SEXUALLY TRANSMITTED DISEASES

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 15-49 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

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. Behavioral FactorsMany partner Change of partners Not using condoms Casual sex Sex with CSW & partner Alcohol & substance use Personal factorsDelay in getting Rx Stigma being ashamed Noncompliance to Rx Socio-economicPovertyReligious Restrictions Women’s position Cultural Biological & clinicalAssymptomatic STIs Age Sex Vulnerability, immunity Risk Factors for Transmission

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 • 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 ControlWHO: 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 levelSOURCE: The Lancet : Nicola Low, Nathalie Broutet, Yaw Adu-Sarkodie, Pelham Barton, MazedaHossain, Sarah Hawkes. Global control of sexually transmitted infections The Lancet Sexual and Reproductive Health Series, October 2006.

17. Impact of STI • Social: • 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, 2006-2015