REPRODUCTIVE TRACT

INFECTION/STD CONTROL
PROGRAMME
SEXUALLY TRANSMITTED DISEASES

 STDs are a group of communicable

diseases that are transmitted
predominantly by sexual contact and
causal by a wide range of bacterial,
viral, protozoal and fungal agents and
ectoparasites.
 SEXUALLY TRANSMITTED
DISEASES (CONT.)
• Syphilis
• Gonorrhoea
• HIV/AIDS
• Chlamydial infection
• Genital herpes
• Genital human papilloma virus infection
 CLASSIFICATION
 Bacterial agents:- Gonorrhea, Chlamydia
trachoma
 Viral agents:-Herpes simplex virus, Hepatitis B
virus
 Protozoal:-Trachoma vaginalis
 Fungal:-Candida albicans
 Ectoparasities:-Phthirus pubis, Sarcoptes
scabiei
 HOST FACTORS

• Age:-20-24yr,followed by 25-29 and 15-19

• Sex:-Both male and female

• Marital status:-Single, divorced and separated

• Socio- economic status:-Low socio-economic

status
 SOCIAL FACTORS
• Prostitutions
• Broken homes
• Sexual disharmony
• Easy money
• Emotional immaturity
• Urbanization and industrialization.
• Social disruption
• International travel
CONT…….

 Changing behavioral patterns.

 Social stigma
 Alcoholism
 CONTROL OF STDS

Initial Planning
 Intervention strategies.

 Support components.

 Monitoring and evaluation.

INTRODUCTION OF RTI/STD PROGRAMME

• Prevention and Management of Reproductive

Tract Infection (RTI) and Sexually Transmitted
Infections (STI).

• Reproductive Tract Infections pose grave

threats to women’s Life throughout the world.
RTI includes sexually transmitted infection,
men also experience RTIs but prevalence and a
consequence for women are much more severe.
CONT……………..
 Services for the prevention and treatment of
RTI/STI are integral part of the Reproductive
Child Health Programme.

 All community based prevalence studies of

women and men’s health conducted in India
indicate that rates of RTI are very high.
 STD CONTROL PROGRAMME
• STD control programme in India was started in
1946.With arrival spread of HIV infection in the
country it was brought under the purview of National
AIDS Organization in the year 1992.
• Based on diagnosis and treatment of STD and relies
on the health seeking behavior of individuals with
STD.
• Current facility: 5 regional STD reference centers,
the skin-Leprosy-STD clinics in medical college and
845 STD clinics usually located at district hospital.
 OBJECTIVES OF RCH I

Reduction of Maternal Morbidity And Mortality

Reduction of Infant Morbidity And Mortality

Reduction of Under 5 Morbidity And Mortality

Promotion of Adolescent Health

Control of Reproductive Tract Infections and

Sexually Transmitted Infections
 COMPONENTS

 Family planning

 Child survival and safe motherhood

component.

 Client approach to health care

 Prevention/ Management of RTI/STD AIDS.

MAIN HIGHLIGHTS OF RCH

 Specialist facilities for STD and RTI are

available in all district hospital and in a fair
number of sub-district level hospitals.
INTERVENTIONS IN ALL
DISTRICTS
 Implementation of Target Free Approach.
 High quality training at all levels.
 IEC activities.
 RTI/STI clinics at Districts Hospitals(where
not available).
 Enhanced community participation through
Panchayats, Women’s groups and NGOs.
 Adolescent health and reproductive hygiene.
 INTERVENTIONS IN SELECTED
STATES/DISTT.

 Screening and treatment of RTI/STD at sub-

divisional level.
SERVICES OF RCH PROJECT IN
INDIA
 Essential Obstetric Care
 Emergency Obstetric Care
 Essential New Born Care
 Medical Termination of Pregnancy
 Contraceptives Delivery
 RTI/STI Care
 Empowering Adolescents
 Strengthening Immunization
RCH PACKAGE OF SERVICES
SERVICES
 Linked to HIV/AIDS control.
 NACO provides assistance for setting up
RTI/STD clinics.
 Training of manpower and drug kits including
disposable equipment.
 Each districts will be assisted by two laboratory
technicians on contract basis for testing blood,
urine and RTI/STD tests.
OBJECTIVES UNDER RCH II

 Promote recognition and referral .

 Strengthen services for diagnosis and

treatment.

 Strengthen linkages and synergy.

 STRATEGIES

 Community level

 Facility level

 Operational research
 COMMUNITY LEVEL

 Train and permit ANMs and provide first

line drugs in ANMs kit.

 Train AWWs and link volunteers.

 Promote community awareness.

 FACILITY LEVEL

 Operationalize services for the diagnosis and

comprehensive treatment.
 Revise essential drug kit.
 Post technicians, strengthen laboratories, and
ensure availability of supplies.
 Provide 1st line drugs at remaining PHCs.
 Train MOs and LHVs.
 OPERATIONAL RESEARCH

 Refine and test syndrome algorithms for the

treatment.

 Estimate burden of RTIs/STIs and sensitivity of

the causative organisms.

 Assess utility of microbicides in preventing

RTIs/STIs.
 RTI/STD UNDER NACO

 RTI/STI linked to HIV/AIDS, therefore, the planning and

implementation of services for RTI/STI has been done in
close collaboration with National AIDS Control Organization
(NACO).

 All STD clinics at the district level are being assisted by

NACO while incorporating the RTI component. The
assistance from Govt. of India is in the form of training,
laboratory equipments, RTI/STI drug kit and financial
assistance for disposable laboratory items
 UNDER NACO

 The importance of treatment and control of

STD in relation to HIV infection was
recognized by NACO.
 After taking over the STD control program in
1992.
 NACO made it an integral component of AIDS
control policy.
 OBJECTIVES

 Reduce HIV cases and there by control HIV

transmission by minimizing the risk factor.

 Prevent the short term as well as long term

morbidity and mortality due to STD.
 STRATEGIES

 Develop adequate and effective Programe management.

 Promote IEC activities for the prevention of transmission of
STD and HIV infection.
 Make adequate arrangement for comprehensive case
management including diagnosis, treatment, individual
counseling, partner notification , and screening of other
diseases,
 Increasing access to health care for STD by strengthening
existing facilities and structures and creating new facilities
wherever necessary.
 Creating facilities for diagnosis and treatment of asymptomatic
infections.
SYNDROMIC APPROACH

• Since 1990 WHO has recommended syndromic

management of STDs in patient presenting with
consistently recognized signs and symptoms of
STD.
• The syndromic approach and offers accessible
and immediate treatment, that is effective and
efficient, management of STD using
flowcharts, is more cost- effective than
diagnosis based on laboratory tests.
SYNDROMIC APPROACH
 Urethral discharge

 Vaginal discharge

 Genital ulcer

 Inguinal swelling, and

 Lower abdominal pain

IMPORTANT CONSIDERATION
 Educate and counsel client and partner/s
regarding STI/RTI, safer sex practices and
importance of taking complete treatment
 Treat partner.
 Advice sexual abstinence or condom use.
 Provide condoms, educate about correct and
consistent use.
CONT………..

 If symptoms persist, assess whether

it is due to re-infection and advise
prompt referral
 Consider immunization against
hepatitis B.
THANK YOU