Sexually transmitted infections Flashcards
Define Public health
“The combination of skills, sciences, and activities directed to the maintenance and improvement of the health of all of the people through collective or social actions.”
(Last, 1988)
OR
“Organized community efforts aimed at the prevention of disease and the promotion of health. It links many disciplines and rests upon the scientific core of epidemiology.”
Define Sexually Transmitted Infections (STI’s)
Sexually transmitted infections are infections caused by:
- bacteria,
- viruses,
- parasites that are transferred mainly via sexual contact, be it vaginal, anal, oral sex.
Burden of STIs
Globally, more than amillion peopleare diagnosed with one or more sexually transmitted infections
Each year, there are an estimated 357 million new infections with 1 of 4 STIs: chlamydia, gonorrhoea, syphilis, and trichomoniasis.
More than 500 million people are estimated to have genital infection with herpes simplex virus (HSV).
More than 290 million women have a human papillomavirus (HPV) infection
Public health Interventions
Public health interventions are focused on maintaining health or preventing disease
Discipline of Public Health employs a variety of approaches to address whatever health issues are most pressing in each place and time at Population level as opposed to just one patient .
Population Health
-‘Population health’ as a unifying paradigm that links disciplines from the biological to the sociological (and political)
-Public Health Practitioners are advocates for the allocation of health resources, health protection and promotion/ illness prevention, and treatments at the population level
Health protection and promotion require also the study of politics (as the study of power relations, and policymaking and policy implementation)
The Critical stance that population health requires
Population health requires a critical stance:
- Describe what the issues are
Explain – ‘but why?’ [why we have these]
Identify root causes
Act
Action at what level? district, provincial or national?
Are we gonna act at clinics or hospitals e.t.c
Bacterial STIs
Chlamydia
Gonorrhea
Syphilis
Parasitic STIs
Pubic lice
Scabies
Trichomoniasis
Viral STIs
Human Papilloma Virus (HPV)
Herpes
HIV / AIDS
Hepatitis
Types of Hepatitis
Hepatitis A is transmitted through fecal oral route
Hep B is transmitted through blood and bodily fluids
Hep C is transmitted mostly through blood but also through bodily fluids
STIs transmitted via non-sexual means
In some instances via non-sexual means, i.e. by means of blood or blood products. Mother-to-child transmission of e.g. chlamydia, gonorrhoea, syphilis, hepatitis B and HIV can also occur during pregnancy and childbirth.
Burden of STIs in South Africa
STIs may have no symptoms or only mild symptoms that may not be recognized as an STI or have clinical symptoms
STIs such as HSV type 2 and syphilis can increase the risk of HIV acquisition.
-A cause for concern IN South Africa, with –7.9 million people living with HIV in 2017– also has a high volume of STIs.
Serious problems caused by STIs
-Globally, over a million pregnant women are infected with syphilis, resulting in over 300 000 stillbirths and newborn deaths.
In some cases, STIs can have serious reproductive health consequences beyond the immediate impact of the infection itself (e.g., infertility or mother-to-child transmission), Pelvic Inflammatory Disease (PID),
Common symptoms of STIs
Common symptoms of STIs include vaginal discharge, urethral discharge or burning of urine in men, genital ulcers, and abdominal pain
Root causes of STIs
-The high level of sexually transmitted infections (STIs) in South Africa can be attributed to:
> low socio-economic conditions, social stigma, gender inequalities, inability to access adequate health care systems and lack of preventative programmes.
-And yet the main STIs are curable i.e. chlamydia, gonorrhoea, syphilis and trichomoniasis, most of which occur in the developing world.
Chlamydia
-Chlamydial infections are the most common STIs
>ocurrs predominantly in young sexually active adults.
> The bacterium Chlamydia trachomatis causes cervicitis in females and urethritis in males as well as rectal and oropharyngeal infections.
> Many do not display symptoms of chlamydia infection
> But pain during urination as well as a discharge or vaginal bleeding has been observed.
Gonorrheoea
> Gonorrhoea is the second most common STI
caused by the bacterium
> Neisseria gonorrhoeae
discharge and painful urination
> It is often asymptomatic in women and if left untreated may lead to serious complications
> i.e. pelvic inflammatory disease, ectopic pregnancy and as infertility.
> In men untreated infections - epididymitis, urethral stricture and infertility.
> Neonatal conjunctivitis & blindness in infants – Mother to child transmission
Syphilis
caused by the bacterium Treponema pallidum
painless sore on the genitals or around the mouth (4–6 weeks); rash; sore throat (a few weeks).
Untreated syphilis - stroke, paralysis and death.
sexually transmission via contact with infected membranes
blood transfusions or mother to foetus via the placenta
Strategies to reduce the burden of STIs
> > Counselling and behavioural approaches
> > Barrier methods
Male and female condoms
> > Availability ofantiretroviral drugs
> > Pre-exposure prophylaxis - prevent HIV infection (not STIs)
Counseling and behavioral approaches
- for primary prevention against STIs (including HIV)
- against unintended pregnancies.
- sexuality education, STI and HIV pre-and post-test counseling;
- safer sex/risk-reduction counseling – Sex workers, MSM, drug injection users, adolescent health
- Recognition of symptoms
Diagnosis of STIs
In South Africa, diagnostic tests for STIs :
- Geographically inaccessible
- Time-consuming, Expensive
- Wait a long time to receive results. This may result in the treatment being incomplete and failing
- Rapid tests for syphilis and HIV are available while tests for other STIs are under development.
W.H.O Recommendation
Due to the inefficient treatment of STIs
World Health Organisation (WHO) recommends and promotes
the syndromic management of STIs in developing countries at the point of contact with the health service provider
With the intention of improving the quality of care of these patients
The syndromic approach to STI management depends on:
patient symptoms and the signs presented at the clinical examination.
The four main syndrome management protocols are for: [drugs given to patients]
- urethral discharge and swollen testes,
- genital ulcers,
- vaginal discharge and
- lower abdominal pain in women
These protocols help with prevention and treatment STIs in South Africa.
Syndromic approach necessary because
ongoing research needed - for improving acceptability, access, prevention, and treatment modalities
It is “Based on the recognition of syndromes and treatment which deals
- with the majority of likely causative agents”
- Clients treated for all major causes of the syndrome
- Algorithms should be adapted to the local prevalence of STIs
- Can be used where laboratory services are unavailable
- Accuracy improves when supplemented with simple
-laboratory tests and minimal clinical signs
(Enhanced Syndromic Approach)
