SEXUALLY TRANSMITTED DISEASES DR EM OHAJU UNIVERSITY OF PRETORIA

Presentation Outline 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 Inguinal bubo LGV, Chancroid Neonatal conjunctivitis

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

Global distribution of burden of disease attributable to 20 leading selected risk factors Underweight Unsafe sex Blood pressure Tobacco Alcohol Unsafe water, sanitation and hygiene Cholesterol Indoor smoke from solid fuels Iron deficiency Overweight Zinc deficiency Low fruit and vegetable intake Vitamin A deficiency Physical inactivity Risk factors for injury Lead exposure Illicit drugs Unsafe health care injections Lack of contraception Childhood sexual abuse Unsafe Sex Developing countries with high mortality Developing countries with low mortality Developed countries 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 Many partner Change of partners Not using condoms Casual sex Sex with CSW & partner Alcohol & substance use Personal factors Delay in getting Rx Stigma being ashamed Noncompliance to Rx Socio-economic Poverty Religious Restrictions Women’s position Cultural Biological & clinical Assymptomatic STIs Age Sex Vulnerability, immunity

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

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

Primary prevention Safer sexual behaviors Program and service package 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

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

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: Economic: 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

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