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
6.
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
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
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.,
