Mr.

Lhakpa Tshering
Lecturer, AAHS
 EPIDEMIOLOGY TRIAD:

Agent:

Environmen
Host:) t:
 Introduction
 Sexually transmitted infections (STIs), also
referred to as sexually transmitted diseases
(STDs), are infections that are primarily spread
through sexual contact, including vaginal, anal,
and oral sex.
These infections can be caused by bacteria,
viruses, or parasites.
 Definition
Sexually transmitted infections (STIs)
are infections or diseases that are passed on
during unprotected sex with an infected
partner.
 Common types of STIs
1. Chlamydia
Caused by the bacterium Chlamydia
trachomatis, chlamydia is one of the most
common STIs.
It can lead to genital and urinary tract
infections in both men and women. If left
untreated, it can cause serious health
complications, such as pelvic inflammatory
disease (PID) and infertility.
2. Gonorrhea
Caused by the bacterium Neisseria
gonorrhoeae, gonorrhea can lead to infections
in the genital, rectal, and throat areas.
If untreated, it can cause serious health
problems like PID, infertility, and an increased
risk of HIV transmission.
3. Human Papillomavirus (HPV)
 HPV is a group of viruses that can cause
genital warts and is also associated with the
development of certain types of cancers,
including cervical cancer.
 Many people with HPV do not have
symptoms and can unknowingly transmit the
virus.
4. Herpes
Herpes simplex virus (HSV) causes genital
herpes, which results in painful sores or
blisters on the genital or anal areas.
There are two types of HSV: HSV-1 and HSV-2.
HSV-1 is commonly associated with oral
herpes, but it can also cause genital herpes
through oral-genital contact.
5. Syphilis
Caused by the bacterium Treponema
pallidum, syphilis progresses through stages if
left untreated.
 It can lead to sores (chancres), rashes, fever,
and potentially serious complications that
affect the heart, brain, and other organs.
6. HIV/AIDS
 Human Immunodeficiency Virus (HIV) attacks
the immune system and can lead to Acquired
Immunodeficiency Syndrome (AIDS).
 It weakens the body's ability to fight off
infections and diseases.
HIV is transmitted through contact with
infected blood, semen, vaginal fluids, or breast
milk.
7. Trichomoniasis
This infection is caused by the parasite
Trichomonas vaginalis.
 It can cause itching, burning, and discomfort
in the genital and urinary tract.
Many people with trichomoniasis have no
symptoms.
8. Hepatitis B and C
 These are viral infections that primarily affect
the liver.
 They can be transmitted through sexual
contact, among other ways.
Chronic hepatitis B and C infections can lead
to liver damage and other complications.
 Epidemiological Triad
Agent

Host Environment
Host: Individual or organism who engages in
sexual activity and infected by a pathogen
(such as a bacterium, virus, or parasite).
Agent: The agents include bacteria (e.g.,
Chlamydia trachomatis, Neisseria
gonorrhoeae), viruses (e.g., Human
Immunodeficiency Virus [HIV], herpes simplex
virus), parasites (e.g., Trichomonas vaginalis).
Environment: the environment encompasses
various factors such as social and cultural
norms, socioeconomic status, access to
healthcare, sexual behaviors, education and
awareness.
 Mode of Transmission
Sexual Intercourse: This is the most common
mode of transmission for many STIs. It
includes vaginal intercourse, anal intercourse,
and oral-genital contact.
Direct Contact with Infected Fluids: Infectious
agents present in bodily fluids such as semen,
vaginal fluids and blood comes into contact
with mucous membranes or open sores on a
partner's body, transmission can occur.
Vertical Transmission: transmitted from an
infected mother to her baby during childbirth
or through breastfeeding.
Skin-to-Skin Contact: Certain STIs can be
transmitted through skin-to-skin [Link].
herpes simplex virus (HSV) can be transmitted
through direct contact with herpes sores or
through asymptomatic shedding of the virus.
Sharing Needles and Drug Paraphernalia: STIs
like HIV and hepatitis B and C can be
transmitted through sharing needles, syringes,
or other drug paraphernalia. This is common
among people who inject drugs.
Non-Sexual Routes: :
– Blood Transfusion: In the past, it was so
common, however modern blood screening
procedures have largely reduced this risk.
– Needlestick Injuries: Healthcare workers may
be at risk of contracting certain STIs through
accidental needlestick injuries when handling
contaminated needles or instruments.
– Invasive Medical Procedures: In rare cases,
medical procedures involving contact with
infected tissues or fluids can lead to
transmission of STIs.
– Contaminated Objects: Sharing personal items
like razors, toothbrushe, or sex toys can
potentially transmit some STIs if contaminated
with infectious fluids or tissues.
 Incubation Period
The incubation period for sexually transmitted
infections (STIs) can vary widely depending on
the specific infection, the individual's immune
response, and other factors.
Chlamydia: The incubation period for
chlamydia within 1 to 3 weeks after exposure.
Gonorrhea: within a few days to around two
weeks after exposure.
Herpes: appear within 2 to 10 days after
exposure.
Syphilis: Primary syphilis develops within 10
to 90 days after exposure. Secondary syphilis
appear a few weeks to a few months.
Human Papillomavirus (HPV): develop visible
genital warts within a few weeks to months
after exposure,
HIV: between 1 and 6 weeks (median 3
weeks) after exposure to
Trichomoniasis: few days to a month or more
 Signs and symptoms
Sexually transmitted infections (STIs) can cause a
wide range of signs and symptoms.
Chlamydia:
– Women: Abnormal vaginal discharge,
painful urination, pelvic pain.
– Men: Discharge from the penis, pain or
burning during urination, testicular pain or
swelling.
Gonorrhea:
– Similar to chlamydia, gonorrhea can cause
similar symptoms including discharge, pain
or burning during urination, and pain in the
pelvic or genital area.
Syphilis:
– Primary stage: A painless sore (chancre) at
the site of infection (genital, anal, or
mouth).
– Secondary stage: Rash, fever, swollen lymph
nodes, and other flu-like symptoms.
– Latent and tertiary stages: If left untreated,
syphilis can progress to more severe stages that
affect the organs, nervous system, and skin.
Herpes:
– Genital herpes can cause painful sores or
blisters on or around the genital or anal areas.
Some people may also experience flu-like
symptoms during the initial outbreak.
Human Papillomavirus (HPV)
– Most HPV infections do not cause
symptoms, but some strains can lead to
genital warts. These warts can appear on
the genital, anal or mouth areas.
HIV
– Many people may not experience
symptoms. Some might have flu-like
symptoms fever, fatigue, sore throat.
As HIV progresses to AIDS, individuals may
experience weight loss, chronic diarrhea, night
sweats, and opportunistic infections due to a
weakened immune system.
Trichomoniasis:
– Women: Frothy vaginal discharge, itching,
burning during urination, discomfort during
intercourse.
– Men: Discharge from the penis, itching,
burning after urination or ejaculation.
 Diagnosis
Medical History
A healthcare provider will ask about sexual
history, any symptoms experiencing, and
any potential exposure to STIs.

Physical Examination: A physical

examination may be conducted to assess
any visible symptoms, such as genital sores,
rashes or discharge.
Laboratory Tests:
– Urinalysis: to detect the presence of
certain STIs, such as chlamydia and
gonorrhea.
– Blood Tests: to identify antibodies or
antigens related to specific infections such
as HIV and syphilis.
– Swabs: Samples from the genital, oral or
anal areas to test for STIs. Swabs are
commonly used for testing herpes,
chlamydia, gonorrhea and other infections.
 – Vaginal Fluid Tests: test for infections like
bacterial vaginosis, yeast infections and
trichomoniasis.
Imaging and Visualization:
– tests such as ultrasound or other imaging
techniques to examine the reproductive organs
for signs of infection or complications.
Pap Smear:
– A Pap smear is often used to screen for cervical
cancer, but it can also detect HPV, which is a
common STI linked to cervical cancer.
 Treatment
Bacterial Infections:
– Chlamydia: Chlamydia is usually treated with
antibiotics, such as azithromycin or doxycycline..
– Gonorrhea: Gonorrhea is treated with antibiotics
as well. However, due to increasing antibiotic.
Viral Infections:
– Herpes: While there is no cure for herpes, antiviral
medications like acyclovir, valacyclovir, and
famciclovir can help manage and reduce the
frequency and severity of outbreaks.
– Human Papillomavirus (HPV): There is no
cure for HPV, but the body's immune
system can often clear the infection over
time.
– HIV: Antiretroviral therapy (ART) is used to
manage HIV by suppressing viral replication,
allowing the immune system to recover.
 Trichomoniasis: Trichomoniasis is treated
with antibiotics, usually metronidazole or
tinidazole.
Syphilis:
– Syphilis is treated with antibiotics such as
penicillin.

It's crucial to complete the full course of

prescribed medications, even if symptoms
improve, to ensure that the infection is fully
treated.
Some potential complications associated with
different STIs:
Pelvic Inflammatory Disease (PID): Untreated
chlamydia and gonorrhea can lead to PID in
women.
Infertility: Several STIs including chlamydia
and gonorrhea can lead to scarring and
damage in the reproductive organs, potentially
causing infertility in both men and women.
Ectopic Pregnancy: Certain STIs, particularly
chlamydia and gonorrhea, can increase the
risk of ectopic pregnancies.
Cervical Cancer: Persistent infection with high-risk
strains of human papillomavirus (HPV) is a major
risk factor for cervical cancer
Neonatal Complications: Pregnant women with
certain STIs, such as syphilis and HIV, can pass the
infection to their baby during childbirth. This can
lead to serious health issues or even death in
newborns.
Chronic Liver Disease: Hepatitis B and C infections
can cause chronic liver inflammation, potentially
leading to cirrhosis and an increased risk of liver
cancer.
Neurological Complications: Syphilis, if left
untreated, can progress to later stages and
affect the nervous system.
Cardiovascular Complications: Untreated
syphilis can also lead to cardiovascular
complications, including aortic aneurysms and
heart valve damage.
Opportunistic Infections: In individuals with
compromised immune systems, are at the risk
of developing opportunistic infections.
Chronic Pain and Discomfort: STIs like herpes
and genital warts can cause chronic pain,
itching, and discomfort even after the acute
symptoms have subsided.
Social and Psychological Impact: STIs can
have psychological and social repercussions,
including stigma, shame, anxiety, and strained
relationships.
 Prevention
Abstinence: The most effective way to prevent
STIs is to abstain from sexual activity.
Barrier Methods: Proper and consistent use of
barrier methods, such as male and female
condoms.
Vaccination:
– HPV vaccine: Protects against certain strains
of human papillomavirus that can cause
genital warts and cervical cancer.
– Hepatitis B vaccine: Prevents hepatitis B
infection, which can lead to liver disease
and cancer.
Regular STI Testing: If sexually active,
especially with new partners, getting
regular STI testing is crucial.
Reducing the Number of Partners: Limiting
the number of sexual partners can reduce the
risk of exposure to STIs.
Personal Hygiene: Maintaining good personal
hygiene can help reduce the risk of infections.
Washing the genital area with mild soap and
water is generally recommended.