Sexually transmitted infections

Question 1

Define Public health

Answer 1

“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.”

Question 2

Define Sexually Transmitted Infections (STI’s)

Answer 2

Sexually transmitted infections are infections caused by:

• bacteria,
• viruses,
• parasites that are transferred mainly via sexual contact, be it vaginal, anal, oral sex.

Question 3

Burden of STIs

Answer 3

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

Question 4

Public health Interventions

Answer 4

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 .

Question 5

Population Health

Answer 5

-‘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)

Question 6

The Critical stance that population health requires

Answer 6

Population health requires a critical stance:

1. 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

Question 7

Bacterial STIs

Answer 7

Chlamydia

Gonorrhea

Syphilis

Question 8

Parasitic STIs

Answer 8

Pubic lice

Scabies

Trichomoniasis

Question 9

Viral STIs

Answer 9

Human Papilloma Virus (HPV)

Herpes

HIV / AIDS

Hepatitis

Question 10

Types of Hepatitis

Answer 10

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

Question 11

STIs transmitted via non-sexual means

Answer 11

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.

Question 12

Burden of STIs in South Africa

Answer 12

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.

Question 13

Serious problems caused by STIs

Answer 13

-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),

Question 14

Common symptoms of STIs

Answer 14

Common symptoms of STIs include vaginal discharge, urethral discharge or burning of urine in men, genital ulcers, and abdominal pain

Question 15

Root causes of STIs

Answer 15

-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.

Question 16

Chlamydia

Answer 16

-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.

Question 17

Gonorrheoea

Answer 17

> 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

Question 18

Syphilis

Answer 18

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

Question 19

Strategies to reduce the burden of STIs

Answer 19

> > Counselling and behavioural approaches

> > Barrier methods
Male and female condoms

> > Availability ofantiretroviral drugs

> > Pre-exposure prophylaxis - prevent HIV infection (not STIs)

Question 20

Counseling and behavioral approaches

Answer 20

1. for primary prevention against STIs (including HIV)
2. against unintended pregnancies.
3. sexuality education, STI and HIV pre-and post-test counseling;
4. safer sex/risk-reduction counseling – Sex workers, MSM, drug injection users, adolescent health
5. Recognition of symptoms

Question 21

Diagnosis of STIs

Answer 21

In South Africa, diagnostic tests for STIs :

1. Geographically inaccessible
2. Time-consuming, Expensive
3. Wait a long time to receive results. This may result in the treatment being incomplete and failing
4. Rapid tests for syphilis and HIV are available while tests for other STIs are under development.

Question 22

W.H.O Recommendation

Answer 22

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

Question 23

The syndromic approach to STI management depends on:

Answer 23

patient symptoms and the signs presented at the clinical examination.

Question 24

The four main syndrome management protocols are for: [drugs given to patients]

Answer 24

1. urethral discharge and swollen testes,
2. genital ulcers,
3. vaginal discharge and
4. lower abdominal pain in women

These protocols help with prevention and treatment STIs in South Africa.

Question 25

Syndromic approach necessary because

Answer 25

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)