Transcript SEXUALLY TRANSMITTED DISEASES (STI)

Dr. Esther Kyungu
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Introduction
Pathology
Epidemiology
Clinical Features
Complications
Differential Diagnosis
Management
Contact notification & treatment
Counseling
Prevention
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A sexually transmitted disease (STD), also known
as sexually transmitted infection (STI) or venereal
disease (VD), is an illness that has a significant
probability of transmission between humans or
animals by means of sexual contact, including
vaginal intercourse, oral sex, and anal sex.
While in the past, these illnesses have mostly
been referred to as STDs or VD, in recent years
the term sexually transmitted infection (STI) has
been preferred, as it has a broader range of
meaning; a person may be infected, and may
potentially infect others, without showing signs
of disease.
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Some STIs can also be transmitted via use of
an IV drug needle after its use by an infected
person, as well as through childbirth or
breastfeeding.
Most STIs affect both men and women, but in
many cases the health problems they cause
can be more severe for women. If a pregnant
woman has an STI, it can cause serious health
problems for the baby.
Bacterial
 Bacterial Vaginosis (BV) - not officially an STI
but affected by sexual activity.
 Chancroid (Haemophilus ducreyi)
 Gonorrhea (Neisseria gonorrhoeae)
 Lymphogranuloma venereum (LGV)
(Chlamydia trachomatis serotypes L1, L2, L3.)
 Syphilis (Treponema pallidum)
Viral hepatitis (Hepatitis B virus)
 Herpes Simplex (Herpes simplex virus (1, 2)
 HIV/ AIDS (Human Immunodeficiency Virus)
 Genital warts - ("low risk" types of Human
papillomavirus HPV)
Fungal
 Yeast Infection
Protozoal
 Trichomoniasis (Trichomonas vaginalis)
Parasites
 Pubic lice (Phthirius pubis)
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Many STIs are (more easily) transmitted through
the mucous membranes of the penis, vulva,
rectum, urinary tract and (less often - depending
on type of infection) the mouth, throat, respiratory
tract and eyes.
The visible membrane covering the head of the
penis is a mucous membrane, though it produces
no mucus (similar to the lips of the mouth).
Mucous membranes differ from skin in that they
allow certain pathogens into the body. Pathogens
are also able to pass through breaks or abrasions
of the skin, even minute ones.
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The shaft of the penis is particularly susceptible
due to the friction caused during penetrative sex.
The primary sources of infection in ascending
order are venereal fluids, saliva, mucosal or skin
(particularly the penis), infections may also be
transmitted from feces, urine and sweat.
The amount required to cause infection varies
with each pathogen but is always less than you
can see with the naked eye.
Some infections labeled as STIs can be
transmitted by direct skin contact. Herpes
simplex, pubic lice and HPV are both examples.
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STI incidence rates remain high in most of the
world, despite diagnostic and therapeutic
advances that can rapidly render patients with
many STIs noninfectious and cure most.
Sexually active adolescent girls both with and
without lower genital tract symptoms
(Worldwide in 2006) include chlamydia
trachomatis (10 to 25%), Neisseria
gonorrhoeae (3 to 18%), syphilis (0 to 3%),
Trichomonas vaginalis (8 to 16%), and herpes
simplex virus (2 to 12%).
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Among adolescent boys (Worldwide, 2006)
with no symptoms of urethritis, isolation rates
include C. trachomatis (9 to 11%) and N.
gonorrhoeae (2 to 3%).
In 2006, WHO estimated that more than 1
million people were being infected daily.
About 60% of these infections occur in young
people <25 years of age, and of these 30% are
<20 years.
Between the ages of 14 and 19, STIs occur
more frequently in girls than boys by a ratio of
nearly 2:1; this equalizes by age 20.
An estimated 340 million new cases of syphilis,
gonorrhea, chlamydia and trichomoniasis
occurred throughout the world in 2006.
In Tanzania
 Between 10-20% of sexually active population
contract STIs each year.
 The surveillance of HIV and syphilis infections
among antenatal clinic attendees in 2003/2004
showed an overall prevalence of syphilis & HIV
to be 7.3% and 8.8% respectively.
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Vaginal itching and/or discharge
Intermenstrual bleeding
Penile discharge & scrotal pain and fullness
Urethral discharge
Painful sex or urination
Pelvic and abdominal pain
Chancre sores (painless/ painful) -genital
area, anus, tongue and/or throat
Small blisters on the genital area
Soft, flesh-colored warts around the genital
area
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Swollen glands, fever and body aches
Unusual infections, unexplained fatigue,
night sweats and weight loss
A scaly rash on the palms and the soles
Itching skin, pain or abnormal tingling
sensation at the site of infection
Yellow eyes and skin, pruritus
Dysuria, urinary frequency and/or urgency
Hepatosplenomegaly
Men
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Urethritis, Epididymitis, Proctitis, Urethral
strictures
Women
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Cervicitis, Pelvic Inflammatory Disease(PID)
Ectopic (tubal) pregnancy, Premature birth
Both Sexes
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Infertility, Urethral fistulas, Blindness
Genital Elephantiasis, Frozen Pelvis
Meningitis, Intestinal obstruction and/or
perforation
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Cystitis
Cervicitis, Vaginitis
Urethritis
Cancer of the cervix, prostate
Candidiasis
PID
Urethral meatus
Gram stain smear and culture for
gonococci
Swab for chlamydia (PCR & LCR)
Vagina
Wet mount & Gram stain for
candida, trichomoniasis & bacterial
vaginosis (clue cells, pH>4.5)
Culture for candida &
trichomoniasis
Cervical os
Gram stain &culture for gonococci
Swab for chllamydia (PCR & LCR)
Rectum
Gram stain smear & culture for
gonococci
Swab for chlamydia
Throat
Culture for gonococci
Swab for chlamydia
Eyes
Gram stain smear & culture for
gonococci
Swab for chlamydia
Contacts of gonorrhoea
Genital & rectal tests (if indicated)
as above
Throat swab for culture for
gonococci
Genital, rectum & throat swab for
chlamydia
Genital ulcers
Serum for dark-field microscopy
for Treponema pallidum
Swab for herpes simplex virus
Swab for bacterial culture if
secondary infection
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Blood for syphilis (RPR, TPHA, FTA-ABS)
HIV serology (Capillus, Biolin, CD4+ etc)
Urinalysis (dipstick) for blood, protein,
glucose and bilirubin
Blood for hepatitis B and C serology (HBsAg,
HBeAg, Anti-HBs)
Liver biopsy
Paps smear for HPV
FBP & ESR
LFT & RFT
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Bacterial Vaginosis –
Metronidazole/Clindamycin (oral/Vaginal)
Candidiasis (Oesophageal/ vulvovaginal) –
Azoles (Clotrimazole, Fluconazole), Nystatin,
Amphotericin B
Chancroid – Azithromycin/Ceftriaxone
Chlamydia – Azithromycin/Ceftriaxone or
Doxycycline
Genital Herpes – Acyclovir
Gonorrhoea – Azithromycin/Ciprofloxacin/
Ceftriaxone + Doxycycline
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Lymphogranuloma Venereum –
Doxycycline/Azithromycin/Erythromycin
Syphilis –Benzathine Penicilin G
Trichomoniasis-Metronidazole
HIV/AIDS-ARV for those eiligible
Hepatitis B –Interferon + Lamivudine
Pubic Lice –Malathion/Carbaryl
Genital Warts –Salicyclic acid or
salicyclic+lactic acids combination
Psychotherapy
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Incision & drainage of abscesses and buboes
Repair of rectovaginal/ vesicovaginal fistulas
Dilatation of strictures
We define the STI client as index case and
his/her sexual partners who could be the
source of infection or who could have been
infected by the index case as contacts.
 The concept of contact notification and
treatment is based on the following facts:
 Each STI client must have been infected by a
sexual partner who should also be treated.
 Each STI client is a potential source of infection
to sexual partner(s) until treatment is
completed.
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treated STI client is cured but not immune.
This means that s/he can be re-infected if the
sexual partners still have the STI, a reason
why these partners should be treated
according to equivalent syndrome of the
index patient to break the chain of STI
transmission and to reduce the chance of the
client being re- infected.
Counseling is a more in-depth process than
health education and requires more time,
privacy and confidentiality.
 Specialized counselors need to provide adapted
messages relevant for each person or couple on
the issues of risk behaviours, vulnerability,
dangers of STI, and specific ways to protect
themselves.
 Identify barriers-What keeps someone from
changing behaviour? Is it personal view, lack of
information, partners pressure? Which of these
can be changed and how?
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 Help
people find the motivation to reduce their
risk (behaviour change)-meeting someone who
has HIV/AIDS, hearing about a family member
or friend who is infertile due to STI or learning
that a partner has an infection.
 Offer real skills-negotiation skills, demonstrate
how to use condoms, and conduct role-playing
conversations.
 People need to feel that they have choices and
can make their own decisions. Discuss
substitute behaviours that are less risky.
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Abstinence
Safe sex – condoms use
Counseling, active & prompt treatment of
sexual partners
Health Education on STI
Vaccines against some viral STIs, such as
Hepatitis B and some types of HPV.
Prudent antimicrobial use
Hygiene (genitals, hands)
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STI’s can be transmitted sexually,
transplacentally, blood transfusion and through
skin contacts.
Genital and extragenital sites may be involved
depending on sexual practice(s). It is possible
to be an asymptomatic carrier of sexually
transmitted diseases.
STI’s in women often cause the serious
conditions of PID, stillbirth and infertility.
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Development and spread of drug-resistant
bacteria (e.g., penicillin-resistant gonococci)
makes some STIs harder to cure.
Concept of counselling, contact notification
and treatment is of paramount importance in
control and prevention of STI.
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“Tanzania’s National Guidelines for
Management of sexually transmitted and
Reproductive Tract infections’’. First Edition,
March 2007.
STD Statistics Worldwide
Workowski K, Berman S (2006). "Sexually
transmitted diseases treatment guidelines,
2006”. Shukla N, Poles M (2004). "Hepatitis B
virus infection: co-infection with hepatitis C
virus, hepatitis D virus, and human
immunodeficiency virus.". Clin Liver Dis 8 (2):
445–60, viii.