2nd Lecture)) Infections Sexually Transmitted 2nd Lecture)) Infections Assistant Professor Khalis Bilal College of Medicine HMU

Objectives: To know: The types of STIs. What are the major STIs. How to Prevent and control of STIs.

Infective agents: There are more than 30 different sexually transmissible bacteria, viruses, protozoa and parasites.

In general, the viral STIs are more prevalent, often causing lifelong infections, frequently asymptomatic in their early phases, and may result in serious long- term sequelae including chronic morbidity or even mortality. In contrast, the bacterial and protozoal STIs are generally curable, and often asymptomatic.

Neisseria gonorrhoeae: Gonorrhea Chlamydia trachomatis: Causative agents: Bacterial agents Neisseria gonorrhoeae: Gonorrhea Chlamydia trachomatis: Urethritis, LGV Treponema pallidum: Syphilis Haemophilus ducreyi: Chancroid Calymmatobacterium granulomatis: Granuloma Inguinale. 5

Viral agents Genital Herpes (HSV) type 1 and 2 Hepatitis A,B,C,D HPV (Human papilloma viruse): Ano-genital warts HPV: Low-risk type: HPV-Type 6, 11(90%). High-risk type: HPV type 16, 18, 31, 33, 35, 45, 52 and 58 (90%). Molluscum contagiosum (Pox virus) HIV/AIDS

Protozol agents: Trichomoniasis: Trichomonas vaginalis Ectoparasites: Phthirus pubis: Pediculosis pubis Sarcoptes scabiei: Scabies

Complications in general STIs are not only a cause of acute morbidity in adults, but may result in complications including male and female infertility, ectopic pregnancy, cervical cancer, premature mortality, congenital syphilis and fetal wastage, low birth weight, and prematurity and ophthalmia neonatorum.

Prevention and control: Obviously, the only foolproof way to prevent STDs is to avoid sex.

control The ABCs of STD Prevention A is for “abstinence.” B is for “be faithful (Mutual monogamy).” C is for “condom and dental dams”. Vaccination Early diagnosis and treatment Screening of risky groups Avoid alcohol consumption and drugs. Male circumcision Health education

A reliable way to avoid transmission of STDs is to abstain or to be in a long-term, mutually monogamous relationship with an uninfected partner.

control Local protection -The use of the male condom diminishes, but does not eliminate, the risk of infection. Condoms are better at protecting against gonorrhea, chlamydia, HIV, HBV and trichomoniasis. But they offer less protection against herpes, syphilis, and genital warts. No protection against pediculosis Pubis and scabies.

Vaccination: Specific vaccination is not available against most of the STDs, except: Hepatitis A and B vaccination. HPV vaccine for girls and boys ages 11 and 12. Two (HPV) vaccines are available: 1. The quadrivalent HPV vaccine (Gardasil) 2. Bivalent HPV vaccine (Cervarix).

Early diagnosis and treatment Adequate evaluation, treatment and counselling of patients and their contacts is the mainstay of STD control. Facilities for the diagnosis and treatment of those diseases must be freely. Elimination of the agent by proper treatment of the reservoir of infection.

Screening of special groups: Pre marital, pregnant women, blood donors, industrial workers, refugees, prostitutes, prisoner, restaurant and hotel staff, pts with other STIs, hemophilia, renal transplants, travelers, blood donors, high-risk sexual behavior places workers.

Screening tests: Screening tests: HIV test VDRL (Venereal dis. Research laboratory) HbsAg HCV test Pap smear Urine examination

Avoid alcohol consumption and drug abuse Alcohol Inhibits judgment and increases willingness for risky activities

Male circumcision There's evidence that male circumcision can help reduce a man's risk of acquiring HIV from an infected woman by as much as 60 percent. Male circumcision may also help prevent transmission of genital HPV and genital herpes.

Health Education It forms the backbone in control of STDs. The principal aim of educational intervention is to help individuals alter their behaviour in an effort to avoid STIs. Discourage sexual promiscuity.

Question??

STI related links British Association for Sexual Health and HIV (BASHH): Clinical Effectiveness Group guidelines http://www.bashh.org/guidelines International Union against STIs (IUSTI): European guidelines http://www.iusti.org/regions/europe/euroguidelines.htm Centers for Disease Control and Prevention (CDC): Sexually transmitted infections treatment guidelines http://www.cdc.gov/std/treatment/2006/toc.htm World Health Organization (WHO): Guidelines for the management of sexually transmitted infections http://www.who.int/hiv/pub/sti/pub6/en/