rule out co-
infection. If co-infection is not ruled out patient must be treated for both
bacteria.

19. HOW IS GONORRHEA DIAGNOSED?
➢N. Gonorrhea Amplified Urine Test is the test for screening patients
suspected of having this infection. This is the screening test with high
sensitivity for Gonorrhea, so a negative test rules out the disease but a
positive test must be confirmed with confirmatory test. Prophylactic
treatment can be initiated.
➢To confirm the diagnosis sample of fluid from the symptomatic area is
taken with a swab and sent to laboratory for culture and sensitivity.

20. GONORRHEA TREATMENT
➢Flouroquinolones are no longer recommended as first line treatment for
gonorrhea and associated diseases (e.g., PID, epidydimitis, proctitis and
cervivitis).
➢Gonorrhea is usually treated with CEFTRIAXONE 125mg IM in a single dose or
CEFIXIME 400mg orally in a single dose.
➢Patient with Gonorrhea is treated for both Gonorrhea and Chlamydia if
Chlamydia infection is not ruled out.

21. WHAT IS SYPHILIS?
➢Syphilis is a sexually transmitted disease (STD) caused by an infection with
bacteria known as “Treponema Pallidum”. Like other STDs, syphilis can be
spread by any type of sexual contact.
➢Syphilis can also be spread from an infected mother to the fetus during
pregnancy or to the baby at the time of birth.
➢Syphilis has been described for centuries. It can cause long-term damage to
different organs if not properly treated.

22. STAGES OF SYPHILIS
➢Shyphilis is a multi stage progressive disease;
▪ Primary syphilis: single painless genital ulcer. Ulcer is painless as t. pallidum effects
the nerve roots of the affected area.
▪ Secondary syphilis: skin lesions, lymphadenopathy, condyloma latum, may be
multisystem involvement.
▪ Tertiary syphilis: gummatous syphilis, cardiovascular syphilis or neurosyphilis.
▪ Latent syphilis: serologic evidence of syphilis without any clinical manifestation.
▪ Early latent syphilis: latent syphilis that was acquired within the preceding year.

23. HOW IS SYPHILIS DIAGNOSED?
Screening Tests
➢ TREPONEMA PALLIDUM PARTICLE AGGLUTINATION ASSAY (TPPA)
➢ RAPID PLASMA REAGIN TEST (RPR)
▪ These are nontreponemal studies for a nonspecific antibody reaction to “T. Pallidum”.
▪ VDRL and RPR titers should not be used interchangeably because RPR titers may be
slightly higher than VDRL titers.
▪ Both of these tests are used to rule out the disease as these tests have high sensitivity.

24. CONTINUED…
Confirmatory Tests
Positive nontreponemal titers should be confirmed
with treponemal-specific tests.
➢Although “dark field microscopy” is the most specific
technique for the diagnosis of syphilis, it is not
convenient to perform in the typical office setting as it
involves the collection of sample and examining it
under a microscope with a dark field condenser.
➢FTA-ABS and T.PALLIDUM HEMAGGLUTINATION
TEST (TPHA) detect antibodies specific to T.pallidum
and have high specificity, so these tests can be used
to confirm the diagnosis of syphilis.
▪ Treponemal specific tests tend to remain reactive for
life whereas nontreponemal test titers decline after the
treatment.

25. TREATMENT OF SYPHILIS
➢The treatment for primary, secondary and early latent syphilis is
“Benzathine penicillin G” 2.4 million units ‘IM’ in a single dose.
➢For late latent and tertiary syphilis, the treatment of choice is “Benzathine
Penicillin G” 7.2 million units total, administered as three doses of 2.4 million
units ‘IM’ at 1 week intervals.

26. WHAT IS TRICHOMONIASIS?
➢Trichomoniasis (or “trich”) is a very common sexually transmitted
disease (STD). It is caused by infection with a protozoan parasite
called Trichomonas Vaginalis.
➢Trichomoniasis can increase the risk of getting or spreading other
sexually transmitted infections.
➢CHARACTERISTIC: Greenish discharge with fishy smell.

27. HOW IS TRICHOMINIASIS DIAGNOSED?
➢ Infection usually requires a sample of
discharge, requiring a pelvic exam for women
and a urethral swab or urine sample for men
➢However, the least invasive way to test for
Trichomoniasis in men or women is simply via a
urine sample.
➢The most common testing method for women
is a “Wet mount”, which allows for evaluation
of the discharge under a microscope to confirm
the presence of the parasite.

28. TRICHOMONIASISTREATMENT
➢Trichomoniasis can be cured with a single dose of prescription antibiotic
medication (either Metronidazole or Tinidazole).
➢About 1 in 5 people get infected again within 3 months after treatment.
➢To avoid getting reinfected, make sure that all of your sex partners get
treated too.

29. WHAT IS HPV?
➢HPV stands for “Human Papillomavirus”.
➢Virus is spread through intimate contact with genital-skin during sexual activity.
➢The burden of HPV disease is enormous. The cdc estimates that approximately
20 million Americans are DNA positive for anogenital HPV at any given time.
➢HPV disease is not limited to homosexual men and sex workers. The
prevalence of HPV is particularly high in sexually active adolescents and young
adults aged 15 to 24 years, regardless of sexual orientation.

30. TYPES OF HUMAN PAPPILOMA VIRUS
➢Low risk HPV:
▪ HPV 6 and 11 are considered low risk HPV and are responsible for 90% of
genital warts.
▪ Genital warts are usually asymptomatic, sometimes pruritic & painful.
▪ Patients with genital warts are risk for infection with multiple HPV subtypes
and need routine cervical cancer screening.
➢High risk HPV:
▪ HPV 16, 18, 31 and 33 are considered high risk HPV. HPV 16 and 18 are
responsible for 70% of cervical cancers.

31. HOW IS HPV DIAGNOSED?
Important methods to diagnose HPV infection are:
➢Colposcopy and acetic acid test
➢Biopsy
➢DNA test (PCR, Southern Blot Hybridization, In Situ Hybridization)
➢Pap smear

32. PREVENTION OF HPV
➢Abstinence, monogamy.
➢Condoms can provide some protection from HPV transmission, although areas
that remain exposed are still vulnerable.
➢Quadrivalent HPV vaccine provides excellent immunity to HPV 6, 11, 16 & 18.
▪ ACIP recommends routine vaccination for girls age 11 or 12 years.
▪ Can also vaccinate adolescents and women age 13 to 26 years.
▪ Sexually active women can still benefit from the vaccine.

33. HPV TREATMENT
Medications to eliminate warts are typically applied directly to the lesion and
usually take many applications before they're successful.
➢Salicylic acid. Over-the-counter treatments that contain salicylic acid also work
but onset of action is usually slow.
➢Imiquimod (Aldara, Zyclara). Prescription cream, might enhance your immune
system's ability to fight HPV.
➢Podofilox (Condylox). Another topical prescription, usually expensive, works by
destroying genital wart tissue.
➢Trichloroacetic acid. This chemical treatment burns off warts on the palms,
soles and genitals.

34. HPV TREATMENT
If medications don't work, your doctor might suggest removing warts by one of
these methods:
➢Freezing with liquid Nitrogen (cryotherapy)
➢Burning with an electrical current (electrocautery)
➢Surgical removal
➢Laser surgery

35. WHAT IS HIV?
➢HIV (human immunodeficiency virus) is a
virus that damages the lymphocytes (specially
CD4 lymphocytes) in immune system and
weakens the ability to fight against infections.
➢AIDS (acquired immune deficiency syndrome)
is the name used to describe a number of
potentially life-threatening infections and
illnesses that happen when your immune
system has been severely damaged by the
HIV virus.
➢10 years is median time from HIV infection to
aids in untreated patients.
➢In the united states, the HIV-1 strain is
responsible for most infection. HIV-2 strain is
endemic to west Africa.

36. SCREENING & DIAGNOSIS OF HIV
➢HIV screening should be voluntary. Verbal or written consent should be obtained prior
to screening.
➢Standard serum screening tests (enzyme immunoassay [EIA]) detect both HIV-1 and
HIV-2 antibodies.
➢Positive EIA test should be followed with more specific tests to confirm HIV. One very
specific test is “Western blot”.
▪ If testing was done within 3 months of exposure and there is concern about a false
positive result, repeat serologic testing may be performed at least 3 months after the
time of exposure.

37. TREATMENT FOR HIV
➢Antiretroviral medications are used to treat HIV. They work by stopping the virus
replicating in the body, allowing the immune system to repair itself and preventing
further damage.
➢HIV is able to develop resistance to a single HIV drug very easily, but taking a
combination of different drugs makes this much less likely.
➢Most people with HIV take a combination of drugs – it's vital these are taken
every day as recommended.

38. HERPES SIMPLEX
➢Herpes simplex is an infection caused by HSV (herpes simplex virus). This virus
affects the external genitalia, anal region, mucosal surfaces, and skin in other
parts of the body.
➢HSV-2 is responsible for most gental herpes. HSV-1 is associated with fewer
recurrences.
➢Symptoms and signs include prodrome of tingling, itching, followed by eruption
of painful vesicular ulcers in genital area. Primary infection may be associated
with systemic symptoms.
➢Herpes simplex is a long-term condition. However, many people never have
symptoms even though they are carrying the virus.

39. HERPES SIMPLEX DIAGNOSTIC TESTS
➢PCR test: The PCR test can tell if you have genital herpes even if you
don't have symptoms. The PCR test looks for pieces of the virus's DNA
in a sample taken from cells or fluids from a genital sore or the urinary
tract.
➢Cell culture: During the exam, your health care provider can take a
sample of cells from a sore and look for the herpes simplex virus (HSV)
under a microscope.

40. HERPES TREATMENT
➢Treatment with antiviral drugs can help people who are bothered by
genital herpes outbreaks stay symptom-free longer.
➢These drugs can also reduce the severity and duration of symptoms
when they do flare up.
➢There are three major drugs commonly used to treat genital herpes
symptoms: acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir
(Valtrex).

41. PELVIC INFLAMMATORY DISEASE
➢Pelvic inflammatory disease (PID) is the
complication of untreated sexually
transmitted diseases. Clinicians need to
maintain a low threshold of suspicion and
consider epidemiologic factors when
diagnosing PID.
➢Patients who are young, have multiple
sexual partners, live in high prevalence areas
for gonorrhea or chlamydia, do not use
barrier contraception and have a history of
prior PID are at highest risk.
➢N. gonorrhea and chlamydia are the most
common infection, but not the only one, that
can lead to PID.

42. DIAGNOSIS AND TREATMENT OF PID
➢According to the 2006 CDC STD treatment guidelines, empiric treatment for PID
should be initiated in young sexually active women who report pelvic or lower
abdominal pain and no other etiology can be identified as the cause of pain and the
following minimal diagnostic criteria are met:
▪ Cervical motion tenderness or uterine tenderness or adnexal tenderness.
➢Supportive criteria include
▪ Oral temp higher than 101F
▪ Abnormal cervical or vaginal discharge
▪ The presence of WBCS on wet prep
▪ Elevated ESR
▪ Elevated CRP

43. DIAGNOSIS AND TREATMENT OF PID
➢Early treatment of PID decreases the probability of tubal scarring and subsequent
infertility.
➢The incidence of infertility is 15% after one episode of untreated or inadequately
treated PID.
➢The CDC suggests hospitalization in the following circumstances
▪ Observation of potential surgical emergencies that cannot be excluded (e.g.,
appendicitis)
▪ Pregnant patients
▪ Failed outpatient treatment
▪ Severe illness such as high temperature, nausea or vomiting
▪ Presence of tuboovarian abscess
➢Laporoscopy is not performed routinely for suspected PID.

44. FAILURE TO CONTROL STDS
➢There has been little emphasis on educational and other efforts to
prevent infection.
➢ Lack of authoritative guidance on a rational, practical and well defined
package of activities that could be the basis for prevention and care
programs.
➢Service delivery has often been through specialized STD treatment
facilities which provide inadequate coverage and are stigmatizing.

45. FAILURE TO CONTROL STDS
➢ Treatment strategies have focused on unrealistic requirements for
definitive diagnosis rather than on practical decision-making.
➢Control efforts have been concentrated on symptomatic patients (usually
men) and have failed to identify asymptomatic individuals (usually women)
until complications develop.
➢Ineffective low-cost antibiotics continue to be used for reasons of economy.

46. RELATIONSHIP BETWEEN AIDS AND STDS
➢Many of the measures for preventing sexual transmission of HIV and STDs
are the same, as are the target audiences for these interventions.
➢Clinical services for STDs are important points of contact with persons at high
risk of both AIDS and STDs, not only for diagnosis and treatment but also for
education.
➢Other STDs, when present, facilitate the transmission of HIV, making early
diagnosis and effective treatment of STDs an important strategy for the
prevention of HIV transmission.

47. MYTHS ABOUT STDS
▪ HIV is a Death Sentence
➢Due to advanced medical technology, patients that have been
diagnosed with HIV are living longer, more fulfilling lives than ever
before.
➢With regular treatment, HIV patients can live normal lives and are even
capable of having children that are HIV-negative.

48. MYTHS ABOUT STDS
▪ I’ve only slept with one partner, I can’t have an STD
➢Having sex with only one partner does not eliminate you from contracting an
STD.
➢The only way to be 100 percent sure that you and your partner do not have an
STD is to get tested by a medical professional.

49. MYTHS ABOUT STDS
▪ I can tell if someone has an STD
➢Many STDs do not have tell-tale signs or symptoms and can, on occasion, go
completely unnoticed.

50. MYTHS ABOUT STDS
▪ I can’t get an STD from oral or anal sex
➢STDs can be transmitted via semen, blood, or genital contact. Having oral and
anal sex will not prevent you from contracting an STD.
➢It is important to practice safe sex at all times

51. MYTHS ABOUT STDS
▪ Birth control pills will protect me from getting an STD
➢Birth control pills are not designed to protect you against HIV and STDs.
➢Using condoms regularly can significantly reduce your chances of both
pregnancy and STDs.

52. CONCLUSION
➢STDs are more than just an embarrassment. They're a serious health problem.
➢Left untreated, some STDs can cause permanent damage, such as infertility
and even death.
➢The best way to avoid STD is if you do have sex, use a condom every time or
get tested for STDs after having sex.