MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS
1. INTRODUCTION AND DEFINITIONS
2. EPIDEMIOLOGY
3. CLASSIFICATION- aetiological, syndromic with examples
4. RISK FACTORS/RISK ASSESSMENTS (including sexuality and STIs)
5. Diagnosis
6. TREATMENT
7. PREVENTION – PRY, SECONDARY,TERTIARY AND QUATERNARY
8. SUMMARY i.e take home
9. References
1. INTRODUCTION
Sexually transmitted infections (STIs) are an important global health
concern as more than 1 million people are newly infected with the four
most curable STIs each day : Treponema pallidum, Neisseria gonorrhoeae,
Trichomonas vaginalis, and Chlamydia trachomatis
The term “sexually transmitted infection” (STI) refers to a
pathogen that causes infection through sexual contact, whereas
the term “sexually transmitted disease” (STD) refers to a
recognizable disease state that has developed from an infection.
[CDC Morbidity and Mortality Weekly Report
Recommendations and Reports / Vol. 70 / No. 4 July 23, 2021]
2. EPIDEMIOLOGY:- More than 1 million sexually transmitted infections (STIs)
are acquired every day worldwide, the majority of which are asymptomatic.
Each year there are an estimated 374 million new infections with 1 of 4
curable STIs: chlamydia, gonorrhoea, syphilis and trichomoniasis.
More than 500 million people 15–49 years are estimated to have a genital
infection with herpes simplex virus (HSV or herpes) (1).
Human papillomavirus (HPV) infection is associated with over 311 000
cervical cancer deaths each year (2).
[[Link]
infections-(stis)]
STIs have a profound impact on sexual and reproductive health worldwide.
More than 1 million STIs are acquired every day. In 2020, WHO estimated
374 million new infections with 1 of 4 STIs: chlamydia (129 million),
gonorrhoea (82 million), syphilis (7.1 million) and trichomoniasis
(156 million). More than 490 million people were estimated to be living
with genital herpes in 2016, and an estimated 300 million women have an
HPV infection, the primary cause of cervical cancer and anal cancer among
men who have sex with men. An estimated 296 million people are living
with chronic hepatitis B globally.
African countries account 20% of all STIs with an estimated prevalence of
12% for trichomoniasis, 4% for gonorrhea, 2% for chlamydia, and 1.5% for
syphilis [4] in the general population.
[[Link]
infections-(stis)]
Globally, over 40 million people are estimated to be living with sexually
transmitted infection/diseases (STI/Ds), including HIV/AIDS. It is said that
sub-Saharan Africa accounts for over a half of that figure, making it the
continent most affected with HIV/AIDS and other STI/Ds.
[[Link]
Venereology 2022, 1(1), 81-97; [Link]
It is estimated globally that 499 million new cases of curable STIs occur
each year. These consists of 10.6 million cases of Syphilis, 106.1 million
cases of Gonorrhea, 105.7 million cases of Chlamydia and 276.4 million
cases of Trichomoniasis. These figures do not include the additional health
burden caused by HIV and other viral STIs such as Herpes Simplex Virus
Infection. While data on incidence of STIs is not readily available, the report
of the 2013 National Demographic and Human Survey (NDHS) indicated
that 4 percent of women and 2 percent of men in Nigeria experienced a
Sexually Transmitted Infection and/or abnormal genital discharge or sore 12
months prior to the survey.
The public health importance of STIs/RTIs is indisputable because they are
associated with significant so
[[Link]
3. CLASSIFICATION
aetiologic :-
STI Classification
Bacterial :-Chancroid Gonorrhea Chlamydia Syphilis
Viral :- Adenoviruses,, Viral hepatitis,s (Hepatitis B viru,s) Herpes simplex
(Herpes simplex virus (1,2)), Genital warts/Human papillomavirus (HPV), Kaposi’
Sarcoma
Parasites:- Pubic lice, collaquially known as “crabs” Scabies
Protozoal:- Trichomoniasis
syndromic classification
Syndromic management refers to the approach of
treating STI/RTI symptoms and signs based on the
organisms most commonly responsible for each
syndrome. A more definite or etiological diagnosis may be
possible in some settings with sophisticated laboratory
facilities, but this is often problematic.
STI Syndromes
SYNDROME MOST COMMON CAUSE
Vaginal discharge Vaginitis(trichomoniasis,
candidiasis)
Cervicitis(gonorrhea,
chlamydia)
Urethral discharge Gonorrhea, chlamydia
Genital ulcer Syphilis, chancroid, herpes
{ More than one etiologic agent (e.g., herpes and syphilis)
can be present in any genital, anal, or perianal ulcer. }
Lower abdominal pain Gonorrhea, chlamydia, mixed
anaerobes
Scrotal swelling Gonorrhea, chlamydia
Inguinal bubo LGV, Chancroid
Neonatal conjunctivitis Gonorrhea, chlamydia
Less common infectious causes of genital, anal, or perianal ulcers
include chancroid, LGV, and granuloma inguinale (donovanosis).
GUDs (e.g., syphilis, herpes, and LGV) might also present as oral
ulcers. Genital herpes, syphilis, chlamydia, gonorrhea, and
chancroid have been associated with an increased risk for HIV
acquisition and transmission. Genital, anal, or perianal lesions can
also be associated with infectious and noninfectious conditions
that are not sexually transmitted (e.g., yeast, trauma, carcinoma,
aphthae or Behcet’s disease, fixed drug eruption, or psoriasis).
4. RISK FACTORS/ASSESSMENT
STI and HIV Infection Risk Assessment
Primary prevention of STIs includes assessment of
behavioral risk (i.e., assessing the sexual behaviors that can
place persons at risk for infection) and biologic risk (i.e.,
testing for risk markers for STI and HIV acquisition or
transmission). As part of the clinical encounter, health care
providers should routinely obtain sexual histories from their
patients and address risk reduction as indicated in this
report. Guidance for obtaining a sexual history is available at
the Division of STD Prevention resource page
([Link] htm) and in
the curriculum provided by the National Network of STD
Clinical Prevention Training Centers ([Link] [Link]).
Effective interviewing and counseling skills, characterized by
respect, compassion, and a nonjudgmental attitude toward
all patients, are essential to obtaining a thorough sexual
history and delivering effective prevention messages.
Effective techniques for facilitating rapport with patients
include using open-ended questions (e.g., “Tell me about
any new sex partners you’ve had since your last visit” and
“What has your experience with using condoms been like?”);
understandable, nonjudgmental language (e.g., “What
gender are your sex partners?”and “Have you ever had a
sore or scab on your penis?”); and normalizing language
(e.g., “Some of my patients have difficulty using a condom
with every sex act. How is it for you?”). The “Five P’s”
approach to obtaining a sexual history is one strategy for
eliciting information about the key areas of interest (Box 1).
In addition, health care professionals can consider assessing
sexual history by asking patients such questions as, “Do you
have any questions or concerns about your sexual health?”
Additional information about gaining cultural competency
when working with certain populations (e.g., gay, bisexual,
or other men who have sex with men [MSM]; women who
have sex with women [WSW] or with women and men
[WSWM]; or transgender men and women or adolescents) is
available in sections of these guidelines related to these
populations.
In addition to obtaining a behavioral risk assessment, a
comprehensive STI and HIV risk assessment should include
STI screening as recommended in these guidelines because
STIs are biologic markers of risk, particularly for HIV
acquisition and transmission among certain MSM. In most
clinical settings, STI screening is an essential and underused
component of an STI and HIV risk assessment. Persons
seeking treatment or evaluation for a particular STI should
be screened for HIV and other STIs as indicated by
community prevalence and individual risk factors (see
Chlamydial Infections; Gonococcal Infections; Syphilis).
Persons should be informed about all the tests for STIs they
are receiving and notified about tests for common STIs (e.g.,
genital herpes,
Rectal and pharyngeal testing by NAAT for gonorrhea
and chlamydia is recognized as an important sexual health
consideration for MSM. Rectal gonorrhea and chlamydia are
associated with HIV infection (82,207), and men with repeat
rectal infections can be at substantially higher risk for HIV
acquisition (208). Pharyngeal infections with gonorrhea or
chlamydia might be a principal source of urethral infections
(209–211).
RISK FACTORS FOR TRANSMISSION
Risk Factors for Transmission
Behavioral Factors
Many partners, Change of partners, Not using condoms,
Casual sex, Sex with CSW & partner Alcohol & substance
use, early coitarche
Personal factors:-
Delay in getting Rx, Stigma being ashamed, Noncompliance
to Rx
Socio-economic”:- Poverty, Religious Restrictions, Women’s
position
Cultural
Biological & clinical: Assymptomatic, history of previous sTd,
current co-infection like HIV STIs, Age, Sex, Vulnerability,
immunity
5. DIAGNOSIS
ETIOLOGY
diagnosis based only on medical history and physical examination
frequently can be inaccurate. Therefore, all persons who have genital,
anal, or perianal ulcers should be evaluated. Specific evaluation of genital,
anal, or perianal ulcers includes syphilis serology tests and darkfield
examination from lesion exudate or tissue, or NAAT if available; NAAT or
culture for genital herpes type 1 or 2; and serologic testing for type-specific
HSV antibody. In settings where chancroid is prevalent, a NAAT or culture
for Haemophilus ducreyi should be performed.
No FDA-cleared NAAT for diagnosing syphilis is available in the United States;
however, multiple FDA-cleared NAATs are available for diagnosing HSV-1 and
HSV-2 in genital specimens. Certain clinical laboratories have developed their
own syphilis and HSV NAATs and have conducted Clinical Laboratory
Improvement Amendment (CLIA) verification studies with genital specimens.
Type-specific serology for HSV-2 might aid in identifying persons with genital
herpes (see Genital Herpes).
CHANCROID
Chancroid prevalence has declined in the United States (141). When infection does
occur, it is usually associated with sporadic outbreaks. Worldwide, chancroid
appears to have decreased as well, although infection might still occur in certain
Africa regions and the Caribbean. Chancroid is a risk factor in HIV transmission and
acquisition (197).
Diagnostic Considerations
A definitive diagnosis of chancroid requires identifying H. ducreyi on special culture
media that is not widely available from commercial sources; even when these media are
used, sensitivity is <80% (427). No FDA-cleared NAAT for H. ducreyi is available in the
United States; however, such testing can be performed by clinical laboratories that have
developed their own NAAT and have conducted CLIA verification studies on genital
specimens.
The combination of one or more deep and painful genital ulcers and tender
suppurative inguinal adenopathy indicates the chancroid diagnosis; inguinal
lymphadenitis typically occurs in <50% of cases (428). For both clinical and
surveillance purposes, a probable diagnosis of chancroid can be made if all of
the following four criteria are met: 1) the patient has one or more painful genital
ulcers; 2) the clinical presentation, appearance of genital ulcers and, if present,
regional lymphadenopathy are typical for chancroid; 3) the patient has no
evidence of T. pallidum infection by darkfield examination or NAAT (i.e., ulcer
exudate or serous fluid) or by serologic tests for syphilis performed at least 7–14
days after onset of ulcers; and 4) HSV-1 or HSV-2 NAAT or HSV culture
performed on the ulcer exudate or fluid are negative
Genital Herpes
Genital herpes is a chronic, lifelong viral infection. Two types of HSV can cause genital
herpes: HSV-1 and HSV-2. Most cases of recurrent genital herpes are caused by HSV-2,
and 11.9% of persons aged 14–49 years are estimated to be infected in the United
States (436). However, an increasing proportion of anogenital herpetic infections have
been attributed to HSV-1, which is especially prominent among young women and MSM
(186,437,438).
The majority of persons infected
Rectal and pharyngeal testing by NAAT for gonorrhea and chlamydia is recognized
as an important sexual health consideration for MSM. Rectal gonorrhea and
chlamydia are associated with HIV infection (82,207), and men with repeat rectal
infections can be at substantially higher risk for HIV acquisition (208). Pharyngeal
infections with gonorrhea or chlamydia might be a principal source of urethral
infections (209–211).
Diagnostic Considerations
Clinical diagnosis of genital herpes can be difficult because the self-limited,
recurrent, painful, and vesicular or ulcerative lesions classically associated with
HSV are absent in many infected persons at the time of clinical evaluation. If
genital lesions are present, clinical diagnosis of genital herpes should be
confirmed by type-specific virologic testing from the lesion by NAAT or culture
(186). Recurrences and subclinical shedding are much more frequent for HSV-2
genital herpes infection than for HSV-1 genital herpes (439,440). Therefore,
prognosis and counseling depend on which HSV type is present. Type-specific
serologic tests can be used to aid in the diagnosis of HSV infection in the
absence of genital lesions. Both type-specific virologic and type-specific serologic
tests for HSV should be available in clinical settings that provide care to persons
with or at risk for STIs. HSV-2 genital herpes infection increases the risk for
acquiring HIV twofold to threefold; therefore, all persons with genital herpes
should be tested for HIV
HSV NAAT assays are the most sensitive tests because they detect HSV from genital
ulcers or other mucocutaneous lesions; these tests are increasingly available (442–
444). Although multiple FDA-cleared assays exist for HSV detection, these tests vary in
sensitivity from 90.9% to 100%; however, they are considered highly specific (445–447).
PCR is also the test of choice for diagnosing HSV infections affecting the central
nervous system (CNS) and systemic infections (e.g., meningitis, encephalitis, and
neonatal herpes). HSV PCR of the blood should not be performed to diagnose genital
herpes infection, except in cases in which concern exists for disseminated infection
(e.g., hepatitis). In certain settings, viral culture is the only available virologic test. The
sensitivity of viral culture is low, especially for recurrent lesions, and decreases rapidly
as lesions begin to heal (443,448). Viral culture isolates and PCR amplicons should be
typed to determine whether HSV-1 or HSV-2 is causing the infection. Failure to detect
HSV by NAAT or culture, especially in the presence of older lesions or the absence of
active lesions, does not indicate an absence of HSV infection because viral shedding is
intermittent. Similarly, random or blind genital swabs in the absence of lesions should
not be used to diagnose genital HSV infection because sensitivity is low, and a negative
result does not exclude the presence of HSV infection.
Cytologic detection of cellular changes associated
6. TREATMENT
Syndromic case management enables all trained first-line service
providers to diagnose an STI syndrome and treat patients on the
patient’s first visit, helping to prevent the further spread of STIs where
etiological diagnosis is not available. Syndromic case management
also includes patient education (about the infection, how STIs are
transmitted, risky sexual behavior and how to reduce risk), partner
management and the provision of condoms and lubricants.
[[Link]
mic-management-sexually-transmitted-infections]
[[[Link]
Therefore, the goal of STIs/RTIs syndromic management is not only to cure the
patient but also to break the chain of transmission, avoid complications, patient
education, partner treatment, provision of condoms, diagnosis and prescription.
The objectives of STIs/RTIs management are:
The objectives of STIs/RTIs management are:
To make a correct diagnosis based on appropriate clinical assessment
To provide proper antimicrobial therapy, obtain cure, decrease infectivity and
avoid complications
To reduce and prevent future high risk behavior
To treat sexual partners in order to break the transmission chain
The components of syndromic management are:
Building the capacity of the health care provider,
provision of counselling for STIs/RTIs,
identifying /treating all STIs/RTIs syndromes,
conducting risk assessment,
specific antimicrobial therapy,
partner notification,
prevention of ophthalmia neonatorum,
prevention of mother-to-child transmission of HIV,
using aetiologic approach of management at secondary/tertiary
healthcare levels and
lastly data collection/management.
CHANCROID
Recommended Regimens for
Chancroid
Azithromycin 1 g orally in a
single dose
or
Ceftriaxone 250 mg IM in a
single dose
or
Ciprofloxacin 500 mg orally 2
times/day for 3 days
or
Erythromycin base 500 mg
orally 3 times/day for 7 days
HERPES
Management of genital HSV should address the chronic nature of
the infection rather than focusing solely on treating acute
episodes of genital lesions.
Recommended Regimens for
First Clinical Episode of
Genital Herpes*
Acyclovir† 400 mg orally 3
times/day for 7–10 days
or
Famciclovir 250 mg orally 3
times/day for 7–10 days
or
Valacyclovir 1 g orally 2
times/day for 7–10 days
* Treatment can be extended if
healing is incomplete after 10
days of therapy.
† Acyclovir 200 mg orally 5
times/day is also effective but is
not recommended because of the
frequency of dosing.
Genital Herpes
Acyclovir 400 mg orally 2
times/day
or
Valacyclovir 500 mg orally once
a day*
or
Valacyclovir 1 g orally once a
day
or
Famciclovir 250 mg orally 2
times/day
* Valacyclovir 500 mg once a day
might be less effective than other
valacyclovir or acyclovir dosing
regimens for persons who have
frequent recurrences (i.e., ≥10
episodes/year).
Recommended Regimens for
Episodic Therapy for Recurrent
HSV-2 Genital Herpes*
Acyclovir 800 mg orally 2
times/day for 5 days
or
Acyclovir 800 mg orally 3
times/day for 2 days
or
Famciclovir 1 g orally 2
times/day for 1 day
or
Famciclovir 500 mg orally once,
followed by 250 mg 2 times/day
for 2 days
or
Famciclovir 125 mg orally 2
times/day for 5 days
or
Valacyclovir 500 mg orally 2
times/day for 3 days
or
Valacyclovir 1 g orally once daily
for 5 days
* Acyclovir 400 mg orally 3
times/day for 5 days is also
effective but is not recommended
because of frequency of dosin
Recommended Regimens for Daily Suppression
of Genital Herpes Among Persons with HIV
Infection
Acyclovir 400–800 mg orally 2–3 times/day
or
Famciclovir 500 mg orally 2 times/day
or
Valacyclovir 500 mg orally 2 times/day
Recommended Regimens for Episodic Genital
Herpes Infection Among Persons with HIV
Infection
Acyclovir 400 mg orally 3 times/day for 5–10 days
or
Famciclovir 500 mg orally 2 times/day for 5–10 days
or
Valacyclovir 1 g orally 2 times/day for 5–10 days
Granuloma Inguinale (Donovanosis)
Granuloma inguinale (donovanosis) is a genital ulcerative disease caused by the
intracellular gram-negative bacterium Klebsiella granulomatis (formerly known as
Calymmatobacterium granulomatis). The disease occurs rarely in the United States;
however, sporadic cases have been described in India, South Africa, and South
America (526–535). Although granuloma inguinale was previously endemic in
Australia, it is now extremely rare (536,537). Clinically, the disease is characterized
as painless, slowly progressive ulcerative lesions on the genitals or perineum
without regional lymphadenopathy; subcutaneous granulomas (pseudobuboes) also
might occur. The lesions are highly vascular (i.e., beefy red appearance) and can
bleed. Extragenital infection can occur with infection extension to the pelvis, or it
can disseminate to intra-abdominal organs, bones, or the mouth. The lesions also
can develop secondary bacterial infection and can coexist with other sexually
transmitted pathogens.
Diagnostic Considerations
The causative organism of granuloma inguinale is difficult to culture, and diagnosis
requires visualization of dark-staining Donovan bodies on tissue crush preparation
or biopsy. Although no FDA-cleared molecular tests for the detection of K.
granulomatis DNA exist, molecular assays might be useful for identifying the
causative agent.
Treatment
Multiple antimicrobial regimens have been effective; however, only a limited
number of controlled trials have been published (538). Treatment has been
reported to halt progression of lesions, and healing typically proceeds inward from
the ulcer margins. Prolonged therapy is usually required to permit granulation and
reepithelialization of the ulcers. Relapse can occur 6–18 months after apparently
effective therap
Recommended Regimen for Granuloma
Inguinale (Donovanosis)
Azithromycin 1 g orally once/week or 500 mg daily for >3
weeks and until all lesions have completely healed
Alternative Regimens
Doxycycline 100 mg orally 2 times/day for at least 3 weeks
and until all lesions have completely healed
or
Erythromycin base 500 mg orally 4 times/day for >3
weeks and until all lesions have completely healed
or
Trimethoprim-sulfamethoxazole one double-strength
(160 mg/800 mg) tablet orally 2 time/day for >3 weeks and
until all lesions have completely healed
Lymphogranuloma Venereum
LGV is caused by C. trachomatis serovars
L1, L2, or L3 (539,540). LGV can cause
severe inflammation and invasive infection,
in contrast with C. trachomatis serovars A–K
that cause mild or asymptomatic infection.
Clinical manifestations of LGV can include
GUD, l
Clinical manifestations of LGV can include GUD, lymphadenopathy, or proctocolitis.
Rectal exposure among MSM or women can result in proctocolitis, which is the most
common presentation of LGV infection (541), and can mimic inflammatory bowel
disease with clinical findings of mucoid or hemorrhagic rectal discharge, anal pain,
constipation, fever, or tenesmus (542,543). Outbreaks of LGV proctocolitis have
been reported among
A definitive LGV diagnosis can be made only with LGV-specific molecular testing
(e.g., PCR-based genotyping). These tests can differentiate LGV from non–LGV C.
trachomatis in rectal specimens. However, these tests are not widely available, and
results are not typically available in a time frame that would influence clinical
management. Therefore, diagnosis is based on clinical suspicion, epidemiologic
information, and a C. trachomatis NAAT at the symptomatic anatomic site, along
with exclusion of other etiologies for proctocolitis, inguinal lymphadenopathy, or
genital, oral, or rectal ulcers (551,552). Genital or oral lesions, rectal specimens,
and lymph node
Recommended Regimen for Lymphogranuloma
Venereum
Doxycycline 100 mg orally 2 times/day for 21 days
Alternative Regimens
Azithromycin 1 g orally once weekly for 3 weeks*
or
Erythromycin base 500 mg orally 4 times/day for 21 days
* Because this regimen has not been validated, a test of cure
with C. trachomatis NAAT 4 weeks after completion of
treatment can be considered
Recommended Regimen for Primary and
Secondary Syphilis* Among Adults
Benzathine penicillin G 2.4 million units IM in a single
dose
* Recommendations for treating syphilis among persons with
HIV infection and pregnant women are discussed elsewhere
in this report (see Syphilis Among Persons with HIV Infection;
Syphilis During Pregnancy).
Recommended Regimen for Syphilis Among
Infants and Children
Benzathine penicillin G 50,000 units/kg body weight IM,
up to the adult dose of 2.4 million units in a single dose
Recommended Regimen for Neurosyphilis,
Ocular Syphilis, or Otosyphilis Among Adults
Aqueous crystalline penicillin G 18–24 million units per
day, administered as 3–4 million units IV every 4 hours or
continuous infusion for 10–14 days
Recommended Regimen for Nongonococcal
Urethritis
Doxycycline 100 mg orally 2 times/day for 7 days
Alternative Regimens
Azithromycin 1 g orally in a single dose
or
Azithromycin 500 mg orally in a single dose; then 250 mg
orally daily for 4 days
Recommended Regimen for Cervicitis*
Doxycycline 100 mg orally 2 times/day for 7 days
* Consider concurrent treatment for gonococcal infection if
the patient is at risk for gonorrhea or lives in a community
where the prevalence of gonorrhea is high (see Gonococcal
Infections).
7. PREVENTION – PRIMARY, SECONDARY, TERTIARY AND QUATERNARY
Primary preventive measures: ( sexual education, abstinence, faithful sexual
relationships, correct and consistent use of condoms and vaccination)
Secondary preventive measures: (Encouraging STI care seeking behavior,
rapid and effective treatment and case finding)
Tertiary preventive measures: (Limitation of disability and rehabilitation
including psychosocial support)
Clinical Prevention Guidance
Prevention and control of STIs are based on the following five
major strategies (3):
1. Accurate risk assessment and education and counseling of
persons at risk regarding ways to avoid STIs through changes
in sexual behaviors and use of recommended prevention
services
2. Pre-exposure vaccination for vaccine-preventable STIs
3. Identification of persons with an asymptomatic infection and
persons with symptoms associated with an STI
4. Effective diagnosis, treatment, counseling, and follow-up of
persons who are infected with an STI
5. Evaluation, treatment, and counseling of sex partners of
persons who are infected with an STI
Primary Prevention Methods [CDC Morbidity and Mortality
Weekly Report Recommendations and Reports / Vol. 70 / No. 4
July 23, 2021]
Pre-Exposure Vaccination
Condoms
External Condoms
Internal Condoms
Cervical Diaphragms
Topical Microbicides and Spermicides
Male Circumcision
Pre-Exposure Prophylaxis for HIV
Pre-Exposure Prophylaxis for STIs
Postexposure Prophylaxis for HIV and STIs
HIV Treatment as Prevention: Antiretroviral Treatment of
Persons with HIV to Prevent HIV Among Partners
HIV Seroadaptive Strategies :- Seroadaptive strategies for HIV
prevention HPV vaccination is recommended routinely for males
and females aged 11 or 12 years and can be administered
beginning at age 9 years. HPV vaccination is recommended
through age 26 years for those not previously vaccinated (11).
Abstinence and Reduction of Number of Sex Partners
8. SUMMARY
The presence of an untreated STD can enhance both the acquisition and
transmission of HIV by a factor of up to 10. Thus STD treatment is an
important HIV prevention
strategy in a general population.
& STDs often exist without symptoms. In women, most gonococcal and
chlamydial infections are asymptomatic. However, up to 90% of men
with the same infections will have symptoms.
& In developing countries STDs and their complications, even excluding
HIV infection, rank among the top five disease categories for which
adults seek health care.
& The complications and long-term consequences of untreated STDs can
be very serious, in women even more than in men. Newborn babies
can also suffer from STDs acquired from infected mothers, with
potentially serious consequences.
& The aim of STD prevention and care is to reduce the prevalence of
STDs through primary prevention and effective case management.
& The magnitude of the problem of STDs, and the strong association with
HIV transmission, highlight the need to explore new and innovative
approaches to prevent and control their spread. One such approach is
the adoption of the ``public health package''. This package for STD
control consists of the following components :
. promoting safer sex behaviour
. strengthening condom programming
. promoting health-care-seeking behaviour
. integrating STD control into primary health care and other health-
care services
. providing specific services for populations at increased risk
. comprehensive case management
. prevention and care of congenital syphilis and neonatal
conjunctivitis
. early detection of asymptomatic and symptomatic infections.
& The traditional method of diagnosing STDs is by laboratory tests.
However, laboratory tests are often unavailable or too expensive.
For this reason, syndromic diagnosis was developed. The syndromic
approach consists of :
. classification of the main causal pathogens by the syndromes they
produce
. use of flow charts to guide the management of a given syndrome
. treatment of the syndrome, covering all the pathogens with
potential to cause grave manifestations and consequences
. promoting treatment of sex partners
[The public health approach to STD control]]
Seroadaptive strategies for HIV prevention HPV vaccination is
recommended routinely for males and females aged 11 or 12
years and can be administered beginning at age 9 years. HPV
vaccination is recommended through age 26 years for those not
previously vaccinated (11).
Key facts [[Link]
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