Sexually transmitted diseases Community medicine presentation - Nepal

1. SEXUALLY TRANSMITTED
DISEASES- STDs
- NIRAJ PRASAD SAH
(3rd YEAR MBBS, NGMC)
Presentation on,
Department of Community Medicine – Mrs. Isha Dhakal Maam

2. INTRODUCTION
• STDs are group of CD transmitted by predominantly via sexual contact and caused by wide
variety of bacteria, viruses, protozoa and fungal agents.
History
• During past few decades, STDs have undergone huge transformation over time.
• Until 1990s, STDs were commonly known as Venereal Disease. (lt. Veneris means Venus, the
Roman goddess of love)
• The name is changed from VD to STD. the list of pathogens which are sexually transmissible
has expanded from 5 classical VD ( Syphilis, gonorrhea, chanchroid, LV and donovanosis).
• Most of the recently established STDs are called as 2nd generation STDs . Eg. Aids.
• The term VD is not used by the medical community now. A person may be infected but may
not have a disease e.g. HIV positive but not suffering from AIDS. So the term STI (sexually
transmitted infection) is preferred over STD.

3. EXTEND OF PROBLEM
• The true incidence of STDs will never be known not only because of inadequate
reporting but because of secrecy that surrounds them.
• However, from the data available, it has shown has high prevalence.

4. • The WHO global progress report on HIV, viral hepatitis and sexually transmitted
infections 2021 estimates
• 374 million new cases of STI per year:
• 128 million new cases of chlamydia trachomatis,
• 82 million new cases of neisseria gonorrhoeae,
• 156 million new cases of trichomonas vaginalis and
• 7.1 million new cases of treponema pallidum (syphilis).

5. EPIDEMIOLOGY IN NEPAL

7. EPIDEMIOLOGICAL DETERMINANTS
A. Agent

8. B. Host
a. Age
• For most notifiable STDs, the highest rates of incidence are observed in 20-24 year-olds,
followed by the 25-29 and 15-19 years age groups.
• The most serious morbidity is observed during foetal development and in the neonate.
b. Sex
• For STDs, the overall morbidity rate is higher for men than for women, but the morbidity caused
by infection is generally much more severe in women, as for example, pelvic inflammatory
disease.
c. Marital status
• The frequency of STDs infection is higher among single, divorced and separated persons than
among married couples.
d. Socio-economic status
• Individuals from the lowest socio-economic groups have the highest morbidity rate.

9. C. Enivronment
Demographic factors
• Population explosion
• Marked increase in young population, the
group at high risk for STD
• Rural to urban migration
• Increasing educational opportunities for
women and delaying their marriage
Social Factors
• Prostitutions- reservoir of infection
• Broken homes
• Sexual disharmony
• International travels
• Social stigma- accounts for non-
detection of the cases, not disclosing
the sources of contact dropping out
before treatment, self treatment.
• I.v. Drug abuse and alcoholism

10. CLINICAL SPECTRUM
1. Gonococcal infection
2. Syphilis
3. Chlamydial infection
4. Trichomoniasis
5. Chanchroid
6. Lymphogranulom Venereum
7. Donovanosis
8. Genital herpes
9. Human papilloma virus.

11. CONTROL OF STDs
• Aim- prevention of ill health resulting
from above conditions through
various interventions.
• These interventions may have
diffrenet prevention focus.
• Primary prevention focus- the
prevention of the infection
• Secondary prevention focus-
minimizing the adverse health effects
of the infection.
• Or combination of both
• Control of std may be considered
under following headings.
1. Initial planning
2. Intervention strategies
3. Support components
4. Monitoring and evaluation.

12. INITIAL PLANNING
• Planning should be designed to meet the unique need of the country and in line with the
country’s health care system, its resources and priorities.
• Steps of planning
 Problem definition – prevalence, psychosocial consequences and other health effects by
geographical areas, population groups through epidemiological and population surveys.
 Establishing priorities – depending upon the health problem considerations eg. Magnitude ,
consequences and feasibility of control. Can be categorized based upon age, sex, place,
occupation etc.
 Setting objectives – priorities must be converted into discrete, achievable and measurable
objectives i.e. to reduce the magnitude of the problem in given population in given time.
 Considering strategies – to consider the most appropriate strategy among all available
strategies to meet the objectives.

13. INTERVENTION STRATEGIES
1. Case detection:
a. Screening
- testing of apparently healthy volunteers from general population for early detection of the
disease
-high priority is given to screening of special groups viz. pregnant women, blood donors,
industrial workers, army, police, refugees, prostitutes, restaurants and hotel staffs.
-availability of appropriate test for screening is must.
b. Contact tracing
- sexual partners of diagnosed patients are identified, located, investigated and treated.
-One of the bets method in control of infection particularly in stds.
-Patients should disclose all sexual contacts voluntarily.
c. Cluster testing

14. 2. Case holding and treatment
 Adequate treatment of pt. and their contacts is the mainstay of STD control.
 There is tendency of the patients suffering from std to disappear or drop out before
treatment is complete.
 Ensure complete and adequate Rx.
3. Personal Prophylaxis
a. Contraceptives
 Mechanical barriers availability and awareness.
 Exposed parts should be washed with soap and water asap after contact.
b. Vaccines- Hepatitis vaccine has raised hopes for the development of vaccines for other stds.
c. Know your partner.
4. Health education
• It is the integral part STD control programmes

15. SUPPORT COMPONENTS
1. STD clinic
• a designated spot where all consultations, inv and rxn , contact tracing and all
other relevant services are available
• An ideal service is one which is free, easily accessible and available for long
hours a day with suitable arrangements for female patients separately.
• This becomes imp that because of the stigma attached with stds clinics,
integration of its important components into PHC becomes essential for std
control programmes.

17. 2. Laboratory services
• Adequate lab facilities and trained staffs
are essential for proper pt management.
• Provides basis for correct etiological
diagnosis and treatment decisions as well
as AMR.
3. PHC
• Current trend is integrating std control
activities into primary health care system.
• To utilize the principle of universal
coverage, community participation, equity
and inersectoral coordination which is
ideally suited for std control in community.
4. Information system
• Basis of an effective control programs of
any CD (eg.Covid)
• National notification system, at best,
• Urgent need to develop an effective,
transparent and detailed reporting
systems of std.
5. Legislation
• Legislations and regulations cant wipe out
STDs , they are nonetheless needed to
establish responsibility and define
standards.
• Mandatory reporting, partner notification,
criminalization for intentional
transmission, age of consent etc.

18. 6. Social welfare measures
• Stds are social problems with medical aspects.
• This means there should be social therapy / measures which would prevent or control
the condition.
• For eg.
 Rehabilitation of prostitutes
 Provision of recreational facilities in the community
 Provisin of decent living conditions
 Marriage counselling
 Prohibiting the sale of sexually stimulating literatures, pornographic books, sites etc.
Monitoring and evaluations of the control activities

21. THANK YOU &
STAY PROTECTED