Transcript SEXUALLY TRANSMITTED DISEASES DR EM OHAJU UNIVERSITY OF PRETORIA

SEXUALLY TRANSMITTED
DISEASES
DR EM OHAJU
UNIVERSITY OF PRETORIA
Presentation Outline
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Introduction
STI Classification
Risk Factors
Prevention and Control Approaches to STI
Prevention and Control at Population level
Impact of STI
References
Introduction
 448 million new infections of curable sexually transmitted
(syphilis, gonorrhoea, chlamydia and trichomoniasis)
infections occur yearly in adults aged 15-49 years.
 Some sexually transmitted infections exist without
symptoms.
 In pregnant women with untreated early syphilis, 25% of
pregnancies result in stillbirth and 14% in neonatal death.
 Sexually transmitted infections are the main preventable
cause of infertility, particularly in women.
 WHO recommends a syndromic approach to diagnosis and
management of sexually transmitted infections
STI Classification
Bacterial
• Chancroid
• Gonorrhea
• Chlamydia
• Syphilis
Viral
• Adenoviruses
• Viral hepatitis (Hepatitis B virus)
• Herpes simplex (Herpes simplex virus (1,2))
• Genital warts/Human papillomavirus (HPV)
• Kaposi’ Sarcoma
Parasites
• Pubic lice, collaquially known as “crabs”
• Scabies
Protozoal
• Trichomoniasis
STI Syndromes
SYNDROME
MOST COMMON CAUSE
Vaginal discharge
Vaginitis(trichomniasis, candidisis)
Cervicitis(gonorrhea, chlamydia)
Urethral discharge
Gonorrhea, chlamydia
Genital ulcer
Syphilis, chancroid, herpes
Lower abdominal pain
Gonorrhea, chlamydia, mixed
anaerobes
Scrotal swelling
Gonorrhea, chlamydia
Inguinal bubo
LGV, Chancroid
Neonatal conjunctivitis
Gonorrhea, chlamydia
Distribution of STIs
 Prevalence higher in urban than rural
 Higher in unmarried & young adults
 More frequent among females than males between the
ages of 14-19
 After the age of 19, there is slight male
preponderance
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Global distribution of burden of disease attributable
to 20 leading selected risk factors
Underweight
Unsafe sex
Blood pressure
Tobacco
Unsafe Sex
Alcohol
Unsafe water, sanitation and hygiene
Cholesterol
Indoor smoke from solid fuels
Iron deficiency
Overweight
Zinc deficiency
Developing countries with high mortality
Low fruit and vegetable intake
Developing countries with low mortality
Vitamin A deficiency
Physical inactivity
Developed countries
Risk factors for injury
Lead exposure
Illicit drugs
Unsafe health care injections
Lack of contraception
Childhood sexual abuse
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Attributable DALYs (% of global DALYs)
Source: WHO, World Health Report, 2002.
Risk Factors for Transmission
 Behavioral Factors  Socio-economic
Many partner
Poverty
Change of partners
Religious Restrictions
Not using condoms
Women’s position
Casual sex
 Cultural
Sex with CSW & partner
Alcohol & substance use  Biological & clinical
Assymptomatic STIs
 Personal factors
Age
Delay in getting Rx
Sex
Stigma being ashamed
Noncompliance to Rx
Vulnerability, immunity
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Main Aims of STI Prevention and Control
 Interrupting the transmission of STI
 Prevent development of disease and
complications
 Reducing the risk of acquiring and
transmitting HIV
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Prevention and Control of STIs
Strategies
 Promotion of safer sexual behavior
 Promotion of health care-seeking
behavior
 Early diagnosis and treatment
 Targeting vulnerable groups
 Case Management
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Health Care Seeking Behaviour – People with STIs
Target for Control
Stage 1 Preventing new infection
Stage 2 Detection & Rx of asymptomatics
Stage 3 Improving health seeking behavior
Stage 4 Improving Rx
Stage 2
Population
with any
STI
With
Without
symptoms symptoms
With STI
STI so far
prevented
Stage 1
Total adult
population
Stage 3
Symptoms
recognized
Not
Seeking
Rx
Seeking
Rx
Inadequate
Rx
Stage 4
Presenting
for Rx
Adequate
Rx
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Primary prevention
 Safer sexual behaviors
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abstention from sexual activity altogether
delaying the age of sexual debut
life-long mutual monogamy
condoms (male or female) are used
 engaging only in non-penetrative sex acts public
 Public education
 Program and service package
 public education campaigns
 providing quality STI care
 providing non-stigmatizing and non-discriminatory service
 continuous supply of drugs & condoms
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Secondary prevention
 case finding and screening:
 Examination of women attending clinics for maternal and
child health and family planning
 partner notification and treatment
 education, investigation and treatment of targeted
population groups who may have placed themselves at risk
of infection
 testing of blood donors for syphilis, HIV and hepatitis B
 community-based screening
 Provision of prophylactic antibiotics against
major STIs for victims of sexual violence
 Integration of STI services within primary care
 training of service providers in case management
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Secondary prevention
 Comprehensive Case Management of STI
 Identification of syndrome
 Antibiotics treatment
 Education and counseling
 Notification and management of sexual partners
 Persuade partners to finish their treatment
 Process must be carried with sensitivity,
consideration of social and cultural factors to
avoid ethical problems
Other Public Health Approach to
STI Prevention and Control
WHO: Guideline for Management of STI, 2003
1. Access to Services
 Accessible, affordable, effective for STI control
 Have balanced intergrated, comprehensive
programmes(STI) in PHC
 Staffed with skilled trained specialist in STI
treatment, epidemiology surveillance and
operational research
Prevention at Population level
SOURCE: The Lancet : Nicola Low, Nathalie Broutet, Yaw Adu-Sarkodie, Pelham Barton, Mazeda Hossain,
Sarah Hawkes. Global control of sexually transmitted infections The Lancet Sexual and Reproductive Health
Series, October 2006.
Impact of STI
 Social:
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Risk of infection with HIV
Stigmatization
Infertility
Divorce & family disruption as a result of
infertility
 Economic:
 Cost of STI drugs may place heavy financial burden on
families , communities, & the country at large
 Absenteesim and less productivity
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Challenges to S & RH
 The increasing and devastating impact of HIV
 Increasing number of young people entering their
reproductive years
 Increasing demand for S & RH services and
commodities
 Weak or deteriorating health systems
 Few health workers especially in poor areas mostly
rural
 Weak polices, laws and regulations
References
 CDC MMWR: STD Rx Guideline, 2006
 WHO, RH Indicators: Guideline for
their interpretation and analysis for
global monitoring, 2006
 Global Strategy for Prevention and
Control of STI, 2006-2015