STIS & UTIS

INTRODUCTION

STIs are diseases that are sexually

transmitted.
Traditionally referred to as venereal
diseases.
Are caused by many organisms such as
bacterial, Viruses, Protozoan and Fungi

EPIDEMIOLOGY
Are mostly seen in sexually active age group.
Commoner among the poor, people of low
socio-economic class, migrant/mobile
populations such as long distant drivers and
Military personnel, High school students, etc.
Adolescents are one of the vulnerable groups
because they experiment what they hear
from their peers (Peer-group pressure).
Commoner in slum dwellers in big cities.

BURDEN OF STIS

STIs are of significant public health burden

because economic vibrant working group in
the population is affected. Productive
working hours is lost when the patient is
seeking treatment.
Of more importance is acquisition of
HIV/AIDS infection which is mostly acquired
by sexual route in this environment.

CLASSIFICATION

(i) Based on aetiological agent eg bacterial

STIs, Viral STIs, Fungi STIs, etc.
(ii) Based on clinical presentations eg genital
ulcer diseases (GUDs) and non-genital Ulcer
diseases (non-GUDs)

DETECTING STIS
(1) From the Patients history

Urethral discharge which may be of

acute onset (2-5 days after coitus), frank
or purulent discharge with painful
micturation (dysuria). These are features
of gonococcal urethritis in heterosexual
male. It is caused by Neisseria
gonorrhoeae, a Gram negative intracellular
diplococcoi. It has affinity for columnar
epithelia linings such as urethral
epithelium in males, cervix in females,
conjunctiva and the orophargnx in both
sexes. Trt= Single oral dose therapy to
ensure compliance (quinolones)

PATIENT HISTORY CONTD

Urethral discharge of long incubation

period (more than one week after sexual
intercourse). This may be associated with
early morning scanty urethral discharge
which comes up after straining (coughing,
defecation). There may be associated
mild dysuria. These are features of nongonococcal urethritis (NGU) seen in
heterosexual males. About 80% of NGU is
caused by Chylamidia trachomatis. This is
an obligate intracellular organism that has
both bacterial and viral properties. Trt =
Tab Doxycycline 100mg bid for 7-10 days

NGU CONTD
The remaining 20% is caused by the following
pathogens: Ureaplasma urealyticum, Herpes
simplex virus type II and Candida albicans.
While gonococcal urethritis is of acute onset
NGU is of chronic onset. Both can lead to the
same complications.
About 95% of urethritis in males are caused
by N. gonorrhoeae and C. trachomatis. The 2
pathogens respond to Azithromycin
(Zithromax). Prescribed in situations when
diagnosis is daisy especially in the absence of
laboratory facilities.

IN FEMALES

Vaginal discharge. Three disease entities that

frequently present as vaginal discharge are
candidiasis caused by (Candida albicans, a
fungus), trichomoniasis caused by
(Trichomonas vaginalis, a protozoa) and
bacterial vaginosis caused by Gardnerella
vaginalis, a bacterium.

In candidiasis; the discharge is watery white

or creamy and of thin or curdy consistency.
There is usually a history of dysuria and
dysparuenia. Examination may also reveal
vulval irritation and soreness. Here the
treatment is topic application of canesten,
nystatin cream or vaginal insertion of
pessaries. For recurring or systemic lesion
you prescribed Tab fluconazole (Difflucan).

In Trichomonas vaginitis, the discharge is

profuse, of lime green, or yellowish in colour
and frothy in consistency. The discharge is
foul smelling, with vulval irritation and
soreness. There is associated dysuria and
urgency.
Treatment: Metronidazole (Flagyl), Fasigyl

In bacterial vaginosis, the discharge is

brownish, watery and offensive with no
associated itching. Presence of clue cells is
diagnostic of the infection. Treatment is
combination of ampicillin and metronidazole.

PRESENCE OF ULCERS
Five commonly sexually acquired GUD are
Syphilis, Chancroid, lymphogranuloma
venereum (LGV), Granoloma inguinale and
Herpes genitalis. The clinical peculiarities
used to diagnose and to manage the
diseases are stated below.
In syphilis: The ulcer (Chancre) which is
usually single, painless, starts as a
papule, is of firm induration, round or oval
in shape with enlarged, non tender but
firm inguinal nodes. Treatment : Benzyl
penicillin.

CHANCROID

The ulcers start as pustule, multiple in

number, very tender, irregular with
undermined edges (hungry-looking) with
purulent or hemorrhagic secretions. The
enlarged inguinal nodes may coalesce and
suppurate to form bubo.
Treatment: oral co-trimoxazole with
aggressive wound dressing to prevent auto
amputation of the penis.
It is the commonest infectious cause of
auto amputation of the penis.

HERPES GENITALIS

The ulcer which may be multiple, starts as a

vesicle. This may coalesce to form a shallow
ulcer which is tender and will heal even
without treatment. The lesion will recur
after some time. There is associated
enlarged, firm, tender inguinal nodes.
Treatment: Acyclovir (sofirax). Symptomatic
treatment.

LGV

The ulcer is usually single, starts with

papule, is of variable shape and size with
tender, enlarged inguinal nodes which may
suppurate.
Treatment: Doxycycline and wound dressing

GRANULOMA INGUINALE

The ulcer which may be variable in number

starts as papule. It is of firm induration with
raised edges. The enlarged tender inguinal
nodes may from a pseudobubo.
Treatment: clo-trimoxazole, tetracycline

IN HOMOSEXUAL MALE

Homosexual male can have proctitis

(inflammation of the rectum and anal region)
and they are particularly prone to HIV
infection.
Females who practice oral sex (Fellatio)may
come down with gonococcal phargnitis
(hoarness of voice with associated
dysphagia).

ASSOCIATION BETWEEN STIS

AND HIV/AIDS

STIs have a strong association with HIV/AIDS.

It is a major co-factor in the sexual
transmission of HIV infection.
People with GUDs are about 100X at risk of
contacting HIV/AIDS.
Measures for preventing the 2 diseases are
the same also target audience for
intervention. Adolescents are particularly at
risk of contacting the 2 disease entities.

PRINCIPLES OF CONTROL OF
STDS

A combination of primary and secondary

preventive measures is the most effective
approach. Action should be taken at the level of
the agent, transmission and host.
Agent: eliminate the reservoir of infection (in
the human host). Give effective treatment to
identified patients and partners (eg, CSWs).
When appropriate tests cannot be performed
apply the syndromic approach method.
For HIV/AIDS, voluntary counselling.

PRINCIPLES OF CONTROL OF
STDS

Transmission: Discourage sexual promiscuity

(abstinence in young unmarried persons; fidelity
in partners; encourage stable family life);
provide affective control of prostitution; provide
local protection with condoms and genital
cleansing soon after sexual exposure.
Host: i) specific prophylaxis not yet available
with the exception of Hep B
ii). Early diagnosis and treatment; provide free
access to services. Apply syndromic approach if
diagnostic resources are limited.
iii). Do case detection by screening, tracing and
treating contacts

CONTROL OF HIV/AIDS

Occurrence: worldwide with high concentration

in Africa, and other developing countries.
Agent is HIV
Reservoir is man
Transmission; sexual contact; blood product
transfusion, contaminated sharps and needles;
mother to child transmission.
Control: education; safe blood supplies;
counselling; specific chemoprophylaxis

SUMMARY

What are STIs

Clinical and Laboratory presentation of STIs
Clinical importance of STIs
Management modalities available
Prevention of STIs

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