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An overview of Sexually Transmitted Infections (S TIs)

An overview of Sexually Transmitted Infections (S TIs) . Vanessa Hamilton Advanced Sexual Health Nurse , Nurse Educator Melbourne Sexual Health Centre. Important local points * Source: DHS Victoria vidb Jul 2007. HIV 91% HIV cases diagnosed in men, *

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An overview of Sexually Transmitted Infections (S TIs)

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  1. An overview ofSexually Transmitted Infections (STIs) Vanessa Hamilton Advanced Sexual Health Nurse, Nurse Educator Melbourne Sexual Health Centre

  2. Important local points *Source: DHS Victoria vidb Jul 2007 • HIV 91% HIV cases diagnosed in men, * 81% of these men-who-have-sex-with-men (MSM)* Decrease in number of diagnoses of AIDS since 94-95 (HAART) 12 cases heterosexual (1 born high prevalence country;6 reported sex in high prevalence country; 3 IDU; 2 – locally acquired?)* • Gonorrhoea 80% in MSM, * nearly all amongst MSM; heterosexual – sex overseas* increasing amongst MSM; Issue – antibiotic resistance • Syphilis 300% increase in infectious syphilis* 90% amongst MSM* • Chlamydia 4 fold increase in last decade in Australia mostly impacting young women • :

  3. Chlamydia • Most commonly reported bacterial infection in Australia • Increasing in all states • Significantly increased rates in Indigenous Australians in NT • Urgent public health situation– notified cases in Victoria almost tripled since 1990s

  4. Epidemiology: Chlamydia trachomatisSource: DHS Victoria www.dhs.vic.gov.au/ideas

  5. Chlamydia by year and State/Territory Source: National Notifiable Diseases Surveillance System

  6. Chlamydia by year and age group Source: National Notifiable Diseases Surveillance System

  7. Chlamydia Sites • cervix, urethra, • can also infect the anus and less commonly eyes and throat Transmission • vaginal, anal and less commonly oral sex

  8. Chlamydia • The highest burden of infection is in the 15- 29 year age group slightly more common in 20-29 • Usually asymptomatic • Significant personal and public (financial) consequences if not detected • However it is relatively cheap and easy to diagnose • Relatively cheap and easy to treat

  9. Chlamydia-symptoms in males • 50% or more of men with chlamydia urethritis are asymptomatic (30-60% quoted depending on study) • Symptomatic urethritis has an incubation period of usually 7-14 days • Symptoms are urethral dishcharge (white or grey), dysuria, discomfort, redness at urethral opening

  10. Chlamydia complications in males • Epididymitis • Sexually reactive arthritis – inclduign Reiter’s syndrome • Transmission to others especially women

  11. Chlamydia – symptoms in females • Cervical STIs are most often asymptomatic • Unusual vaginal discharge • dysuria • deep dyspareunia, • intermenstrual or Post coital bleeding • lower abdominal pain • cervix may appear inflamed with a mucopurulent discharge and contact bleeding. (MPC mucopurulent cervicitis)

  12. Chalamydia complications in women • 50% will have endometritis • Between 10-40% of women infected with chlamydia develop PID • Tubo-ovarian abscess • Ectopic pregnancy; infertility

  13. Chlamydia Diagnosis • Nucleic Acid Amplification Tests (NAATs) Detect Chlamydia trachomatis in swabs and urine • These DNA amplification tests include • PCR polymerase chain reaction • LCR ligase chain reaction • Check with your local lab as to which test they use

  14. Chlamydia Diagnosis cont… Male • Urethral, urine • Rectum (MSM) Rectum and throat not validated Female • Endocervical, high vaginal, urine

  15. Management • Antibiotic Treatment • Azithromycin 1g orally once or • Doxycycline 100mg bd for 10 days or • Roxithromycin 300mg daily as a single dose (or 150mg bd) for 10 days • Recommended to avoid sex during and for seven days after treatment

  16. Chlamydia Management Continued • Contact Tracing • TORI – 3 months

  17. Gonorrhoea • Bacterium Neisseria gonorrhoeae • Mucous membranes of the urethra, cervix, anus throat and eyes • Readily transmitted by anal, vaginal and oral sex

  18. Gonorrhoea • Rates going up more recently on NSW and VIC and SA – MSM • Rates much higher in NT and WA specifically due to rates in Indigenous Australian populations

  19. Gonorrhoea by year and State/Territory Source: National Notifiable Diseases Surveillance System

  20. Gonorrhoea by year and age group Source: National Notifiable Diseases Surveillance System

  21. Gonorrhoea • Highest rates in 15-29 year age group • Different to CT as also somewhat higher rates in 30-35 year old due to higher incidence in MSM and Indigenous Australian populations

  22. Gonorrhoea - Diagnosis • Isolation of N. gonorrhoeae by culture is the diagnostic standard • DNA based tests • Advantages • Rapid results • Good for remote areas – transport • Urine or tampon • Sensitivity equal or better than culture

  23. Gonorrhoea • Ceftriaxone 250mg via IMI recommended treatment in Australia • Sensitivity tests in April 2003 of MSM showed 7% resistance to Ciprofloxacin • Gonorrhoea resistance not covered here. • Please refer to Venereology Society of Victoria, National Management Guidelines for STIs, 2002 or MSHC website

  24. Syphilis

  25. Infectious syphilis by year and sex Source: National Notifiable Diseases Surveillance System

  26. Syphilis • A complex systemic illness with multiple clinical manifestations • Syphilis can be acquired: • Through sexual contact • By passage through the placenta • By kissing or other close contact with an infected lesion • By transfusion of fresh human blood • By accidental direct inoculation

  27. Serologic Tests • Nonspecific nontreponemal tests • The RPR • Cheap, rapid • Convenient for screening large numbers of sera • Indicates disease activity • Specific antibody tests • TPHA, FTA-Abs • Establish the high likelihood of infection • Generally remain reactive over time, even after treatment

  28. Sypilis treatment • Early Syphilis: Benzathine penicillin 1.8 gm IM single dose or Doxycycline 100mg twice daily for 14 days if allergic to penicillin • Late latent syphilis: Benzathine penicillin 1.8 gm IM weekly for three weeks

  29. HIV Victorian Prevelence

  30. The HIV epidemic in Victoria Cumulative figures to 31 December 2006 • HIV diagnoses - 5,390 • AIDS - 2,041 • Deaths - 1,481

  31. Diagnoses of HIV infectionand AIDS1 in Australia 1. AIDS diagnoses adjusted for reporting delays. Source: State and Territory health authorities

  32. The HIV epidemic in Australia Cumulative figures to 31 December 2006 • HIV diagnoses - 26,267 • AIDS - 10,125 • Deaths - 6,723

  33. Global summary of the HIV/AIDS pandemic, as of December 2007 Number of people living with HIV/AIDS Total 33.2 million (30.6 – 36.1 million)Adults 30.8 million (28.2 – 33.6 million) Women 15.4 million (13.9 – 16.6 million) Children under 15 years 2.5 million (2.2 – 2.6 million) People newly infected with HIV in 2007 Total 2.5 million (1.8 – 4.1 million)Adults 2.1 million (1.4 – 3.6 million) Children under 15 years 420 000 (350 000 - 540 000) AIDS deaths in 2007 Total 2.1 million (1.9 – 2.4 million)Adults 1.7 million (1.6 – 2.1 million) Children under 15 years 330 000 (310 000 - 380 000) The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.

  34. Post-exposure Prophylaxis • There is some evidence that antiretroviral therapy, given within 72 hours of exposure, may reduce the risk of infection • Treatment is given for four weeks • A risk-assessment must be performed, and weighed against the side-effects and possible development of drug resistance • balance between the amount of HIV produced each day and the amount of HIV cleared by the immune system

  35. Further Reading • ASHM, HIV/Hepatitis: a guide for primary care, 2001 • Holmes KK et al, Sexually Transmitted Diseases, 3rd edition, 1999, McGraw-Hill

  36. Trichomoniasis • Trichomonas Vaginalis • Vaginal infection • Vaginal sex

  37. Trichomoniasis • Symptoms variable: thin, frothy, malodorous vaginal discharge • 50% women may be asymptomatic • 95% men asymptomatic (and ? self-limiting)

  38. Diagnosis • Wet prep from posterior fornix of vagina • Culture • DNA testing – not widely available

  39. Management Antibiotics • Tinidazole 2g orally stat or • Metronidazole 2g orally stat • Metronidazole 400mg bd for 5/7 or • Clotrimazole 1% PV daily for 6 days Treat partner

  40. BACTERIAL VAGINOSIS • What is it? • Not a Sexually Transmitted Infection • Syndrome of disordered vaginal ecology

  41. Typical presentation of BV • Malodour • Increased vaginal discharge, more noticeable after menstruation or coitus • But mostly asymptomatic

  42. Complications of BV? • PID? • Premature rupture of membranes • LBW • Post-partum endometritis

  43. VAGINAL DISCHARGE

  44. Herpes simplex Virus • Type 1 and Type 2 NEW KNOWLEDGE • HSV I is now a more common cause of genital herpes in some populations • Genital herpes can substantially facilitate the transmission of HIV infection

  45. Biology of Herpes Simplex: Biological Differences Between HSV 1 and 2 • Either type is equally adept at infecting sacral or trigeminal ganglia • HSV-1 establishes competent latencyin trigeminal ganglia • HSV-2 establishes competent latency in sacral ganglia

  46. Biology and Latency

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