Control of STD.pdf

National STD control programme

1. Control
of
sexually transmitted diseases
Name -Suhani chhabra
Roll No -160
Batch -2019
Government Doon medical college

2. National STD Control Programme

3. •In 1949 -project for control of venereal diseases.
•In 1955 -Establishment of at least on VD clinics in every district and one clinic and
laboratory in every state.
•In 1957 -A central VD organisation was set up in the Directorate general of Health
Services, New Delhi, for implementing and coordinating the programme in the
country.
Free supply of penicillin and Venereal Disease and Research
Laboratory (VDRL) antigen were made available to the VD clinics.
•Since 1981, the strategy of the programme has been changed. The centrally
sponsored component of supply of drugs to the state has been discontinued and
focus has been on training, teaching and research on various aspects of STD.

4. • To provide training facilities to the in-service medical and paramedical personnel in venereology, the
government in running two training centre's, namely, the institute for Study of SID, Madras Medical
College, MADRAS, and STD Training and Demonstration Centre, Safdarjung Hospital, New Delhi
• A regional training centre is being established at Kolkata for the eastern zone. A regional reference
laboratory has been functioning at the office of the serologist and the chemical examiner to the
government.
• The scheme was converted into a centrally sponsored scheme during the fourth five year plan and the
central government
assistance was limited to:-
-Giving grant-in-aid for establishing new STD clinics.
-Supplying of drugs (Benzathine Benzyl Penicillin) to the STD clinics.

5. •The scheme was again reviewed and during sixth and seventh five year plan it was decided
to establish five regional STD training, teaching and research centres at Delhi, Madras,
Nagpur, Hyderabad and Calcutta.
• Recognising STD as one of the major factors for transmission of HIV infection the
programme has been merged with the AIDS control programme.
•The existing components of the programme viz. teaching, training, research and
epidemiology, however have been retained outside the world bank assisted activities of the
National AIDS control programme

6. OBJECTIVES
•Reduce the STD cases and there by control of HIV transmission by minimising the risk
factors.
• Prevent the short term as well as long term morbidity and mortality due to STD.

7. STRATEGIES
• Development of adequate and effective programme management.
• Prevention of the transmission of STD/HIV infection through IEC and promotion of safer sexual behavior by the use
of condoms.
• Adequate and comprehensive case management including diagnosis, treatment, individual counseling, partner
notification and screening for other disease.
• Increasing access to health care for STD by strengthening existing facilities and creating new facilities.
• Early diagnosis and treatment of mostly asymptomatic infections through case finding and screening.
• The main strategy aimed at achieving the above outlined has been to integrate STD services into the existing health
care system (public & private) with a special emphasis on integration at primary health care
(PHC) level.

8. ACTION/ACTIVITIES
Training of health care workers in both public and private sectors in
comprehensive STD case management.
• Development of appropriate laboratory service for the diagnosis of STD.
• Conduct microbiologist, social behavioural and operation research.
• Surveillance to assess the epidemiology situation, and monitor and evaluate on
going STD control programme.
• One of the major actions taken along the lines suggested in the strategies was
strengthening the existing facilities and structure of STD clinics.

9. FACILITIES IN SURAKSHA
CLINICS
•Standardised training to the medical and paramedical personnel based on
syndromic care management approach.
• Counselling services from trained counsellor in Suraksha clinics.
• Color coded syndromic drug kits are being centrally
procured and supplied to these clinics.

10. PRE-PACKED STI / RTI COLOUR CODED KITS : pre-packed color coded STI/ RTI kits
have been provided for free supply to all designated STI/ RTI clinics. These kits are being
procured centrally and supplied to all State AIDS Control societies.
The color code is as follows:
• KIT 1-grey, for urethral discharge, anorectal discharge and cervicitis.
• KIT2 -green, for vaginitis.
• KIT 3-white, for genital ulcers.
• KIT 4 -blue, for genital ulcers.
• KIT 5-red, for genital ulcers.
• KIT 6-yellow, for lower abdominal pain.
• KIT 7-black, for inguinal bubo.

11. Control of STDs
Initial planning
Intervention
strategies
Support
components
Monitoring and
evaluation

12. •AIM -prevention of ill health through various intervention
•Interventions may be- PRIMARY
PREVENTION FOCUS —prevention of infection.
•SECONDARY PREVENTION FOCUS —minimising the
adverse health effects of infection.
COMBINATION OF TWO .

13. INITIAL PLANNING
1) PROBLEM DEFINITION : Defined in terms of
•prevalence
•psychosocial consequences
•geographical areas
•population groups
•sero epidemiological survey and population survey

14. ESTABLISHING PRIORITIES -depends upon
•Health problem consideration ( magnitude,consequences)
•availability of adequate resource
•feasibility of control
•social and political commitment

15. SETTING OBJECTIVES
•priorities must be converted into discrete ,achievable and measurable
objectives.
•To reduce the magnitude of problem in a given population and time.
•objectives should be unambiguous and quantifiable.
•broad coverage of population

16. CONSIDERING STRATEGIES
•Intervention strategies are available.
•mixture of strategies appears to be most appropriate .

17. INTERVENTION STRATEGIES
•Case detection
•Case holding and treatment
•Epidemiological treatment
•Personal prophylaxis
•Health education

18. CASE DETECTION
•1) SCREENING: testing of apparently healthy volunteers from general
population for early detection of disease.
Important consideration-sensitivity, specificity and predictive value of test
•2) CONTACT TRACING : term used for technique by which sexual partners
of diagnosed patients are identified,located,investigated and treated.
One of the best methods of controlling the spread of infection.
•3) CLUSTER TESTING :Patient is asked to name other persons of either
sex who move in the same socio -sexual environment and then these
persons are screened .

19. CASE HOLDING AND
TREATMENT
•Complete and Adequate treatment of patients and their contacts is the
main stay of STD control.
•Not less than the recommended dosages should be used .
•efforts should be made that patient should not drop out before the
treatment is complete.

20. EPIDEMIOLOGICAL
TREATMENT
•Also known as CONTACT TREATMENT ( keystone of the control
campaigns) .
•Consist of -administration of full therapeutic dose of treatment to persons
recently exposed to STD while awaiting the results of laboratory tests.
•Effects are not lasting unless combined with a venereological examination
and tracing of contacts revealed by that examination.

21. PERSONAL PROPHYLAXIS
•1) CONTRACEPTIVES : Mechanical barriers ( condoms and diaphragms).
Barrier methods when used with spermicides minimise the risk of acquiring
STD infections. The
exposed parts should be washed with soap and water as soon after
contact as possible.
•2) VACCINES: for Hepatitis B

22. HEALTH EDUCATION
•Health education is an integral part of STD control programme.
Aim :
•To help individuals alter their behaviour in an effort to avoid STDs .
•Minimise disease acquisition and transmission.
Target groups are general public , patients , priority groups ,community
leaders etc.

23. SUPPORT COMPONENTS
•STD clinic
•laboratory services
•primary health care
•Information system
•Legislation
•Social welfare measures

24. STD clinic
•Starting point for control of STDs
STDs clinics consist of :-
•Consultation
•Investigations
•Treatment
•Contact tracing and other relevant services are available.

25. •IDEAL SERVICE :-is one that is free, easily accessible to patients and
available for long hours each day . Suitable arrangements for treating
female patients separately.
•It is essential to have in each administrative unit one specialised centre
which provide necessary clinical and laboratory expertise and coordinate
control activities at all levels of health care system .

26. Laboratory services
•Adequate laboratory facilities and trained staff are essential for proper
patient management.
provide basis for :-
•correct etiological diagnosis and treatment decision.
•For contact tracing .
•surveillance of morbidity
•detection of antimicrobial resistance

27. Primary health care
•Current trend to integrate STD control activities into PHCs.
•Inclusion of primary health care workers in STD health team .
•Primary health care -based on principles of universal coverage
,community participation,equity and intersect-oral coordination to control
STD in the community.

28. Information system
•Basis of an effective control programme of any communicable disease .
•prerequisite for effective programme planning , coordination, monitoring
and evaluation.
Three types of data requirement in control of STDs —
•Clinical notification
•Laboratory notification
•sentinel and adhoc surveillance

29. •National Notification system includes only the classical venereal diseases
where existing, reporting system suffer from under notification, inaccurate
diagnosis and concealment of cases owing to social stigma.
Without notification system it is not possible :
•To assess the magnitude of the problem
•To allocate resources
•To evaluate the impact of control measures
Sentinel surveillance system and/ or adhoc surveys can be used to
supplement the routine reporting system .

30. The information system should be built around a small number of questions:
•How many cases were interviewed?
•How many villages were visited ?
•How many cultures were examined?
The system should provide information on
•Activities
•Resources utilisation
•Task accomplishment of programme personnel .

31. Legislation
Purpose of legislation-
•to encourage patients to seek early treatment and name their sexual contacts.
•To screen high risk groups .
•To improve notification by general practitioner.
•Health education of the public.
The Immoral Traffic (prevention) Act ,1986 ( which replaced the earlier Suppression of the
Immoral Traffic Act ,1956 ) covers—all persons whether male or female , who are exploited
sexually for commercial purposes.
•Punishment more stringent than previous Act

32. Social welfare measures
•STDs are social problems with medical aspects.
•SOCIAL THERAPY which would prevent or control conditions leading to promiscuity and STDs.
Social measures include-
•Rehabilitation of prostitutes.
•provision of recreation facilities in the community.
•provision of descent living conditions.
•marriage counselling.
•prohibiting the sale of sexually stimulating literature , pornographic books and photographs etc

33. MONITORING AND
EVALUATION
EVALUATION
•will show if the activities have been performed in a satisfactory way.
•provides a more direct measure of programme effectiveness .
•used to determine the appropriateness of the selected intervention
strategies for a particular setting

34. Thank you