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Reproductive Public Health > Epidemiology of STIs > Flashcards

Epidemiology of STIs Flashcards

1
Q

What are the clinical features of STIs?

A
  1. Genital ulceration
  2. Genital urinary discharge (GUD) +/- dysuria
  3. Lower Abdominal Pain (LAP) in women
  4. Scrotal pain/swelling
  5. Dyspaurenia - pain during sex
  6. Genital lumps and bumps
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2
Q

What makes the clinical diagnosis of STIs in women difficult?

A

mostly asymptomatic

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3
Q

Describe the STI epidemiology?

A
  1. Worldwide, ~376 million new cases/year of curable STIs such as syphilis, gonorrhoea, chlamydia and trichomoniasis (WHO, 2016)
  2. number of STI cases higher if one includes HIV, HPV, HSV-2, Hep B
    - 500m people have incurable HSV-2 leading cause of GU
    - 290m women have HPV > 500 000 cervical cancer cases, 240 000 deaths/year
    - Hep B: 350m chronic hepatitis and 1m cancer/cirrhosis deaths
  3. Burden of STIs greatest in low-income countries (Asia, Africa)
  4. more than 1 million STIs acquired every day
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4
Q

What are the complications of STIs in fetuses/neonates?

A
  1. mortality - fetal and neonatal deaths ( 305,000/year),
  2. low birth weight and/or premature death (200,000/year)
  3. opthalmia neonatorum - an eye infection that occurs within the first 30 days of life due to contact with the mothers birth canal that is infected with an STI
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5
Q

What are the complications of STIs in women?

A
  1. Cervical cancer (570,000/year > 300,000 deaths)
  2. Infertility (85% attributable to STIs)
  3. ectopic pregnancy
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6
Q

What are complications of STIs seen in both men and women?

A
  1. anogenital cancer

2. HIV risk

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7
Q

What are the physical, psychological and social consequences of STIs?

A
  1. chronic abdominal pain
  2. divorce
  3. stigma
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8
Q

Describe the relationship between STIs and HIV?

A

STIs are a risk factor for HIV transmission (5-10-fold increase in risk)

  1. Genital ulceration (syphilis, HSV-2) increase HIV acquisition by > 3-fold
  2. Genital tract inflammation > increases HIV transmission
  3. STI symptoms severe in HIV+: ↑↑↑period infectivity and standard treatments likely to fail
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9
Q

What is the burden of STIs in Mangochi?

A
  • Cumulative incidence up to 12 months
  • HIV: 1.5 per 100 persons per year, higher in Nkope (2.69) than Monkeybay (0.19)
  • 7/8 incident cases from one area in Nkope & 6/8 cases females
  • HSV-2: 16.2 per 100 per year
  • Syphilis: 3.0 per 100 per year
  • Reference: Pregnancy rate: 12.7 per 100 per year
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10
Q

What are the direct (proximal determinants) risk factors in STIs?

A

unprotected sexual intercourse (consensual, coercive, ritual)

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11
Q

What are the underlying (distal determinants) risk factors for getting STIs?

A
  1. Cultural factors
  2. Gender-based power imbalance
  3. Macro and microeconomic factors (poverty)
  4. Alcohol & substance abuse
  5. Peer pressure
  6. Religious and political
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12
Q

What are the things we do to increases STIs?

A
  1. war
  2. contraception
  3. sexual liberation
  4. poverty
  5. opioid and alcohol consumption
  6. forced population mobility e.g. climate refugees
  7. effective new treatment for HIV e.g. cART, PrEP
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13
Q

What are the objectives of STI control?

A
  1. To prevent the development of disease, complications and sequelae
  2. To interrupt the transmission of STIs
  3. To reduce the transmission of HIV infection.
    - Overall Goal is to Contribute to improving sexual health rights
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14
Q

What is the basic reproduction number?

A

number of new cases generated, in a susceptible population, by an infectious person= βCD
- β = probability of infection given exposure
- C = number of contacts made by the infectious - person
D = duration of “infectiousness” of the infected person

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15
Q

What are the Ministry of Health Policies of STI control?

A
  1. STI and HIV/AIDS services shall be available at all levels of the health care system and at community level.
  2. Ensure that STI services are appropriate for and accessible to women, young people and other vulnerable groups
    - Young people will not require parental consent for STI treatment
  3. STI services must be provided in complete privacy and confidentiality must be assured at all times.
  4. All antenatal women shall be screened and treated for syphilis and if infected, then treated along with their partners.
  5. Clients with STIs shall be managed using the syndromic management approach.
  6. Partner referral and treatment services and condom use shall be fully integrated in the management of STIs.
  7. HIV Counselling and Testing
    - All STI clients shall be offered services.
  8. Registered Nurses and Nursing Midwifery Technicians shall be permitted to prescribe STI drugs following training in the Syndromic Management Approach
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16
Q

What are the National Strategic Plan interventions?

A
  1. Strengthen screening for HIV, viral hepatitis and syphilis throughout pregnancy and breastfeeding period.
  2. Treat syphilis in pregnant and breastfeeding women together with their partners
17
Q

Describe the management of STI clients?

A
  1. History Taking
    - Risk Assessment > diagnostic leads & counseling prep
  2. Physical Examination
    - Confirm diagnosis
  3. Treatment
  4. Counseling
    - Prevent re-infection and spread
  5. Follow-up including contact tracing
    - Prevent complications, re-infection and spread
18
Q

What is aetiological management of STIs?

A

identifying causative agent using lab tests

19
Q

What are the advantages of the aetiological approach?

A
  • Avoids overtreatment

- used to screen asymptomatic clients

20
Q

What are the disadvantages of the aetiological approach?

A
  1. places constrains on time and resources
  2. increases costs and reduces access to treatment
  3. Untimely treatment of patients > spread of STI & increasing the risk of complications
  4. Experience has shown clinical judgement can be wrong (up to 50%)
    - Misdiagnose an STI
    - Miss mixed infections
  5. Requires skilled lab facilities
    - Usually not available at primary level clinics
21
Q

What is clinical management approach of STIs?

A

uses clinical experience to identify symptoms typical of a specific STI

22
Q

What is the advantage of clinical management approach?

A
  1. Saves time

2. reduces lab expenses

23
Q

What are the disadvantages of the clinical management approach to STIs?

A
  1. Requires high clinical skills

2. mixed infections often overlooked

24
Q

What is the syndromic approach to managing STIs?

A

Most common causes of STIs present with signs and symptoms that can be grouped and used as a basis for treatment
- treatment targets locally known pathogens causing the syndrome
Note: adopted in 1992 in Malawi

25
Q

Describe the syndromic STI treatment rationale?

A
  1. urethral discharge > Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) or Trichomonas Vaginalis (TV)
  2. Vaginal discharge > CT, NG, TV, Candidiasis
  3. Genital Ulcers > HSV-2, syphilis, chancroid, LGV
  4. Lower Abdominal pain > CT, NG, TV, Mixed anaerobes
  5. Scrotal Swelling, Inguinal Bubo, neonatal conjuctivitis
26
Q

What are the advantages of syndromic STI treatment?

A
  1. is problem-oriented (it responds to the patient’s symptoms);
  2. Minimizes the risk of missing mixed infections;
  3. treats the patient at the first visit;
  4. makes STI care more accessible
  5. Simple, rapid, inexpensive, accessible to broad range of health workers, able to treat mixed infections
27
Q

What are the weaknesses of syndromic STI treatment?

A
  1. weighs towards over-treatment, rather than under-treatment > drug intolerance
  2. Promotion of drug resistance
  3. Curious or educated clients may not be satisfied when they are treated ineffectively and hence, may find alternative modes or places for treatment
  4. requires prior research on common causes of syndromes
  5. Stock out of STI drugs
  6. Implementation challenges in the private sector:
    - Poor documentation
    - Reporting issues
    - Limited capacity of service providers
  7. Neisseria gonorrhea (Ng) antimicrobial resistance (AMR) a big concern worldwide and Malawi
28
Q

What is the future burden if STIs in Malawi?

A
  • More people report STIs
  • More people treated
  • Trends for most STI syndromes stable over time
  • ~40% untreated STIs
  • Growing NG resistance
  • 1/5 of STI unknown etiology (new pathogens?)
  • Burden may potentially remain stable or increase

Reproductive Public Health (8 decks)

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