Download Sexually Transmitted Diseases

Sexually Transmitted Infections
Agis Terzidis, Paediatrician
Spyridon Gialamas, Medical Doctor
IFAKARA TTIHC
29 JUNE 2009
Socio - economic data
• Population 37.440.000 ( 63% rural )
• Life expectancy at birth 46y. Infant mortality( 5 yrs.) 126/1000 births
• HDI 0.43
•
HIV morbidity 6.5% TB cases 479/100.000 - Malaria 1.207/100.000
• Population with no access to drinkable water 38% (20l/day- 1km max)
• Malnutried population 44 % (  food intake )
Sexually Transmitted Infections
• Bacterial
–
–
–
–
–
Neisseria gonorrhoeae
Chlamydia trachomatis
Treponema pallidum
Haemophilus ducreyi
Klebsiella granulomatis
• Viral
–
–
–
–
–
Human immunodeficiency virus
Herpes simplex virus type 2
Human papillomavirus
Hepatitis B virus
Cytomegalovirus
• Parasitic
– Trichomonas vaginalis
– Candida albicans
Most usual ways of STIs transmission
child
• STIs often exist without symptoms
• Men and women with sexual partners who
have STI symptoms should seek care and
receive treatment, regardless of a lack of signs
• STIs disproportionally affect women and
adolescent girls
• 1/20 adolescent girls gets a bacterial infection
through sexual contact
• 30-40% of female infertility cases due to postinfection damage of Fallopian tubes
• 10-40% of women with untreated chlamydial
infections develop symptomatic pelvic
inflammatory disease
• Condoms are one of the most effective
methods of protection against STIs
• Partner notification can prevent reinfection
and reduce the wider spread
• Sexual or economic conditions / sexual
behaviours increase vulnerability to STIs
Chlamydial infections
Estimated new cases of chlamydial infections among adults, 1999
Basic facts about chlamydia
• 70-75% of women symptom free
• Clinical manifestations: urogenital tract, throat
or rectum mucosal inflammation, neonatal eye
infection/ pneumonia
• Complications: chronic pelvic inflammatory
disease, ectopic pregnancy, infertility
• Diagnosis: costly equipment, not always
available in developing countries
Gonorrhoea
Estimated new cases of gonorrhoea among adults, 1999
Basic facts about gonorrhoea
• Up to 80% of women and 10% of men are
asymptomatic
• Clinical manifestations: urogenital tract, throat
or rectum mucosal inflammation, neonatal
eye infection
Basic facts about gonorrhoea
• Complications:
– Women: infertility, ectopic pregnancy, chronic
pelvic inflammatory disease, chronic pelvic pain
– Men: urethral strictures
– Both sex: septicaemia, arthritis, endocarditis,
meningitis
– New born: blindness
• Diagnosis: costly equipment, not always
available in developing countries
Syphilis
• Untreated early syphilis is responsible for 25% of
stillbirths and 14% of neonatal deaths
• 4-15% of pregnant women in Africa test positive
for syphilis
• 492.000 stillbirths per year could be prevented
with effective screening, in Africa
Estimated new cases of syphilis among adults, 1999
Basic facts about syphilis
• Clinical manifestations: urogenital tract,
mouth or rectum ulceration, disseminated
mucocutaneous lesions, fever, general
malaise, hair loss, mild hepatitis
• Complications: pregnancy wastage, congenital
syphilis, musculo-skeletal / cardiovascular and
nervous system disorders
• Diagnosis: simple, relatively cheap screening
test, not always available in developing
countries
Estimated new cases of trichomoniasis among adults, 1999
Basic facts about trichomoniasis
• Most common worldwide
• 50% of women are symptomatic
• Men: urethral infection, short duration
• Men easily transmit the parasite to women,
when infected
Basic facts about trichomoniasis
• Clinical manifestations: vaginitis, male urethritis
• Complications:
– no systemic complications
– Vaginal infection facilitates the spread of HIV infection
• Diagnosis: Test not always available in developing
countries
HPV infection
• Virtually all cervical cancer cases are linked to genital
infection with the human papilloma virus (HPV)
• 500000 new cases, 250000 deaths per year
• The new vaccine prevents the infection and the
cancer of the cervix
The link between STIs and HIV/AIDS
 certain STIs facilitate the transmission of HIV;
 the presence of HIV can make people more
susceptible to the acquisition of STIs;
 the presence of HIV increases the severity of some
STIs and their resistance to treatment
A global view of HIV infection
33 million people [30–36 million] living with HIV, 2007
New infections among children, 1990–2007
600 000
500 000
400 000
300 000
200 000
100 000
0
1990 1991 1992 1993 1994 1995 1996 19971998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
This bar indicates the range
Child deaths due to AIDS, 1990–2007
500 000
400 000
300 000
200 000
100 000
0
1990 1991 1992 1993 1994 1995 1996 19971998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
This bar indicates the range
Percentage of most-at-risk populations
reached with HIV prevention programmes, 2005–2007
100
90
80
70
60
60.4%*
(39 countries)
46.1%**
% Median 50
(15 countries)
40.1%*
(27 countries)
40
30
20
10
0
Sex
workers
Source: UNGASS Country Progress Reports 2008
Injecting
drug users
Men having
sex with men
* Percentage of sex
workers and men
having sex with men
reported knowing
where they can
receive an HIV test
and that they were
given condoms.
** Percentage of injecting
drug users who reported
knowing where they
could receive an HIV
test and be provided
with condoms and
sterile injecting needles
and syringes.
Countries implementing one or more elements of the WHO Global
Strategy for Prevention and Assessment of HIV Drug Resistance and the
HIVResNet laboratory network (as of December 2007)
Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, June 2008
May 2006
Global Strategy on Prevention and Control
of STIs by WHO, endorsed by the
World Health Assembly
Primary prevention of STIs
• Health education and promotion of safer sex
• Information campaigns on the association
between HIV and other STIs
• Promotion of condoms
Secondary prevention of STIs
• Promotion of early health care seeking behaviour
• Accessible, effective and acceptable care
• Education and counselling
• Early detection and treatment of asymptomatic
infections through case finding and screening
Key features of syndromic case management
is problem-oriented (it responds to the patient’s symptoms)
is highly sensitive and does not miss mixed infections
treats the patient at the first visit
makes STI care more accessible as it can be implemented at primary health-care
uses flowcharts that guide the health worker through logical steps
provides opportunity and time for education and counselling
Syndromic flowcharts
Syndromes are easy to identify and it is possible to devise a flowchart for each one
Flowchart is a diagram repr. steps to be taken through a process of decision making
Service providers find them easy to use
you can offer prompt treatment because patients with STIs are treated at their first visit
many more patients with STIs have access to treatment
there are opportunities for introducing preventive and promotive measures such as
education - condom distribution
A patient complains of a discharge from the penis
Ph/ex
discharge from the urethra.
Sign and symptom together suggest urethral discharge syndrome
ETIOLOGY
Urethral discharge syndrome is commonly caused by gonorrhoea and/or chlamydial
Can cause serious complications and/or facilitate HIV transmission and
acquisition
ESSENTIAL that we treat the patient for BOTH
Thank you!