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Sexually transmitted diseases : 

Sexually transmitted diseases DR SNIGDHA PATNAIK, ASSOCITE PROF, DEPT OF COMMUNITY MEDICINE.

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Group of communicable diseases,that are transmitted by sexual contact. Classical disease : syphilis, gonorrhea, chancroid, Lympho granuloma venerum and Donavon sis

Syphilis : 

Syphilis Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It is highly infectious and shows symptoms in three stage

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mother to child This infection can be effectively treated and later stages can be avoided if diagnosed early and treatment is given promptly and routinely.

First stage, : 

First stage, ulcer at the site of infection; Lymphadenopathy The ulcer generally appears within two to six week persists for several weeks.

secondary stage. : 

secondary stage. two months after initial infection and may overlap with the first stage; fever, pains, enlarged lymph nodes and a rash usually found on the chest, on the palms of the hands and on the bottoms of the feet. The rash often appears as rough, red or reddish brown spots. sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness

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An infected person who has not been treated can easily infect sexual partners during the first two stages, which usually last one to two years. In the second stage infection can also spread through the broken skin of an infected sore by any physical contact either sexual or non-sexual.

Third stage : 

Third stage years after infection, in untreated people. numerous tumour-like masses throughout the body in skin, muscle, bone, brain, spinal cord and the other organ such as the liver, stomach etc

infected infants : 

infected infants skin sores, rashes, fever, weakened or hoarse crying sounds, swollen liver and spleen, yellowish skin (jaundice), anemia, and various deformities.

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Sometimes symptoms in infants go undetected and as they grow older they may develop the symptoms of late-stage syphilis including damage to their bones, teeth, eyes, ears, and brain.  In pregnancy if the infection is left untreated, it can even cause still birth or neonatal death.

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Diagnosis is confirmed by taking a swab from the infectious sores and by examining using dark field microscopy

treatment : 

treatment Single dose of penicillin can cure persons who has had syphilis for less than a year but larger doses may be needed for others. The treatment is successful in stopping further damage, but it will not repair any damage already done.

Gonorrhea : 

Gonorrhea Gonorrhea, is a common STD caused by the bacteria Neisseria gonorrhoeae. It is found in the mucous membranes of the vagina, urethra, throat, mouth and anus.  The bacteria grows and multiples in the warm moist areas of the body. Gonorrhea is primarily spread through sexual contact (vaginal, oral, or anal).

In Men : 

In Men A pain or burning sensation when urinating. A yellowish white discharge   Painful or swollen testicles. Painful sore throat. Pus containing discharge from the anus with pain and inflammation of the rectum.

Women : 

Women Vaginal discharge green or yellow green in colour. Pain or burning sensation when urinating  Inflammation of the rectum causing discharge, anal itching, painful bowel movements and bleeding.  Sore throat

Urethral discharge : 

Urethral discharge

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large dose of Penicillin or tetracycline are commonly used. Resistance: ceftriaxone or spectinomycin

Genital herpes : 

Genital herpes caused by herpes simplex virus (HSV) type 2. Blisters Decrease in Appetite Genital Lesion Malaise Painful Urination Recurrent Infection Swollen Lymph Nodes Vaginal Discharge

Chancroid : 

Chancroid Chancroid is a sexually-transmitted infection caused by a type of bacteria called Haemophilus ducreyi. 1 day - 2 weeks after getting chancroid, a person will get a small bump in the genitals. The bump becomes an ulcer within a day of its appearance

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The ulcer: Ranges in size from 1/8 inch to 2 inches across Is painful Has sharply defined borders Has irregular or ragged borders Has a base that is covered with a grey or yellowish-grey material Has a base that bleeds easily About half of infected men have only a single ulcer. Women often have 4 or more ulcers. The ulcers appear in specific locations.

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Genital ulcers

Treatment : 

Treatment azithromycin, ceftriaxone, ciprofloxacin, and erythromycin. Large lymph node swellings need to be drained, either with a needle or local surgery.

Donovanosis : 

Donovanosis Granuloma inguinale is caused by the bacteria Calymmatobacterium granulomatis.

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bout 50% of infected men and women have lesions in the anal area. Small, beefy-red bumps appear on the genitals or around the anus. They are usually painless, but bleed easily if injured. The disease slowly spreads and destroys genital tissue. Genitals and surrounding skin has a loss of skin color.

Lymphogranuloma venereum (LGV) : 

Lymphogranuloma venereum (LGV) Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD) caused by the bacteria Chlamydia trachomatis.

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painless ulcer on the male genitalia or in the female genital tract. The swollen lymph nodes (buboes) may break open and drain through the skin.

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Small painless ulcer on genitalia Swelling and redness of the skin in the groin area Swollen groin lymph nodes on one or both sides Drainage from lymph nodes in groin Blood or pus from the rectum (blood in the stools) Pain while having a bowel movement (tenesmus)

Treatment : 

Treatment antibiotic therapy. tetracycline, doxycycline, and erythromycin.

Genital human papillomavirus (HPV) : 

Genital human papillomavirus (HPV) Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI). The virus infects the skin and mucous membranes. There are more than 40 HPV types that can infect the genital areas of men and women,

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Genital warts usually appear as small bumps or groups of bumps, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. Warts may appear within weeks or months after sexual contact with an infected person. If left untreated, genital warts may go away, remain unchanged, or increase in size or number. They will not turn into cancer.

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www.skinchoice.com

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Cervical cancer does not have symptoms until it is quite advanced. For this reason, it is important for women to get screened regularly for cervical cancer

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The HPV vaccine is routinely recommended for girls 11 and 12 years of age and is given in a series of three injections over a six-month period. The second and third doses should be given two and six months (respectively) after the first dose. The vaccine is also recommended for girls and women 13 through 26 years of age who did not receive it when they were younger. HPV vaccine may be given at the same time as other vaccines.

Trichomoniasis : 

Trichomoniasis Trichomoniasis is caused by the single-celled protozoan parasite, Trichomonas vaginalis. The vagina is the most common site of infection in women, and the urethra (urine canal) is the most common site of infection in men.

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frothy, yellow-green vaginal discharge with a strong odo irritation and itching of the female genital area. In rare cases, lower abdominal pain can occur. Symptoms usually appear in women within 5 to 28 days of exposur e

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STDs can have many of the same consequences for pregnant women as women who are not pregnant. STDs can cause cervical and other cancers, chronic hepatitis, pelvic inflammatory disease, infertility, and other complications.

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Burden: 340 million new episodes globally per year Morbidity: poor pregnancy outcomes infertility in women and men Infection in newborn babies premature death in babies Link with HIV: Facilitates transmission and acquisition of HIV

Sexually Transmitted Diseases : 

Sexually Transmitted Diseases Symptomatic Asymptomatic

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STI transmission dynamics at population level High frequency transmitters Bridging population General population

Social factors : 

Social factors Prostitution Broken homes Sexual disharmony Easy money Emotional immaturity Urbanization Social disruption International travel

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Changing behavioural pattern Social stigma Alcoholism.

Comprehensive STI case management : 

Comprehensive STI case management History taking and symptoms Examination Treatment Client and partner(s)

Control of STD : 

Control of STD INITIAL PLANNING INTERVENTION STRATEGIES SUPPORT COMPONENTS MONITORING AND EVALUATION

INITIAL PLANNING : 

INITIAL PLANNING PROBLEM DEFINATION: Establishing priorities Setting objectives Strategies

INTERVENTION STRATEGIES : 

INTERVENTION STRATEGIES Screening Contact tracing Cluster testing Epidemiological treatment (contact treatment) Personal prophylaxis(contraceptives,vaccines) Health education

Support component : 

Support component STD clinic Laboratory services Primary health care Information system Legislation Social welfare measures MONITORING AND EVALUATION

Phases of spread of HIV epidemic in India : 

Phases of spread of HIV epidemic in India Commonest mode of HIV spread in India is by sexual route Mother to child transmission is on the rise HIV spread among intravenous drug users mostly in north-eastern states Blood transfusion associated spread is on the decline

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High prevalent States States where HIV prevalence in antenatal women is 1% or more. Moderate prevalent States States where the HIV prevalence in antenatal women is less than 1% and prevalence in STD and other high risk groups is 5% or more. Low prevalent States States where the HIV prevalence in antenatal women is less than 1% and HIV prevalence among STD and other high-risk group is less than 5%.

High Prevalent states : 

High Prevalent states HIV Prevalence STD% ANC% Andhra Pradesh 16.4 >2 Karnataka 16.4 1.13 Maharashtra 9.2 1.75 Manipur 10.5 1.75 Nagaland 7.4 1.25 Tamil Nadu 12.6 1.13

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Kaposi’s sarcoma (Cancer associated with AIDS) Oral Thrush (yeast infection) Common infection associated with AIDS Oral Leukoplakia

WHO CASE DEFINATION : 

WHO CASE DEFINATION MAJOR SIGNS;wt loss >10% in a mnth Chronic diarrhoea >1mnth Fever>1mnth Minorsigns ;persistent cough,generalised pruritic dermatitis, herpes zoster,oropharyngeal candidiasis,herpes simplex infection

control of aids : 

control of aids Prevention Antiretroviral therapy Post exposure prophylaxis Specific prophylaxis Primary health care

Nucleoside analogs : 

Nucleoside analogs Zidovidine Didanosine Zalcitabine Stavudine lamuvidine

Protease inhibitors : 

Protease inhibitors Ritonavir Indinavir Non nucleoside inhibitors Nevirapine Delavirdine

NATIONAL AIDS CONTROL ORGANISATION : 

NATIONAL AIDS CONTROL ORGANISATION Blood safety programme. Counselling and HIV testing. Std controll programme: syndromic approach Condom promotion

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HIV Surveillance Behavioural surveillance Targeted intervention School education programme IEC Family health awareness programme Prevention of Hiv transmission from mother to child ART

Trachoma : 

Trachoma More than 6 million people in asia and africa suffer from irreversible blindness. 152 million suffer from the disease. 540 million at the risk of infection.

Epidemiology : 

Epidemiology Approximately 1/5th population of world is affected by Trachoma, amounting to 150 million people across the 48 countries . It is estimated that 6 million people are blind in both eyes. It still remains a significant problem in areas of Africa, South East Asia, the Middle East and Australia

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Chlamydia muridarum, Chlamydia trachomatis, Chlamydia pneumoniae . Endemic trauchmoa :A ,B ,C Sexually transmitted ; DEFGHIJK

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Both Chlamydia trachomatis and Chlamydia pneumoniae are Gram-negative ,aerobic, intracellular pathogens.

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The symptoms of Chlamydia depend on the site of infection. It is transmitted through infected secretions, and mainly infects mucosal membranes, particularly the cervix, rectum, urethra, throat and conjunctiva (eyes)

Clinical feature : 

Clinical feature Trachoma, one of the primary causes of blindness is due to infection by Chlamydia trachomatis. produces scar tissue on the conjuntiva. This forces the eye lid to turn inward, where eye lashes can rub the cornea, causing scarring.

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Follicle on upper tarsal conjunctiva Limbal follicles Vascular pannus Typical conjunctival scarring Vascular pannus

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In Women Chlamydia is often silent in women, with up to 90% of women asymptomatic.

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symptoms occur within 3 weeks after getting the infection and include the following: Constant lower abdominal pain  Mild, milky or yellow mucus-like vaginal discharge Nausea and fever Pain during urination Pain during sexual intercourse Spotting between periods

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Cervicitis 5-13% of the women in the who get Chlamydia get cervicitis. Salpingitis   Ectopic Pregnancy

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babies 1/4 of babies passing down the infected birth canal will get Chlamydia Pneumonia 1/2 of all babies born to infected women after delivery through the birth canal will develop Chlamydial Conjunctivitis (pink eye) a week after birth In severe cases blindness may occur  The child may have respiratory diseases for a long time if not treated

TRANSMISSION : 

TRANSMISSION Direct person-to-person contact through: Blood Baby during birth Semen Touching eyes when infected

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Risk Groups Babies (from infected mothers) Sexually active people, regardless of their sexual preference Children

control : 

control Chemotherapy : 1% opthalmic ointment of tetracycline Mass therapy :where prevalence is more than 5% Tetra cycline 1% ointment twice daily for 5 days

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SAFE: Surgery, Antibiotics, Facial cleanliness, Environmental improvement.

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S – Lid surgery for those at immediate risk of blindness A– Antibiotics to treat individual cases and to reduce infection in a community F – Facial cleanliness and hygiene promotion to reduce transmission E – Environmental improvements such as provision of water and household sanitation

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S - SurgerySurgery reverses the in-turned eyelashes of people with severe trachoma. Lid surgery is a fairly simple procedure that can be offered in the community or at health centers. Offering community-based surgery is the best way to encourage people suffering with trichiasis to seek help. Lid surgery takes away the pain of lashes scraping against the eyes and prevents further damage, but does not restore sight that was already lost.

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A - AntibioticsAntibiotics are used to treat active trachoma and reduce infection in a community. Antibiotics may be given on a case-by-case basis or in mass drug administration to the community. The World Health Organization currently recommends mass drug administration if the prevalence of active trachoma among children aged 1 to 9 years exceeds 10 percent. Pfizer Inc. generously donates millions of doses of the antibiotic Zithromax ® for trachoma control.

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F - Facial CleanlinessDirty faces are associated with active trachoma. Children with dirty faces are more likely to transmit trachoma if they have an active infection or to get trachoma if they are not infected. Discharge from the eyes and nose attracts flies that can bring the infection or carry it to other people. Wiping or rubbing dirty eyes with cloths, bed sheets, or a mother's shawl can contribute to the transmission of trachoma. With support from the Carter Center Trachoma Control Program, communities are educated on the importance of clean faces.

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E - Environmental ImprovementTrachoma persists where people live in poverty with crowded living conditions and without water, sanitation, and proper waste disposal. Transmission of trachoma occurs where these conditions exist and should be expected to return after antibiotic treatment if the conditions are not changed. Improvements like construction of household pit latrines and hand-dug wells will bring about sustainable elimination of trachoma.

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