surface infections STD's /RTI's diseases.pptx

STD's are the most common communicable diseases with high morbidity

1. 1. Cluster testing is useful in detecting cases of: a) STD b) Cancer c) Diabetes d) Unimmunized children

2. 2. Case detection in STD’s is done by all except Contact tracing Screening Cluster testing notification

3. Surface infections Dr L Aruna Assistant professor, Community medicine dept

4. List of surface infections Trachoma Tetanus Leprosy STD’s Yaws AIDS

5. Definition of STD’s A group of communicable diseases which are transmitted from one person to another person by sexual contact Pathological agents are Bacterial, Viral, Protozoal, Fungal & Ectoparasites

6. Venereal disease Syphilis Gonorrhoea Chancroid Lymphogranuloma venereum Donovanosis

7. Disease burden – STI’s World > 1 million infections every day @ 376 million new infections every year = 50% of STI’s are trichomonosis > 500 million people are living with genital HSV (herpes) infections > 290 million women have HPV infection at any point of time .

8. India – major public health problem Syphilis : 15,995 cases reported with 40 deaths Gonorrhoea: 55,470 cases and 5 deaths Chancroid : soft sore, widely prevalent in India LGV : more prevalent in southern states than northern states Donovanosis : greater prevalence in coastal areas Due to inadequate reporting , the true incidence of STD’s is not known

9. Consequences Herpes and syphilis can increase the risk of HIV acquisition > three fold Mother to child transmission results to stillbirth, neonatal death , LBW , prematurity, sepsis, pneumonia , neonatal conjunctivitis, and congenital deformities. HPV : 5.2 lakhs cervical cancers & 2.6 lakhs deaths

10. Epidemiological Determinants Agent : over 20 pathogens

11. Host factors: Age: high rates of incidence in 20-24 yrs Followed by 25-29 yrs , 15-19 yrs. Sex: men> women, but more severe forms of STI’s in women Marital status: higher frequency in single, divorced, and separated persons. Socio - economic status: highest morbidity rates in low socioeconomic groups .

12. Demographic factors: Population explosion Rising young population Rural to urban migration Increasing educational opportunities for women delaying marriage .

13. social factors: Prostitution : she acts as a reservoir for infection, Broken homes Sexual disharmony Easy money Emotional immaturity Social disruption : due to disasters, wars &civil unrest International travel Changing behavioural patterns: a) there is relaxation of moral and cultural values in present day society b) the tendency to break away from traditional ways of life

14. Social stigma: For non – detection of STI’s cases Not disclosing the sources of contact Incomplete treatment Going to quacks for treatment Self treatment Alcoholism: indirectly increases the prostitution,

15. Clinical spectrum Gonococcal infection: symptoms of gonorrhea within 2 to 30 days after exposure. Males: urethritis, proctitis, Females: vaginitis, cervicitis, PID Syphilis: ulceration of the uro - genital tract, mouth & rectum, Clinical symptoms ranges from skin eruptions to complications of CVS &CNS . Congenital syphilis: most common cause for stillbirth.

16. Chlamydial infection Similar to gonorrhoea, Males : urethritis, epididymitis Female: sterility ; vertical transmission during child birth – conjunctivitis. Trichomoniasis: Males: no symptoms - urethritis Females: vaginitis, Adverse outcomes in pregnancy- PROM, LBW

17. Chancroid: small papule to deep painful ulcer at inoculation site, painful inguinal lymph nodes Lymphogranuloma venereum : swelling of lymph nodes in groin, painless ulcer in the genital area , Untreated cases – extensive lymphatic damage – elephantiasis of genitalia. Donovanosis: Granuloma inguinale , painless granulomatous lesion , readily bleed on contact. Genital herpes: HSV-2 papular lesions – blisters- ulcers, LIFE-LONG infection & recurrent ulcerative episodes occur – 4 to 5 episodes per year. No cure for HSV-2 , antiviral treatment effective in reducing severity.

18. Human papilloma virus(HPV) Ano-genital warts: cauliflower like growth to popular flat warts , Cervical cancer

19. signs and symptoms of the most common STI: In men: Urethral discharge : chlamydia, gonorrhoea, trichomonas infection Genital ulcer: treponema pallidum, H. ducreyi , Herpes Simplex infection Genital itching : chlamydia, gonorrhoea, trichomonas infection Swollen and/or painful testicles : chlamydia, gonorrhoea

20. In women: Unusual vaginal discharge: BV, Chlamydia, gonorrhoea, trichomonas infection, vaginal yeast infection Genital itching: BV, trichomonas infection, vaginal yeast infection Abnormal and/or heavy vaginal bleeding: chlamydia, gonorrhoea (Note: This symptom is often caused by factors other than STI.) Bleeding after intercourse: chlamydia, gonorrhoea, chancroid, genital herpes Lower abdominal pain (pain below the belly button; pelvic pain): chlamydia, gonorrhea and mixed anaerobic infection. Persistent vaginal candidiasis: HIV/AIDS Dyspareunia

21. Complications of STI/RTI in males ( i ) Infertility I nfection of the upper reproductive tract can occasionally result in partial or complete blockage of the sperm ducts, and disorders in sperm production. This can cause low sperm counts in semen or abnormal sperm, which contribute to male infertility. (ii) Carcinoma of the penis Infection with Human papilloma virus (HPV) is associated with the development of penile cancer

22. Complications of STI/RTI in neonates Perinatal and neo-natal infections: Congenital syphilis Gonorrhea HIV Hep.B,C CMV, chlamydia, HSV-1,2 Prematurity LBW

23. Syndromic approach to STD Since 1990, WHO has recommended it, In patients presenting with consistently recognized signs and symptoms of STD . Syndromic approach is a scientifically derived approach and offers accessible& immediate treatment ,that is effective , efficient, management of STD’s using flowcharts Treatment for main organisms responsible for causing the syndrome

24. Syndromic approach to STD 1 . Main features Classify main causative agents by the clinical syndromes to which they give rise Use flow charts to identify causes of a given syndrome Treat patient for all the important causes of the syndrome Ensure that partners are treated

25. 2. Supplementary elements Patients education on treatment compliance Patients education on risk reduction Providing Condoms

26. Advantages Accessibility Immediate treatment Effectiveness Efficiency Quality assurance / standardization Disadvantages Over treatment in some patients, Doe's not cover asymptomatic infections

27. Operational model of the role of health services in STI case management Population with STI Aware and worried Seeking care Correct diagnosis Correct treatment Cure Treatment completed Promotion of health care seeking behaviour Improve quality of care Attitudes of personnel

28. Operational model of the role of health services in STI case management Population with STI Aware and worried Seeking care Correct diagnosis Correct treatment Cure Treatment completed Syndromic approach Include STI drugs in essential list Prescribe single dose Counsel about compliance

29. Population with STI Aware and worried Seeking care Correct diagnosis Correct treatment Cure Treatment completed asymptomatic STI Partner notification Case finding Screening Selective mass treatment Operational model of the role of health services in STI case management

30. Control of STD’s Primary prevention:- Prevention of infection Secondary prevention:- Minimising the adverse health effects of infection 1. Initial Planning 2. Intervention Strategies 3. Support Components 4. Monitoring & Evaluation

31. Initial planning 1. Problem definition : in terms of prevalence, Psycho-social consequences, Health effects 2. Establishing priorities : By age,sex,place,occupation & drug addiction 3. Setting objectives : objective should be unambiguous and quantifiable- broad coverage of the population 4. Considering strategies : select most appropriate to the target population.

32. Intervention strategies 1.case detection: screening contact tracing cluster testing 2. case holding & treatment 3. epidemiological treatment 4. personal prophylaxis 5. health education

33. Support components 1. STD clinic 2. laboratory services 3. primary health care 4.Information system 5. legislation 6. social welfare measures Monitoring & evaluation: Ongoing evaluation of disease trends provides direct measure of effectiveness programme interventions . National STD control programme