SEXUALLY TRANSMITTED
INFECTIONS
Dr. Benjamin Bekoe
Content
• Definition of STIs
• Epidemiology
• Etiology and pathogenesis
• Clinical features
• Prevention and control of STIs
Definition
• Sexually transmitted infections (STIs) are infections that are passed
from one person to another through sexual contact.
• STIs are transmitted through vaginal, oral, or anal sex.
• These infections present themselves commonly in the following
syndromes (genital ulcer, urethral discharge, vaginal discharge, lower
abdominal pain, scrotal swelling, inguinal bubo and neonatal
conjunctivitis)
Epidemiology
Sexually transmitted infections remain a public health problem of
major importance in both developed and developing countries, but are
specially so in developing countries where access to diagnostic and
treatment facilities is inadequate, very limited or non - existent at all.
In many developing countries throughout the world STIs rank among
the top ten conditions for which adults seek health care. These
diseases are important for three reasons, because of their magnitude,
their potential for causing serious complications and their linkage with
HIV/AIDS.
Epidemiology
• According to a WHO report, in 1995 an estimated 340 million new cases of
the five most common curable STIs occurred globally in both men and
women of 15 - 49 age range. On average an estimated 930,000 people are
infected every day with curable STI globally.
• Currently in Ghana, the Ghana Health Service has begun the 95-95-95
programme in the management of HIV/AIDS patients. This programme
aims at:
ensuring 95% of people living with HIV known their status
95% of people diagnosed with HIV receive antiretroviral treatment
people receiving antiretroviral therapy have 95% viral suppression.
Etiology
The main STI pathogens include:
a. Bacterial
Neisseria gonorrhea (causing gonorrhoea)
Chlamydia trachomatis (chlamydial infection)
Treponema pallidum (syphilis)
Haemophilus ducreyi (chancroid)
Clamatato bacterium granulomatis (granuloma inguinale, or
donovanosis)
Gardnella vaginalis
Etiology
b. Viral
Herpes simplex type I and II
Human papillomavirus (genital warts)
Hepatitis B virus
Cytomegalovirus
HIV
Etiology
c. Others (Parasitic and Fungal)
Trichomonal vaginalis (Trichomoniasis): a parasitic infection another
important sexually transmitted agent which causes vaginitis and has also
been shown to facilitate HIV transmission.
Candida albicans: can be sexually transmitted, is the cause of a common
fungal infection responsible for vulvovaginitis in women and inflammation
of the glans pines and fore skin in men.
Genital scabies: an itchy condition caused by the mite sarcoptes scabies
which is frequently transmitted by close contact with an infected person.
Pediculosis pubis: an itching caused by the public lice (phythirus pubis)
and transmitted through sexual contact
Clinical Features
The syndromic approach is highly based on the patient’s history. The physical
examination of a case suspected on STI is complimentary to the history of
the case. The following syndromes are common in patients with STI.
Urethral discharge or burning on urination
Vaginal discharge in women
Lower abdominal pain in women: severity and type of pain, onset, quality
of pain, radiation to other body areas and presence of vaginal discharge or
other systematic symptoms like fever, nausea and vomiting
Clinical Features
Scrotal swelling
Inguinal bubo: presence of pain, ulceration, discharge and swelling.
Genital ulcer in men and women
Ophthalmia neonatorum: conjunctivitis with purulent discharge
Prevention and Control of STI
• Promotion of safer sexual behavior:
Avoiding multiple sexual partners or casual sex and consistent and
correct use of condoms with all partners not known to be free of an
STI.
• Education regarding prevention of STI:
The awareness about the STI and sex in particular is very vital. A
variety of methods can be used for the purpose, comprising public
education, briefings at religious places, news items and
documentaries on television and radio. Sex education should be a
major topic in the school and college curriculums.
Prevention and Control of STI
• Remember the ABCs of prevention of STI:
Abstain from sex. This is the only guaranteed protection.
Be mutually faithful. Always have sex with the same person. This person
also must not have sex with any one else and must not have an STI.
(Important: You usually can not tell if a person has an STI just by looking at
him or her. People with STI, including HIV, usually do not look sick.)
Consistently use condoms, use them every time and use them correctly.
Prevention and Control of STI
• Early detection and treatment of cases
Early detection and treatment of cases is very important. It prevents
more serious complications in patient’s, and it benefits the
community by preventing further transmission.
• Identification, notification and evaluation of sexual partners
This is an important public health activity by which the partners of
those identified as having STI are traced, informed of their probable
exposure to infection and offered medical and counseling services
Prevention and Control of STI
• Early detection and treatment of cases
Early detection and treatment of cases is very important. It prevents
more serious complications in patient’s, and it benefits the
community by preventing further transmission.
• Identification, notification and evaluation of sexual partners
This is an important public health activity by which the partners of
those identified as having STI are traced, informed of their probable
exposure to infection and offered medical and counseling services
Prevention and Control of STI
• Counseling as a prevention and control activity
Whatever the overall STI/HIV prevention and control strategy,
counseling should be a major integral part.
• Integration of STI prevention into primary health care, reproductive
health care facilities, private clinics and others.
• Targeting vulnerable groups such as, commercial sex workers,
adolescents, long distance truck drivers, military personnel and
prisoners.
• Involving community leaders, religious leaders and community health
workers in public awareness creation, prevention and control of STI