SEXUALLY TRANSMITTED DISEASES

1. SEXUALLY TRANSMITTED
DISEASES
DR. MAHESWARI JAIKUMAR
maheswarijaikumar2103@gmail.comHIV VIRUS

2. DEFINITION
• STD (Sexually Transmitted Disease)
are a group of communicable
diseases that are transmitted
predominantly by sexual contact
and caused by a wide range of
bacterial, viral, protozoal & fungal
agents & ecto parasites

3. SEXUALLY TRANSMITTED
DISEASES (STDS)
• STDs or STIs (sexually transmitted
infections) are infections/diseases that
can be transferred from one person to
another through sexual contact. In
India, the prevalence of sexually
transmitted diseases is quite high.
Among the sexually transmitted
diseases, AIDS is a serious concern.

4. • STDs or STIs (sexually transmitted
infections) are infections/diseases that
can be transferred from one person to
another through sexual contact.
• Some of the Sexually Transmitted
Infections are also transmitted through
birth, intravenous needles or
breastfeeding.

5. • Adolescents and young adults (15-24)
are the age groups at the greatest risk
for acquiring a Sexually Transmitted
Disease (STD). STDs can have severe
consequences if not treated, especially
in women.
• It is important to go for STD testing
whenever you suspect that you have
contracted a sexually transmitted
disease.

6. CLASSIFICATION OF STD AGENTS
A. BACTERIAL AGENTS.
B. VIRAL AGENTS.
C. PROTOZOAL AGENTS.
D. FUNGAL AGENTS.
E. ECTOPARASITES.

7. A. BACTERIAL AGENTS:
Nesseria gonorrhoea.
Chlamydia trachomatis.
Haemophilus ducreyi.
Mycoplasma hominis.
Ureaplasma urealyticum.
Callymmatobacterium granulomatis.
Shigella spp.
Grp B steptococcus.
Bacteial vaginitis associated organisms.

8. NESSERIA GONORRHOEA.

9. CHLAMYDIA TRACHOMATIS.

10. HAEMOPHILUS DUCREYI.

11. MYCOPLASMA HOMINIS.

12. UREAPLASMA UREALYTICUM.

13. SHIGELLA Sp

14. GRP B STREPTOCOCCUS

15. VIRAL AGENTS.
• Human (alpha) Herpes virus.
• Human (beta) Herpes virus.
• Hepatitis B virus.
• Human Papilloma Virus.
• Molluscum contagiosum virus.
• Human Immunodeficiency virus.

16. HEPATITIS B VIRUS

17. HUMAN PAPILOMA VIRUS

18. HEPATITIS VIRUS

19. HUMAN IMMUNO VIRUS

20. MOLLUSCUM CONTAGIOSUM
VIRUS.

21. PROTOZOAL AGENTS.
• Entamoeba histolytica.
• Giardia lamblia.
• Trichomonas vaginalis

22. ENTAMOEBA HISTOLYTICA.

23. GIARDIA LAMBLIA.

24. TRICHOMONAS VAGINALIS

25. FUNGAL AGENTS
• Candida albicans

26. ECTOPARASITES.
• Phthirus pubis.
• Sarcoptes scabiei

27. PHTHIRUS PUBIS.

28. SARCOPTES SCABIEI

29. EXTENT OF THE PROBLEM
WORLD:
• True incidence will never be known
not only due to inadequate
reporting but also because of the
secrecy that surrounds them.
• Most of them are not even
notifiable.

30. INDIA
STD is becoming a major public
health problem in India.

31. SYPHILIS
2011 – About 37,243 cases
(19,032 males/18,211 females)
were reported in the country
with two deaths.

32. GONORRHOEA
Information is notoriously lacking as
most cases are not reported.
Generally gonorrhoea is widely
prevalent than syphilis.
2011- About 2,50,155 cases (56,386
males/93,769 female) were
reported with 3 deaths.

33. CHANCROID
• Is widely prevalent in India
CHANCRIOD VIRUS

34. LGV
• Is more prevalent in southern
states of Tamil Nadu, Andra
Pradesh, Maharastra &
Karnataka

35. DONOVANOSIS
• Is endemic in Tamil Nadu, Andra
Pradesh, Odisha, Karnataka &
Maharashtra.
• A greater prevalence along coastal
areas has been reported.

36. OTHER STDs
Information is not available, as
there is no reporting system for
these diseases.

37. AIDS

38. PATHOGENS & STD
PATHOGEN DISEASE OR SYNDROME
Neisseria
gonorrhoeae
Gonorrhoea, urethritis,
cervicitis, salpingitis,
PID, noe natal
conjuctivitis
Treponema
pallidum
Syphilis

39. PATHOGEN DISEASE OR SYNDROME
Haemophilus
ducreyi
Chancroid
Chamydia
trachomatis
LGV, urethritis, cervicitis,
proctitis, epididymitis,
PID
Calymmatob
acterium
granulomatis
Donovanosis

40. PATHOGEN DISEASE OR SYNDROME
Herpes
simplex virus
Genital herpes
Herpes B
virus
Acute & Chronic
hepatitis
Human
Papilloma
virus
Genital & anal warts

41. PATHOGEN DISEASE OR
SYNDROME
Human
Immuno
Deficiency virus
AIDS
Mollucum
contagiosum
Genital molluscum
contagiosum

42. PATHOGEN DISEASE OR SYNDROME
Candida
albicans
Vaginitis
Trichomonas
vaginalis
Vaginitis

43. HOST FACTORS
• AGE: Highest rate are prevalent in 20-24
yers old & followed by 25-29 & 15-19
years age groups.
• GENDER: Morbidity is higher in men.
• MARITAL STATUS : Higher among single,
divorced and separated persons than
among married couples

44. • SOCIO ECONOMIC STATUS:
Individuals from the lowest socio
economic groups have the highest
morbidity rates

45. DEMOGRAPHIC FACTORS
Certain demographic factors contribute
to a higher prevalence rates. They are;
1. Population explosion.
2. Rural to Urban migration.
3. Increasing educational opportunities
for women.
4. Delayed marriage due to the afore said.

46. SOCIAL FACTORS
1. Prostitution (good time girl).
2. Broken homes.
3. Sexual disharmony.
4. Easy money.
5. Emotional immaturity.
6. Urbanization.
7. International travel.
8. Changing behavioural patterns.
10. Alcoholism.

47. CLINICAL
SPRECTRUM

48. GONOCOCCAL INFECTION
• Causes inflammation of the
genital tract involving urethra in
men & women and rectum
among homosexuals.
• Other sites are throat & eyes.

49. GONORRHOEA

50. • Complications in women include PID
(infertility).
• In men it may lead to epididymitis
(urethral strictures).
• The antibiotics of choice are
CIPROFLAXIN, CEFTRIAXONE,
CEFIXIME or SEPTINOMYCIN.

51. SYPHILIS
• Causes ulceration of the uro genital
tract, mouth or rectum.
• Later skin eruptions may be seen.
• Final stage is marked with
complications of CVS, Nervous
system.

52. • Congenital syphilis is an
important cause for still birth.
• Penicillin, doxycycline and
eryhtromycin are drug of choice.

53. FEMALE SYPHILIS

54. MALE SYPHILIS

56. CHLAMYDIAL INFECTION
• Individuals may not exhibit clinical
manifestations.
• The symptoms mimic like
gonorrhoea.
• It can result in vertical transmission
to the foetus.

57. CHLAMYDIA

58. CHLAMYDIA

59. • The drug of choice include
doxycycline, azithromycin /
amoxycillin, ofloxacin, erythromycin
or tetracycline.

60. TRICHOMONIASIS
• The parasitic infection leads to
vaginitis & vaginal discharge in
women.
• Usually there are no symptoms. In
men it may cause urethritis.
• The treatment option is metronidazole
/ tinidazole.

61. CHANCRIOD
• After infection a small papule
develops at the site of inoculation
within 2-3 days.
• The lesion then erodes into a deep
ulcer that is extremely painful.
• This is followed by painful swelling of
the inguinal lymph node (BUBO).

62. CHANCROID

63. • The antibiotics used are
ciprofloxacin, erythromycin,
ciftriaxone and azithromycin.

64. LGV
• It commonly presents with swelling
of lymph nodes in the groin.
• Initially there is a small painless
ulcer of the genitalia 3-30 days after
exposure.
• It may pass unrecognized and
resolve spontaneously.

65. GRANULOMA

66. • If left untreated the disease may cause
extensive lymphatic damage resulting in
elephantiasis of the genitalia.
• The antibiotics used are doxycycline,
erythromycin & tetracycline.
• Later it may cause rectal strictures
(surgery required)

67. DONOVANOSIS
• Symptoms are similar togranuloma
venereum.
• The first manifestation appears after a
3-40 days incubation period.
• Usually it is a small papule which
ruptures to form a granulomatous lesion
that is characteristically pain free &
bleeds readily on contact.

68. GRANULOMA

69. • The drug used are azithromycin
& doxy or alternatively
erythromycin, tetracycline,
trimethoprim-sulfamthoxazole.

70. GENITAL HERPES
• HSV type 2 is the primary cause of
genital herpes.
• It can be recognized by presence of
typical papular lesions that progress to
multiple blisters & ulcers.
• The first manifestations are frequently
associated with a prolonged course of
ulceration lasting to 3-4 wks

71. HERPES SIMPLEX

72. HERPES (LIPS)

73. • Anti virals such as acyclovir
valaciclovir and famiclovir are
effective.

74. HPV
• Causes genital warts, which vary from
the common soft, flesh coloured
protuberances which may become
exuberant (cauliflower like) to papular
flat warts on drier areas (shaft of the
penis).
• Can cause cervical cancer in women.

75. HPV

76. HPV

77. • Prevention is the drug of choice.
(sexually active individuals)

78. STD CONTROL PROGRAMME
• National STD Control Programme in
India was started in 1946. With the
arrival spread of HIV infection in the
country it was brought under the
purview of National AIDS
Organization in the year 1992.

79. OBJECTIVES OF STD CONTROL
PROGRAMME (INDIA)
1.Reduce STD cases and thereby
control HIV transmission by
minimizing the risk factor
2. Prevent the short term as well as
long term morbidity and mortality
due to STD

80. STRATEGIES
• The broad strategies for
controlling STD, as outlined in
the strategic plan for the
prevention and control of AIDS
in India are the following:

81. • Adequate and effective programme
management
• Prevention of the transmission of
STD/HIV infection through IEC and
promotion of safer sexual behaviour
by the use of condoms.

82. • Adequate and comprehensive case
management including diagnosis,
treatment, individual counseling,
partner notification and screening for
other diseases.
• Increasing access to health care for STD
by strengthening existing facilities and
structures and creating new facilities
wherever necessary.

83. • Early diagnosis and treatment of
mostly asymptomatic infections
through case finding and screening.

84. ACTIONS
• Training of health care workers in
both public and private sectors in
comprehensive STD case
management.
• Development of appropriate
laboratory services for the diagnosis
of STD

85. • Conduct of Microbiological,
Socio-behavioural and Operation
research.
• Surveillance to assess the
epidemiological situation, and
monitor and� evaluate the on
going STD control programme.

86. • One of the major actions taken
along the lines suggested in the
strategies was strengthening the
existing facilities and structure of
STD clinics.

87. • This year following drugs are supplied to
the STD clinics other than the usual.
• Erythromycin 500 mg Tabs.
• Doxycycline caps 100 mg
• Norfloxacin 400 mg Tabs
• Fluconazole 150 mg tabs
• Clotrimzole Vag Tab 500 mg
• Acyclovir cream 5 mg tubes

88. AIDS
REFER AIDS CONTROL
PROGRAMME IN INDIA

89. CONTROL OF STDs
INVOLVES FOUR STEPS:
1. Initial planning.
2. Intervention strategies.
3. Support components.
4. Monitoring and evaluation.

90. INITIAL PLANNING
COMPRISES OF THE FOLLOWING STEPS:
1. Problem definition.
2. Establishing priorities.
3. Setting objectives.
4. Considering strategies.

91. INTERVENTION STRATEGIES
INCLUDES:
1. Case detection (Screening, contract
tracing, cluster testing).
2. Case holding and treatment.
3. Epidemiological treatment(contact
treatment)

92. 4. Personal prophylaxis.
5. Health education

93. SUPPORT COMPONENTS
INCLUDE:
1. Establishing of STD clinics.
2. Laboratory services.
3. Primary Health Care.
4. Information System.
5. Legislation.
6. Social Welfare Measures. (Socio
therapy)

94. SOCIAL WELFARE MEASURES
1.Rehabilitation of Commercial Sex
Workers.
2. Provision of recreation facilities.
3. Marriage counselling.
4. Prohibiting Sexually stimulating
literature.
5. Prohibition of pornography
(Advertisements & Photographs).

95. MONITORING & EVALUATION
THIS CRITICAL ASPECT INCLUDES:
1. Monitoring of disease trends.
2. Evaluation of programme activities.
3. On going evaluation of the disease.
4. Determining the appropriateness of
intervention strategies.

96. SEXUALLY TRANSMITTED
DISEASES
DR. MAHESWARI JAIKUMAR
HIV VIRUS