PUBLIC HEALTH

ASPECTS OF
UROGENITAL SYSTEM
DISEASES
IRWIN ARAS
URINARY TRACT INFECTIONS
Overview ;
UTI is a common infection
Bacteria enter the opening of urethra
& multiply in the urinary tarct
Kidneys, ureters, bladder and urethra
UPJ prevent urine from backing up into
the kidneys
The flow of urine through the urethra
helps to eliminate bacteria
Men, women and children develop UTIs
Epidemiology ;
8-10 million people in US develop UTI
each year
Women develop the condition much
more often than men (US ; 20% and 20%
have a reccurence)
Rare in boys and young men
UTI more common in under the age of 2

URINARY TRACT INFECTIONS
Prevention ;
Avoid products that may irritate the
urethra
Always cleanse the genital area
Drink plenty of water
Do no routinely resist the urge to
urinate
Women and girls should wipe from
front to back after voiding
URINARY TRACT INFECTIONS
URINARY TRACT STONES
Overview ;
Stones (calculi) are hardened
mineral deposits that form in the UT
When waste materials in the urine
do not dissolve completely, crystals
and UT stones are likely to form
Stones can cause some discomfort
or severe pain as they pass out of
the body
URINARY TRACT STONES
Overview ;
A lodged stone can block the
flow of urine
Etiology and location varies
around the world;
West : upper tract and of ca-
oxalate or struvite composition
Developing : lower tract and of
ca-oxalate and ammonia acid
urate.
URINARY TRACT STONES
Epidemiology ;
Greeks and Romans recorded urolithiasis as
early 4800 BC
Common disorder affecting 0.2% of
population
More commons in males 3 : 1 ratio
URINARY TRACT STONES
Epidemiology ;
US National Institutes of Health ; 1 person in
10 develops kidney stones
Renal stones disease accounts for 7-10 of
every 1000 hospital admission
Most prevalent in between the ages of 30 and
45, and decline after age 50
Prevention ;
Drink plenty of water to dissolve waste
products
Avoid water contain high calcium
Prevent from UTI

URINARY TRACT STONES
ORCHIO-EPIDIDYMITIS
(Epididymo-orchitis)
Overview ;
OE is an inflammation of the epididymis and
the testicle
Chronic epididymitis refers to epididymal
pain and inflamation (usually without scrotal
swelling)
Hippocrates first described mumps orchitis
during the fifth century BC
ORCHIO-EPIDIDYMITIS
(Epididymo-orchitis)
Epidemiology ;
In the US ; estimated 1 in 1000 men is affected
yearly. More than 600,000 medical visits /year for
acute epididymitis (AE)
In the UK ; 13,000 medical visits /year for acute
epididymitis
OE have no predilection for any racial or ethnic
group
AE most commonly occurs in patient aged 15-30
years older than 60 years.
Mumps orchitis occurs in 20-40% of postpubertal
boys with the mumps, it is rare in prepubertal boys

ORCHIO-EPIDIDYMITIS
(Epididymo-orchitis)
Prevention ;
Prevent from UTI
Avoid the scrotum from trauma ; a
precipitating event
Get health sex ; prevent from STDs
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Autoimmune rheumatic disease
Commonly effects the skin &
musculoskeletal systems
but can affect every organ
Kidney
Heart
Lungs
The Central Nervous System
Epidemiology
Estimated incidence of lupus in kids under 15
yrs is 6 per 100,0003
Incidence varies with racial origin (1:250 in
black American women)
Sex ratio in childhood SLE varies to that of
adults (more boys than girls in paeds, 9 times as
common in women as men)
? Genetic component (related to
incidence/area) Twins study
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

The name of this group of diseases was changed from
venereal diseases to sexually transmitted
diseases or STDs

Now many persons call them sexually transmitted
infections or STIs.

A STI is an infection that is transmitted through
sexually activity


SEXUALLY TRANSMITTED DISEASE (STD)
SEXUALLY TRANSMITTED DISEASE (STD)
Overview ;
A disease caused by pathogen (e.g., virus, bacterium,
parasite, fungus) that is spread from P to P primarily
through sexual contact
STDs can be painful, irritating, debilitating and life-
threatening
More than 20 STDs have been identified
A person infected with an STD is more likely to
become infected with HIV, and a person infected
with HIV and another STD is more likely to transmit
HIV

STDs are a Significant Problem
The consequences of untreated STDs
Ectopic pregnancy (7-10 times increased risk in
women with history of PID)
Increased risk of cervical cancer
Chronic abdominal pain (18% of females with a
history of PID)
Source: Lande 1993.
SEXUALLY TRANSMITTED DISEASE (STD)
STDs are a Significant Problem
Infertility:
20-40% of males with untreated chlamydia and
gonorrhea
55-85% of females with untreated PID
(8-20% of females with untreated gonorrhea
develop PID)
Increased risk of HBV and HIV/AIDS transmission
Source: Lande 1993.
SEXUALLY TRANSMITTED DISEASE (STD)
SEXUALLY TRANSMITTED DISEASE (STD)
Epidemiology ;
Occur most commonly in sexual active in teenagers
and young adults (especially with multiple sex
partners)
An estimated 200-400 million people worldwide are
infected
Representing men and women of all economic class
In the US, more than 13 million people are infected
each year

SEXUALLY TRANSMITTED DISEASE (STD)
Prevention ;
Sexual abstinence is the only 100% effective method to prevent
sexually transmitted diseases
MONOGAMY WITH AN UNINFECTED PARTNER
The risk for transmission is dramatically reduce with the use of
condoms
STDs and Family Planning; What Can Be Done:
Most STDs (e.g., gonorrhea, syphilis) can be
treated.
All STDs can be prevented.
If not prevented, early diagnosis and treatment
can decrease the possibility of serious
complications such as infertility in both women
and men.
SEXUALLY TRANSMITTED DISEASE (STD)
A Final Word on STI control
Contraceptive pills and injections and
surgery for preventing pregnancy
DO NOT PREVENT TRANSMISSION OF STIs !
SEXUALLY TRANSMITTED DISEASE (STD)
One of many reasons why STI
control is difficult is that many
persons have these infections or
are carrying the micro-
organisms without knowing it


HIV/AIDS
Background
AIDS first recognized in US in 1981
Homosexual males in large cities diagnosed with
Pneumocystis carinii pneumonia (PCP) and Kaposis
Sarcoma (KS)
Syndrome soon recognized in hemophiliacs, injection
drug users, children of high-risk mothers
AIDS patients presented with a marked decrease of
CD4-positive T-helper lymphocytes which left them
susceptible to opportunistic infections and neoplasms

HIV/AIDS
40 million people globally living with HIV

HIV/AIDS is #1 cause of death in sub-Saharan Africa and
#4 killer worldwide

Tuberculosis is most common opportunistic infection in
developing countries; PCP is most common in
industrialized countries

Majority of new infections occur in young adults, 1/3 of
HIV infected are aged 15-24; most do not know they
carry virus
Transmission
HIV present in blood, semen, vaginal
secretions, breast milk, saliva and
tears

Modes of Transmission
sexual contact with an infected
person
sharing needles and/or syringes
blood transfusions with infected
blood
mother to child before or during
birth or through breast feeding

There is evidence that higher viral
loads may be associated with
increased risk of heterosexual
transmission of HIV-1
HIV does not survive well
outside of the human body
and cannot replicate outside
of a host cell!!!
Sexual Transmission
Predominant mode of transmission
worldwide is heterosexual contact
Factors that facilitate sexual transmission
Pre-existing STD
Ignorance of HIV status
Sexual mixing
Low levels of male circumcision
Lack of treatment to suppress viral load- more
infectious
Mother to Child Transmission
Accounts for 15-25% of all new infections
Occurs before, during, or after birth (breast
feeding)
High maternal virus load may increase
probability of transfer


Monitoring and Surveillance
Reporting of AIDS cases is primary surveillance tool
AIDS is reportable disease in all states
HIV is only reportable in 38 states
34 name-based, 4 unique identifier; controversial
Only document cases as they transition from HIV+ status
to AIDS
Cannot directly calculate incidence of HIV infection- cannot
predict epidemic
Simulation modeling used instead
After antiretroviral therapy introduced, development of
AIDS delayed
AIDS case reporting no longer reflected the true epidemic


CDC AIDS Case Definition
Current CDC case definition:
all HIV-infected adults and adolescents with a
CD4 T-cell count below 200 or who have been
diagnosed with pulmonary tuberculosis, invasive
cervical cancer, recurrent pneumonia, HIV
encephalopathy, chronic isosporiasis,
disseminated histoplasmosis, wasting syndrome,
or other conditions.
CDC AIDS Case Definition
The AIDS case definition and competing interests:
Surveillance purposes:
definition should be sensitive and specific, but it should
also be consistent over time.
For public health service providers:
the number of AIDS cases in a region affects federal funding
allocations, and the completeness of case reporting is an
important consideration.
Patient's point of view:
the most important consideration is obtaining access to care
and services, some of which depend on meeting the case
definition, without exposure to possible negative social
consequences from being identified as an AIDS case.
Prevention and Control
Education campaigns launched by CDC
Behavior interventions:
school-based programs
peer-to-peer interventions
strategies that limit needle sharing
strategies that use parent-to-child communication
Routine counseling and voluntary testing of
pregnant women for HIV and offering zidovudine to
infected women and their infants
Highly active antiretroviral therapy

Integrated Disease Management Program
HIV vaccine???
Microbicide for women that is safe and
effective in reducing transmission of HIV
Ensure sustained access to HIV tests,
preventive and treatment services
Continue education and behavior
intervention


HIV/AIDS in sub-Saharan Africa
28.1 million people living with HIV/AIDS in this
region
8.4% of adult population living with HIV/AIDS
55% of the HIV positive adults are women
92% of the worlds AIDS orphans live in this region
77% of the global total of AIDS deaths occur here
68% of new HIV infections in 2001 occurred in this region
population only accounts for 10% of the global
population!!!

Social Factors Fueling Epidemic
High prevalence of other STDs
facilitates transmission of HIV
Stigma and fatalism around AIDS
Ignorance of HIV status
Low levels of male circumcision
uncircumcised males more likely to transmit HIV
Women infected younger and at higher rates than men.
Many young girls have sex with older men
Rape
Domestic violence
Subordinate sexual and economic status
Sex work for money
Lack of female-controlled preventive measures
Political and Economic Effects
Skilled workers are dying
teachers, health care workers, agricultural
workers, military
Migration
regular commuting for work as well as due to
political instability, environmental disasters,
etc.
Weak health infrastructures
Lack of access to treatment
Antiretrovirals not affordable

Monitoring and Surveillance

The UNAIDS/WHO Working Group on Global
HIV/AIDS/STI Surveillance
WHO Regional offices collect information
Info. compiled in a global database for analysis
Info. disseminated through global reports and
publication
Data used to produce an HIV Epi Fact Sheet for each
individual country- contains the most updated
information relevant to HIV, including demographic,
social, behavioral and STI data
Monitoring and Surveillance
The WHO AIDS surveillance case definition:
At least two of the major signs :
weight loss equal to 10 percent or more of body weight,
chronic diarrhea for over one month, and prolonged fever
for over one month
At least one of the minor signs:
persistent cough for over one month, history of herpes
zoster, chronic progressive or disseminated herpes simplex
infection, and generalized lyphadenopathy
The presence of Kaposi sarcoma or cryptococcal
meningitis is also sufficient for an AIDS diagnosis under
this definition

Prevention and Control

Must take cultural factors into account
Condom distribution
Education campaigns
Vaccine trials underway

Integrated Disease Management Program
STD Treatment
Antiretroviral Treatment
Access to condoms
Female condoms/microbicides
Behavior change communication/education
Increased access to HIV testing
Antiretroviral therapy during pregnancy and for
neonate
Mothers counseled not to breast feed if safe
alternatives to breast feeding exist
Needle exchange or bleach
HIV vaccine???
MAKASSAR, FEB 6 2006