SEXUALLY TRANSMITTED DISEASES
ROLL NO.: 2177 - 2075
INTRODUCTION
STDs are a group of communicable diseases that are transmitted predominantly by
sexual contact and caused by a wide range of bacterial, viral, protozoal and fungal
agents and ectoparasites.
Initially, the name was venereal diseases.
The list of pathogens included 5 “classical” venereal diseases:
- Syphilis
- Gonorrhea
- Chancroid
- Lymphogranuloma venereum
- Donovanosis
Now, it includes more than 20 agents.
CAUSATIVE AGENTS
A. Bacterial Agents C. Protozoal Agents
Neisseria gonorrheae Trichomonas vaginalis
Chlamydia trachomatis Giardia lamblia
Treponema pallidum
Haemophilus ducreyi D. Fungal Agents
Mycoplasma hominis Candida albicans
B. Viral Agents E. Ectoparasites
Human Immunodeficiency Virus Sarcoptes scabiei
Hepatitis B virus Phthirus pubis
Herpes Simplex Virus
Human papilloma virus
EPIDEMIOLOGY
WORLD
More than 1 million STIs acquired every day.
Each year, estimated 374 million new infections are seen with 128 million new
cases of Chlamydia trachomatis, 82 million new cases of Neisseria gonorrhoeae,
156 million new cases of Trichomonas vaginalis and 7.1 million new cases of
Treponema pallidum - WHO Global Progress Report 2021
More than 500 million people are living with genital herpes infection.
NEPAL
There were 108,419 annual reported cases of STI in the fiscal year 2077/78,
according to national Integrated Health Management Information System (IHMIS).
EPIDEMIOLOGY
EPIDEMIOLOGY
EPIDEMIOLOGY
EPIDEMIOLOGY
EPIDEMIOLOGICAL DETERMINANTS
AGENT FACTORS
Pathogen Disease/Syndrome
Gonorrhoea, urethritis, cervicitis,
Neisseria gonorrhoeae
epididymitis, salpingitis
Treponema pallidum Syphillis
Haemophilus ducreyi Chancroid
LGV, urethritis, cervicitis, proctitis,
Chlamydia trachomatis
infant pneumonia, Reiter’s syndrome
Klebsiella granulomatis Donovanosis (Granuloma inguinale)
Candida albicans Vaginitis
Trichomonas vaginalis Vaginitis
HOST FACTORS
Age
- Highest rates of incidence observed in 20-24 year olds, followed by 25-29
year olds, then by 15-19 year olds
- Most serious morbidities observed during fetal development and neonates.
Sex
- Overall morbidity rate higher in men, but more severe in women
Marital Status
- More common in single, divorced and separated people than in married
people.
Socio-economic Status
- People with poor socio-economic status have higher morbidities.
DEMOGRAPHIC FACTORS
Population explosion
Increase in young population
Rural to urban Migration
SOCIAL FACTORS
Social disruption
Prostitution
International Travel
Broken homes
Changing Behavioral Patterns
Sexual disharmony
Easy money
Emotional immaturity
Urbanization and industrialization
Social stigma
Alcoholism
CLINICAL SPECTRUM
GONOCOCCAL INFECTION
Caused by Neisseria gonorrhoeae, a non-capsulated Gram negative
kidney-shaped diplococcus
No animal reservoirs
Transmission
- Sexual route: male to female transmission is more efficient.
- Vertical Transmission: results in ocular infection
Pathogenesis
- infects columnar cells
GONOCOCCAL INFECTION
Manifestations
Asymptomatic
Urethritis (males)
- Painful micturition
- Urethral discharge (purulent, thick, profuse and creamy)
- Redness of urethral meatus
In pregnant women
Prolonged rupture of membranes,
In females,
premature delivery, sepsis in infant
Cervicitis
In neonates
Vulvovaginitis
Ophthalmia neonaturum: purulent eye
Fitz-Hugh-Curtis Syndrome
discharge, 2-5 days after birth
- peritonitis with perihepatic
In HIV infected people
Inflammation
Non ulcerative gonorrhea: increases HIV
transmission by 3 folds
SYPHILIS (The Great Pretender)
Caused by Treponema pallidum, a spirochete, cork-screw shaped, motile bacteria
Only known host is human,
Transmission
- Sexual route
- Blood transfusion
- Needle prick
- Vertical transmission: important cause of stillbirth
Pathogenesis
- T. pallidum penetrates through minute abrasions on the skin or mucosa, enters the
lymphatics and blood to produce systemic infection and metastatic foci.
Classification
Primary Syphilis Latent Syphilis
- Single painless, hard indureated - 2 - 6 weeks
ulcer, covered by thick exudate in
genitals Tertiary Syphilis
- Regional lymphadenopathy within 1 - Gumma formation
week of skin lesions, painless, firm, - Neurosyphilis: Tabes dorsalis
bilateral - Aneurysms
Secondary Syphilis
- Skin rashes Congenital Syphilis
- Condylomata lata (mucocutaneous
papules that coalesce to form large pink
to grey lesions in perianal, scrotal regions
and vulva)
- Generalized lymphadenopathy
SYNDROMIC MANAGEMENT OF STI
Guidelines given by National Center for AIDS and STD Control
History Taking
Clinical Examination
Establishing Diagnosis
Health education and Counseling
Partner Notification and Treatment
Follow-up and Referral
STI Reporting
SYNDROMIC MANAGEMENT OF STI
5 most common syndromes of STI
Urethral Discharge Syndrome
Vaginal Discharge Syndrome
Lower abdominal pain
Genital ulcer disease syndrome
Anorectal Discharge syndrome
URETHRAL DISCHARGE SYNDROME
URETHRAL DISCHARGE SYNDROME
Treatment
Cefixime 400mg, orally, single dose *
Plus
Azithromycin 1gm, orally single dose
(* Ceftriaxone 250mg, IM, single dose
preferred for suspected resistance or
recurrent discharge)
URETHRAL DISCHARGE SYNDROME
Treatment
Cefixime 400mg, orally, single dose *
Plus
Azithromycin 1gm, orally single dose
(* Ceftriaxone 250mg, IM, single dose
preferred for suspected resistance or
recurrent discharge)
VAGINAL DISCHARGE SYNDROME
Treatment
Metronidazole 400mg, orally, twice
daily for 7 days
Fluconazole 150 mg, orally, single dose
Cefixime 400mg, orally, single dose *
Plus
Azithromycin 1gm, orally single dose
LOWER ABDOMINAL PAIN
Treatment
Cefixime 400mg, orally, single dose *
Plus
Azithromycin 1gm, orally single dose
Doxycycline 100mg, orally, twixe daily
for 14 days
GENITAL ULCERS
CONTROL OF STD
Global Health Strategy target for STI for 2030 are:
• 90% reduction of T. pallidum incidence globally.
• 90% reduction in N. gonorrhoeae incidence globally.
• ≤ 50 cases of congenital syphilis per 100 000 live births in 80% of countries.
• sustain 90% national coverage with the human papillomavirus vaccine in their
national immunization programme in at least 80% in every country.
The national response to HIV and STI in Nepal started with the National policy on
Acquired Immunodeficiency Syndrome (AIDS) and Sexually Transmitted Diseases
(STDs) control in 1995.
CONTROL OF STD
Initial Planning:
- Problem Definition Health Education
- Establishing Priorities Support Components
- Setting Objectives - STD Clinics
- Considering Strategies - Lab services
- Primary Health Care
Interventional Strategies - Information System
- Case Detection - Legislation
- Screening Monitoring and Evaluation
- Contact Tracing
- Cluster Testing
- Case holding and Treatment
- Epidemiological Treatment (Contact Treatment)
- Personal Prophylaxis
- Contraceptive
- Vaccine
