Sexually Transmitted Diseases

1. 09/01/2014 1 Sexually Transmitted Infections  ( STI ) SAgun PAudel Health Assistant Shima Kunwar Staff Nurse Lila Kumari Sharma Staff Nurse EIHS, Naulo Ghumti Nepal

2. S exually T ransmitted I nfections  ( STI ) 09/01/2014 2 S exually T ransmitted I nfections  ( STI ) are   illnesses that predominantly   transmitted by means of  sexual behavior, including vaginal intercourse, anal sex and oral sex.

3. Classification of STIs 09/01/2014 3 Bacterial Chancroid ( Haemophilus ducreyi ) Chlamydia ( Chlamydia trachomatis ) Gonorrhea ( Neisseria gonorrhoeae ) Syphilis ( Treponema pallidum ) Donovanosis

4. 09/01/2014 4 Parasites Crab louse pubic lice" ( Pthirus pubis ) Scabies ( Sarcoptes scabiei ) Protozoal Trichomoniasis ( Trichomonas vaginalis Viral Viral hepatitis ( Hepatitis B virus Herpes simplex ( Herpes simplex virus HIV HPV Molluscum contagiosum

5. Mode of Transmission 09/01/2014 5 Sexual contact: from one infected person to another primarily by Sexual contact- Anal, Vaginal or oral From Mother to child: during Pregnancy and child birth Occasionally through contaminated fingers, blood and blood products, organ transplants, contaminated needles and fomites such as towels, sex toys.

6. Sign and symptoms of STIs 09/01/2014 6 Male Urethral discharge Burning and pain during urination Pain of itch in and around genitalia, perineum and anus/rectum Papules, vesicles, erosion/ulcers or fleshy growths in and around genitalia, perineum and anus/rectum, oral cavity and occasionally on other sites. Swelling in inguinal, anal region and of scrotum.

7. 09/01/2014 7 Female abnormal vaginal discharge Burning and/or increased frequency of urination Lower abdominal pain Pain, itch, Papules , vesicles, erosion/ulcers or fleshy growths in and around genitalia, perineum and anus/rectum, oral cavity and occasionally on other sites. Swelling in inguinal, anal region and of scrotum.

8. 09/01/2014 8

9. Possible complications related to STIs 09/01/2014 9 Male urethral stricture Epididymo-orchitis Penile and anal cancer Rarely disseminated infections

10. 09/01/2014 10 New born (from mother) congenital syphilis and neonatal conjunctivitis Premature and low birth weight Herpetic/HPV infection

11. 09/01/2014 11 Female P elvic inflammatory disease Cervical and cancer Ectopic pregnancy Abortion, still birth STI increases risk of HIV infection

12. Common complications in male and female 09/01/2014 12 infertility Scarring, distortion and mutilation of the genitalia Systemic infection Anxiety depression Social rejection by community member, family members Stigma and discrimination Intra-marital discord and divorce etc

13. STI risk factors 09/01/2014 13 health care related behaviors Lack of willingness to seek medical advice and choice of health care Lack of compliance with therapy Lack of partner’s referral for therapy Practice of vaginal cleaning of douching, enema

14. 09/01/2014 14 Sexual behaviors sexual contact with multiple partners Sexual contact without using protective barriers Sexual contact with causal partners Sexual contact with high possibilities of trauma – anal Other factors age, socioeconomic status, drug and alcohol use etc.

15. STIs management strategy 09/01/2014 15 STIs management program should be comprehensive It should be designed in such a way that: identification of maximum number of symptomatic and asymptomatic individuals. provide effective on-the-spot treatment Identify those who have increased risk behavior for contracting STIs Promote positive behavior change and maintenance to reduce sexual and other risks through appropriate health education and communication program.

16. E pidemiology 09/01/2014 16 Estimated annual Incidence WHO: 1999 340 million new cases (syphilis, gonorrhea, chlamydial and trichomoniasis primarily occurring in men and women aged 15-49 years) Syphilis: 12 million Gonorrhea: 62 million Chlamydial infection: 92 million Trichomoniasis : 173 million

17. 09/01/2014 17 According to HMIS 2064/65 BS; 28,2229 STIs Research by Zeeb (1996) estimated a total of 6,000 to 8,000 annual STIs client in kaski District. IBBS, 2008 in pokhara 30% of FSW reported at least one symptom of STIs.

18. Public health aspect 09/01/2014 18

19. Approaches of STIs Diagnosis and management 09/01/2014 19 Clinical Etiological Syndromic Enhanced syngromic

20. Clinical approach 09/01/2014 20 Based on clinical findings

21. Etiological approach 09/01/2014 21 identification of causative organisms or their antibodies through laboratory testing.

22. Syndromic approach 09/01/2014 22 Identification of consistent STI-related groups of symptoms and clearly recognized signs are called STI syndromes. The provision of clinical care which will cure the majority of organisms responsible for producing each syndrome is called syndromic case management.

23. Enhanced syndromic 09/01/2014 23 An approach that aims toward reducing the prevalence of STIs through a single round of presumptive treatment of cervicitis, with subsequent monthly clinical care through an enhanced syndromic management protocol on risk assessment and laboratory tests.

24. Main STI syndromes 09/01/2014 24 UDS SSS GUDS IBS VDS LAPS NCS

25. 4Cs of S yndromic management 09/01/2014 25 Compliance with treatment Counseling Contact tracing Correct and consistent condom use.

26. Activities inside C linic 09/01/2014 26

27. FAMILY PLANNING SERVICE 09/01/2014 27

28. Problems 09/01/2014 28 Client do not easily agree for STI examination especially for PV examination. Irregular client flow. acceptance of dual methods.

29. R eferences 09/01/2014 29 National Training Manual on the Management of Sexually Transmitted Infection. (Training manual) updated: 2011

30. Do not forget to suggest 09/01/2014 30 [email protected] www.facebook.com/preventionisbest www.facebook.com/sagun.paudel

31. 09/01/2014 31 T hankyou