1. 1
Sexually Transmitted
Infections (STI)
SAgun
PAudel
Shima
Kunwar
Lila Kumari
Sharma
Health
Assistant
Staff Nurse
Staff Nurse
EIHS, Naulo Ghumti Nepal
08/01/2014

2. Sexually Transmitted
Infections (STI)
2
Sexually Transmitted
Infections (STI) are illnesses
that predominantly transmitted
by means of sexual behavior,
including vaginal
intercourse, anal sex and oral
sex.
08/01/2014

3. Classification of STIs
3

1.
2.
3.
4.
5.
Bacterial
Chancroid (Haemophilus ducreyi)
Chlamydia (Chlamydia trachomatis)
Gonorrhea (Neisseria gonorrhoeae)
Syphilis (Treponema pallidum)
Donovanosis
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4. 4
Parasites
 Crab louse pubic lice" (Pthirus pubis)
 Scabies (Sarcoptes scabiei)
Protozoal
Trichomoniasis (Trichomonas vaginalis
Viral
1.
Viral hepatitis (Hepatitis B virus
2.
Herpes simplex (Herpes simplex virus
3.
HIV
4.
HPV
5.
Molluscum contagiosum
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5. Mode of Transmission
5



Sexual contact: from one infected person to
another primarily by Sexual contact- Anal,
Vaginal or oral
From Mother to child: during Pregnancy and
child birth
Occasionally through contaminated fingers,
blood and blood products, organ transplants,
contaminated needles and fomites such as
towels, sex toys.
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6. Sign and symptoms of STIs
6
Male
• Urethral discharge
• Burning and pain during urination
• Pain of itch in and around genitalia, perineum
and anus/rectum
• Papules, vesicles, erosion/ulcers or fleshy
growths in and around genitalia, perineum and
anus/rectum, oral cavity and occasionally on
other sites.
• Swelling in inguinal, anal region and of
scrotum.
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7. 7
Female
 abnormal vaginal discharge
 Burning and/or increased frequency of
urination
 Lower abdominal pain
• Pain, itch, Papules, vesicles, erosion/ulcers or
fleshy growths in and around genitalia,
perineum and anus/rectum, oral cavity and
occasionally on other sites.
• Swelling in inguinal, anal region and of
scrotum.
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8. 8
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9. Possible complications related
to STIs
9
Male
 urethral stricture
 Epididymo-orchitis
 Penile and anal cancer
 Rarely disseminated infections
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10. 10
New born (from mother)
•
congenital syphilis and neonatal conjunctivitis
• Premature and low birth weight
• Herpetic/HPV infection
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11. 11
Female
 Pelvic inflammatory disease
 Cervical and cancer
 Ectopic pregnancy
 Abortion, still birth
STI increases risk of HIV
infection
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12. Common complications in male
and female
12







infertility
Scarring, distortion and mutilation of the
genitalia
Systemic infection
Anxiety depression
Social rejection by community member, family
members
Stigma and discrimination
Intra-marital discord and divorce etc
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13. STI risk factors
13
health care related behaviors
 Lack of willingness to seek medical advice and
choice of health care
 Lack of compliance with therapy
 Lack of partner’s referral for therapy
 Practice of vaginal cleaning of douching,
enema
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14. 14
Sexual behaviors
 sexual contact with multiple partners
 Sexual contact without using protective
barriers
 Sexual contact with causal partners
 Sexual contact with high possibilities of trauma
– anal
Other factors
 age, socioeconomic status, drug and alcohol
use etc.
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15. STIs management strategy
15
STIs management program should be
comprehensive
It should be designed in such a way that:

identification of maximum number of symptomatic
and asymptomatic individuals.

provide effective on-the-spot treatment
 Identify those who have increased risk behavior
for contracting STIs
 Promote positive behavior change and
maintenance to reduce sexual and other risks
through appropriate health education and
communication program.
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16. Epidemiology
16
Estimated annual Incidence WHO: 1999
 340 million new cases (syphilis, gonorrhea,
chlamydial and trichomoniasis primarily
occurring in men and women aged 15-49
years)
 Syphilis: 12 million
 Gonorrhea: 62 million
 Chlamydial infection: 92 million
 Trichomoniasis: 173 million
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17. 17
According to HMIS 2064/65 BS;
 28,2229 STIs
Research by Zeeb (1996) estimated a total of
6,000 to 8,000 annual STIs client in kaski
District.
IBBS, 2008 in pokhara 30% of FSW reported at
least one symptom of STIs.
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18. Public health aspect
18
General
population
High Risk
population
Bridge
population
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19. Approaches of STIs Diagnosis and
management
19




Clinical
Etiological
Syndromic
Enhanced syngromic
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20. Clinical approach
20

Based on clinical findings
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21. Etiological approach
21

identification of causative organisms or their
antibodies through laboratory testing.
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22. Syndromic approach
22


Identification of consistent STI-related groups
of symptoms and clearly recognized signs are
called STI syndromes.
The provision of clinical care which will cure
the majority of organisms responsible for
producing each syndrome is called syndromic
case management.
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23. Enhanced syndromic
23

An approach that aims toward reducing the
prevalence of STIs through a single round of
presumptive treatment of cervicitis, with
subsequent monthly clinical care through an
enhanced syndromic management protocol on
risk assessment and laboratory tests.
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24. Main STI syndromes
24







UDS
SSS
GUDS
IBS
VDS
LAPS
NCS
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25. 4Cs of Syndromic management
25




Compliance with treatment
Counseling
Contact tracing
Correct and consistent condom use.
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26. Activities inside Clinic
26
STI COUNSELING
STI EXAMINATION
STI MANAGEMENT AND
POST TEST COUNSELING
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27. FAMILY PLANNING SERVICE
27
FP
COUNS
ELING
FP
SERVICE
PROVISION
(IF CLIENT
WANTS)
Post
service
Counse
ling
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28. Problems
28



Client do not easily agree for STI examination
especially for PV examination.
Irregular client flow.
acceptance of dual methods.
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29. References
29

National Training Manual on the Management
of Sexually Transmitted Infection. (Training
manual) updated: 2011
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30. Do not forget to suggest
30



mail4sagun@gmail.com
www.facebook.com/preventionisbest
www.facebook.com/sagun.paudel
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31. 31
Thankyou
08/01/2014