Hiv and std

short presentation of HIV and STD

1. HIV Acquired I mmuno 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 DEFICIENCY VIRUS Attacks T4 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 Sexual Transmission 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. DIAGNOSIS ELISA - Screening test for HIV – detect antibodies Western Blot test – Confirmatory – Detect more specific antibody to viral core protein

7. CONTROL OF AIDS PREVENTION Education Combination HIV prevention Biomedical Behavioural Structural interventions Prevention of blood borne transmission

8. ANTIRETROVIRAL TREATMENT: Nucleoside reverse transcriptase inhibitors (NRTIs) Nucleotide reverse transcriptase inhibitors ( NtRTIs ) Non-Nucleoside reverse transcriptase inhibitors ( NNRTIs ) Protease inhibitors (PPs) Integrase strand transfer inhibitors (INSTIs)

9. 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

10. Problem statement Under reporting and not notifiable With available data – high prevalence 1-14% - World Antimicrobial resistance Second generation STD’s like chlamydia > N.Gonorrhea In India STD is a major public health problem

11. Epidemiological determinants AGENT Nisseria gonorrhoeae Treponema pallidum Haemophilus ducreyi Chlamydia trachomatis Calymmatobacterium granulomatis Herpes simplex virus Hepatitis B HPV HIV Molluscum contagiosum Candida albicans Trichomonas vaginalis

12. 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

13. Social factors Prostitution Broken homes Sexual disharmony Easy money Emotional immaturity Urbanization Social disruption - war International travel Changing behavior pattern Social stigma Alcoholism

14. 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

15. 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

16. 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

17. Trichomoniasis Parasitic infection Vaginitis and vaginal discharge Men – usually asymptomatic – urethritis Adverse outcome in pregnancy – low B W, premature rupture of membrane Treatment – metronidazole or tinidazole

18. 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

19. 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

20. Donovanosis Small papules – ruptures to form granulomatous lesion – painless Bleeds on contact Treatment – azithromycin, doxycycline

21. 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

22. 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

23. Syndromic approach in STD Since 1990 WHO recommended Easily accessible and immediate treatment

24. 1. Urethral discharge in males Suspect gonorrhea, chlamydia Treatment – cefixime 400mg OD + azithromycin 1 gm OD – single dose - Both partners Review after 7 days – if cured – clinical cure If not – whether compliance or not in treatment – if not compliance – continue same regime

25. If compliance still symptoms – secindazole 2gm stat – to cover trichomonas vaginalis If partner is pregnant – erythromycin 500mg 4 times 7 days or A moxycillin ICTC – screening HIV, HepB, Syphilis Promote condom, sexual abstinence Failure of treatment – referral to district hospital

26. 2. Vaginal discharge Suspect vaginitis and cervicitis History Rule out pregnancy Type of discharge Itching/burning sensation Ulcer Genital complaints in partner Low backache

27. Examination Per speculum examination Vaginitis Greenish discharge – T.Vaginalis Curdy white –candidiasis Adherent – bacterial vaginosis Atypical – mixed infection Cervicitis Erosion/ulcer Bimanual pelvic examination – r/o PID

28. Treatment Vaginitis – ( T.Vaginalis,Bacterial vaginosis , candida) Secindazole 2gm stat Flucanazole 150mg stat Cervicitis – (chlamydia/gonorrhea) Cefixime 400mg stat Azithromycin 1gm stat In pregnant partners Clotrimazole vaginal pessaries and metronidazole pessaries

29. 3.Lower abdominal pain PID – chlamydia, gonorrhea, anaerobes History Lower abdominal pain Fever Vaginal discharge Menstrual irregularities Dyspareunia Dysuria, tenesmus Low back ache IUD usage