1. SEXUALLY TRANSMITTED DISEASES
DR EM OHAJU
UNIVERSITY OF PRETORIA

2. Presentation Outline Introduction STI Classification Risk Factors
Prevention and Control Approaches to STI
Prevention and Control at Population level
Impact of STI
References

3. Introduction
448 million new infections of curable sexually transmitted (syphilis, gonorrhoea, chlamydia and trichomoniasis) infections occur yearly in adults aged 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

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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

18. 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

19. 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,