BY

Professor KO WRIGHT

MEDICAL UNDERGRADUATES, LASUCOM

1. Neisseria meningitidis =roughly 5 to 10 percent of adults likewise carry N.
meningitidis in the back of the nose and throat. Studies suggest they can potentially
transmit the bacteria to partners through oral sex, deep kissing or other kinds of close
contact that transmit infected droplets.
2. Mycoplasma genitalium
M. genitalium, one of the smallest bacteria known, is gaining an outsized reputation as
a worrisome STI. 1 to 2 percent of people and is especially common in adolescents and
young adults.
3. Shigella flexneri
 Shigellosis (or Shigella dysentery) is passed on by direct or indirect contact with
human faeces. ases of shigellosis in gay and bisexual men in the 1970s. S. flexneri,
scientists believe, essentially exploited a new niche for transmission through anal-
oral sex and has led to multiple STI outbreaks around the world since then
 4. Lymphogranuloma venereum (LGV)

 This STI, caused by unusual strains of Chlamydia trachomatis,

 More than 1 million sexually transmitted infections (STIs) are acquired every day
worldwide.
 Each year, there are an estimated 357 million new infections with 1 of 4 STIs:
chlamydia, gonorrhoea, syphilis and trichomoniasis.
 More than 500 million people are estimated to have genital infection with herpes
simplex virus (HSV).
 More than 290 million women have a human papillomavirus (HPV) infection (1).
 The majority of STIs have no symptoms or only mild symptoms that may not be
recognized as an STI.
 STIs such as HSV type 2 and syphilis can increase the risk of HIV acquisition.
 Over 900 000 pregnant women were infected with syphilis resulting in approximately
350 000 adverse birth outcomes including stillbirth in 2012 (2).
 In some cases, STIs can have serious reproductive health consequences beyond the
immediate impact of the infection itself (e.g., infertility or mother-to-child
transmission)
 Drug resistance, especially for gonorrhoea, is a major threat to reducing the impact of
STIs worldwide.
 Table 1. WHO estimates of new cases of chlamydia, gonorrhoea, trichomoniasis, and syphilis
among adults for 1995, 1999, 2005, and 2008 using various methods [4 –7].

Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, et al. (2015) Global Estimates of the Prevalence and Incidence
of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. PLOS ONE 10(12):
e0143304. https://doi.org/10.1371/journal.pone.0143304
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0143304
Box 1 Factors underlying the high prevalence of STIs in developing countries
Demographic factors (a large young population which is sexually active)

Urban migration with accompanying sociocultural changes

Migration and displacement (labour, wars, natural catastrophes)

Increase in levels of prostitution through economic hardship

Multiple and concurrent sexual partnerships

Lack of access to effective and affordable STI services

High prevalence of antimicrobial resistance for some pathogens

 CONTROL OF STIS
 According to the WHO and UNAIDS,7 STI control programmes have three objectives

 to interrupt the transmission of STIs;

 to prevent the development of diseases, complications, and sequelae; and

 to reduce the transmission of HIV infection.

 Health education and condom promotion can modify behaviour, and hence reduce the
incidence of STIs. Screening, case finding, improved access to care, and improved case
management can prevent complications, and also reduce transmission, by shortening th
duration of infection. Mass or targeted presumptive periodic treatments attempt to
bypass the need for treatment seeking, since STIs are frequently asymptomatic, with th
aim to reduce incidence by reducing the pool of infected individuals, in populations wi
high STI prevalence or incidence
 Screening and case finding

 Universal serological testing of antenatal clinic

attenders for syphilis is recommended by the
WHO

 Blood donors should be screened for at least

hepatitis, syphilis, and HIV to protect
recipients, and it may be possible to screen
populations such as military recruits and
company employees. In all cases, careful
attention should be paid to patient
confidentiality, counselling, and treatme
 Box 3 Reasons why STI control programmes often fail in developing
countries
 Low priority for policy makers and planners in allocating resources because
STI are perceived to result from discreditable behaviour

 Failure to recognise the magnitude of the problem in the population

 Failure to associate the diseases with serious complications and sequelae

 Control efforts concentrated on symptomatic patients (usually men) and

failing to identify asymptomatic individuals (commonly women) until
complications develop

 Lack of simple screening tests for cervical infections that could be used to
screen women attending family planning, antenatal, or maternal and child
health clinics

 Service delivery through specialised STI healthcare facilities which provide

 Counselling and behavioural approaches
 Counselling and behavioural interventions offer primary prevention
against STIs (including HIV), as well as against unintended
pregnancies. These include:

 comprehensive sexuality education, STI and HIV pre- and post-test

counselling;
 safer sex/risk-reduction counselling, condom promotion;
 interventions targeted at key populations, such as sex workers, men
who have sex with men and people who inject drugs; and
 education and counselling tailored to the needs of adolescents.
 Low- and middle-income countries rely on identifying
consistent, easily recognizable signs and symptoms to guide
treatment, without the use of laboratory tests. This is called
syndromic management.

 This approach, which often relies on clinical algorithms,

allows health workers to diagnose a specific infection on the
basis of observed syndromes (e.g., vaginal discharge, urethral
discharge, genital ulcers, abdominal pain).

 Syndromic management is simple, assures rapid, same-day

treatment, and avoids expensive or unavailable diagnostic
tests. However, this approach misses infections that do not
demonstrate any syndromes - the majority of STIs globally.
 Thank you