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Sexually Transmitted Infections

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Sexually Transmitted Infections. Definition. Diseases transmitted from one person ... 1) Sexually transmitted. Exclusively transmitted by sexual contact ... – PowerPoint PPT presentation

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Title: Sexually Transmitted Infections


1
Sexually Transmitted Infections
2
Definition
  • Diseases transmitted from one person to another
    through heterosexual or homosexual intercourse
  • OR
  • Through intimate touch with the sex organs, mouth
    or rectum of an infected person

3
  • STIs divided into two groups
  • 1) Sexually transmitted
  • Exclusively transmitted by sexual contact
  • Chancroid
  • Chlamydia
  • Gonorrhea
  • Syphilis

4
  • 2) Sexually Transmissible
  • Can be transmitted sexually, but have other modes
    of transmission

5
STI Infections
  • Transmission
  • 1. Direct sexual contact
  • Chancroid
  • Chlamydia
  • Gonorrhea
  • Syphilis
  • HPV
  • Herpes

6
  • 2. Auto-innoculation
  • Chlamydia
  • Gonorrhea
  • Herpes

7
  • 3. Direct contact during LD
  • Chlamyida
  • Gonorrhea
  • HPV
  • Herpes

8
  • 4. Placental transfer
  • Syphilis
  • Body fluid exchange
  • Hepatitis B
  • AIDS

9
  • Susceptibility
  • 1. Universal
  • Chancroid
  • Chlamydia
  • Gonorrhea
  • Primary syphilis
  • Secondary syphilis
  • Herpes
  • AIDS

10
  • 2. Resistance conferred by infection
  • Tertiary syphilis
  • Hepatitis B
  • 3. Resistance acquired by passive immunization
    (post-exposure)
  • Hepatitis B

11
  • 4. Resistance acquired by active immunization
    (pre-exposure)
  • Hepatitis B
  • 5. Not known
  • HPV

12
  • Communicability
  • 1. While lesions present
  • Chancroid
  • HPV
  • Herpes

13
  • 2. Unknown/variable (likely until treated)
  • Chlamydia
  • Syphilis
  • Primary
  • Secondary
  • 3. Until treated
  • Gonorrhea

14
  • 4. Lifetime
  • Hepatitis B (all HbsAg carriers are
    communicable)
  • AIDS

15
  • Incubation Period
  • 1. Short
  • Chancroid (3-5 days)
  • Chlamydia (5-14 days)
  • Gonorrhea (2-7 days)
  • Herpes (2-12 days)

16
  • 2. Moderate
  • Syphilis (10-90 days)
  • 3. Long
  • HPV (2-3 mo., as long as 20 mo.)
  • AIDS (1-3 mo for antibodies 1-10 yr for
    symptoms)
  • HepB (45-180 days)

17
  • Detection
  • 1. Physical examination
  • Always
  • For each disease, need to know clinical
    presentation

18
  • 2. Culture
  • Chancroid
  • Chlamydia
  • Gonorrhea
  • Herpes

19
  • 3. Direct antigen test
  • Chlamydia
  • Gonorrhea
  • Primary syphilis
  • 4. Stain/smear
  • Gonorrhea

20
  • 5. Blood work
  • Syphilis
  • AIDS
  • HepB
  • 6. Biopsy
  • HPV
  • Herpes

21
  • Manifestations
  • 1. Local lesions
  • Chancroid
  • Primary syphilis
  • HPV
  • Herpes

22
  • 2. Infection of GI tract
  • Chlamydia
  • Gonorrhea
  • 3. Infection of rectum
  • Chlamydia
  • Gonorrhea
  • HPV
  • Herpes

23
  • 4. Oral infections
  • Chlamydia
  • Gonorrhea
  • HPV
  • Herpes
  • 5. Infection of reproductive tract (including
    PID)
  • Chlamydia
  • Gonorrhea

24
  • 6. Systemic infections
  • Gonorrhea (disseminated gonococcal infection)
  • Secondary syphilis
  • Tertiary syphilis
  • HepB
  • AIDS

25
  • Fetal Manifestations
  • 1. Conjunctivitis
  • Chlamydia
  • Gonorrhea
  • 2. Oral infections
  • Chlamydia
  • Gonorrhea
  • HPV

26
  • 3. Pneumonitis
  • Chlamydia
  • 4. Anomalies
  • Syphilis

27
  • 5. Multiple generalized effects r/t infection
  • Herpes (late manifestation, usually 1 week after
    delivery)
  • Syphilis
  • HepB
  • AIDS

28
Impact on Population Health
  • 1) Significant cost to the health care system
  • 2) Significant personal social costs

29
  • 3) Small segment of population may carry
    disproportionate burden of risk
  • Young
  • Those with more than 6 sex partners (cumulative)
  • Poor homeless
  • Women
  • Those living where access to preventive services
    is difficult

30
Epidemiology of STI in Canada
  • Chlamydia
  • Most commonly diagnosed communicable disease in
    Canada
  • More frequently diagnosed in women than in men

31
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32
  • Unacceptable high rates in women under age 25
  • Associated risk of PID and future fertility
    problems

33
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34
  • Regional variations in incidence

35
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36
  • Gonorrhea
  • Epidemiological contrast to Chlamydia
  • Dramatic decrease in infection rates since 1981
  • Slight increase since 1998

37
  • Infection rates higher in males overall
  • However, infection rates higher in females during
    adolescence

38
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39
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40
  • Regional patterns of infection are similar to
    chlamydia

41
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42
  • Syphilis
  • Like gonorrhea, infection rates are higher in
    males than in females

43
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44
  • Still an excess of cases in females aged 15-24

45
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46
  • Regional patterns of disease also vary

47
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48
Prevention of STIs
  • Specific preventive activities related to this
    formula and to Primary Secondary prevention
    tend to overlap because
  • Secondary prevention depends on effective Primary
    Prevention
  • Primary prevention depends on effective Secondary
    prevention

49
Primary Prevention
  • Reducing Probability of Transmission
  • 1) Use of barrier methods
  • 2) Reduction in use of high risk sexual practices
  • 3) Vaccines

50
  • 4) Reproductive Health Education
  • 5) Changing social values
  • 6) Community development

51
  • Reducing Contact Between Infected
    Uninfected Persons
  • 1) Reducing of sex partners
  • 2) Delaying initiation of sexual activity
  • 3) Deliberate appraisal of new sex partners

52
  • Harm Reduction
  • First priority is to limit the harmful
    consequences of the health risk in question
  • Examples
  • Sexual activity
  • Injection drug use
  • Illicit tattooing

53
  • Recognition that abstinence may not be a
    realistic or desirable goal for everyone
  • Main principles
  • 1. Pragmatism
  • Acceptance that risky behaviours are unlikely to
    disappear entirely

54
  • 2. Humanism
  • No moral judgements
  • 3. Focus on harms
  • Risky behaviour is secondary to the harms it
    might produce

55
  • 4. Hierarchy of goals
  • Focus on the most pressing needs first

56
Secondary Prevention
  • 1) Prompt diagnosis treatment of known cases
  • Always screen for multiple STIs
  • 2) Contact Tracing
  • Make no assumptions about who is doing what with
    whom
  • Confidentiality

57
  • 3) Monitoring/surveillance/screening of known
    high risk populations
  • Young people
  • Sex trade workers
  • 4) Reporting to appropriate authorities

58
National STI Prevention Goals
  • A goal without a deadline is only a wish.
  • Canada established several goals for the
    reduction of STIs in Canada in 1997

59
  • For chlamydia in general
  • By the year 2000, rate to be less than 80/100,000
  • Actual rate in 2000 151.1/100,000
  • By the year 2010, rate to be less than 50/100,000

60
  • For chlamydia in females
  • By the year 2000, rate for females 15-14 to be
    less than 500/100,000
  • Actual rate for females 15-19 714.4/100,000
  • Actual rate for females 20-24 818.7/100,000
  • By the year 2010, rate for females 15-24 to be
    less than 200/100,000

61
  • For infectious syphilis
  • By the year 2000, rate to be less than
    0.5/100,000
  • Actual rate 0.6/100,000
  • By the year 2010, endemic infectious syphilis to
    be eliminated

62
  • For congenital syphilis
  • By the year 2000, congenital syphilis to be
    totally prevented

63
  • Congenital syphilis in Canada since 1992
  • 1992 4 cases
  • 1993 4 cases
  • 1994 3 cases
  • 1995 2 cases
  • 1996 1 case
  • 1997 2 cases
  • 1998 2 cases
  • 1999 0 cases

64
  • For gonorrhea
  • By the year 2010, endemically acquired gonorrhea
    to be eliminated
  • For PID ectopic pregnancies
  • By the year 2010, rates for PID ectopic
    pregnancies to be reduced to 50 of that recorded
    in 1996

65
  • Wide variation in infection rates in different
    regions of the country
  • Related to isolation, inadequate access to
    services

66
Challenges
  • 1. Antibiotic resistance
  • 2. Asymptomatic infections
  • 3. Co-existing infections
  • 4. Long latent periods

67
  • 5. Importation of cases
  • 6. Lack of uniform reporting systems
  • 7. Synergistic effects of host agent
  • 8. Synergistic effects of host environment
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