SHRI GUJARATI SAMAJ, INDORE

S. K. R. P. GUJARATI
HOMOEOPATHIC MEDICAL
COLLEGE,
HOSPITAL & RESEARCH CENTRE
DEPARTMENT OF COMMUNITY MEDICINE
2012-2013

Guided By: Submitted By:

Dr. Preeti Balwani
Rupal Agrawal
B. H. M. S. IV Proff.
SEXUALLLY TRANSMITTED
DISEASES (STD)

Problem & Epidemiology, Control

STDs : group of Communicable
Diseases

Mode of transmission:
Predominantly by Sexual Contact

Agents:
Bacterial, Viral, Protozoal, Fungal,
Ectoparasites.
 CAUSES FOR INCREASED
PREVALENCE
Increased promiscuity and multiple sex
partners
Better understanding of modes of
transmission
Better screening tests
Antibiotic resistance
Increasing DNA virus infection
 BACTERIAL AGENTS

N.gonorrhoea
Chlamydia trachomatis
Treponema pallidum
Haemophilus ducreyi
Mycoplasma hominis
Ureaplasma urealyticum
Calymmatobacterium granulomatis
Shigella Sps.
Campylobacter spp.
Group B streptococcus
Bacterial vaginosis-associated organisms
 VIRAL AGENTS

Human (alpha) herpesvirus 1 or 2

Human (beta) herpesvirus 5
Hepatitis virus B
Human papilloma virus
Molluscum contagiosum virus
Human immunodeficiency virus
 PROTOZOAL AGENTS

Entamoeba histolytica
Giardia lamlia
Trichomonas vaginalis
 FUNGAL AGENTS

Candida albicans

ECTOPARASITES

Sacrcoptes scabiei
Phthirus pubis
 PROBLEM STATEMENT

World: WHO estimated at least 340 million

new cases of STD other than HIV in 1999
Incidence: Bacterial STD:
Gonorrhoea: 62 millions
Genital chlamydial: 92 millions
Syphilis: 12 millions
Chancroid: 7 millions
Viral STD:
Genital herpes: 20 millions
Human Papilloma virus: 30 millions
Trichomonas vaginalis: 173 millions
INDIA: STD is a major health problem.
Syphilis: survey showed prevalence of 2.4%
positivity.
Gonorrhoea: More prevalent than syphilis
LGV: Higher in South India
Donovanosis: Endemic in Coastal areas
Chancroid: widely prevalent in India.
AGENT FACTOR
 HOST FACTORS

Age: Highest in 20-24 yrs, followed by

25-29; 15-19 yrs.
Sex: M > F
Marital status: Single, divorced,
separated
Socioeconomic status: Higher in Lower
groups
 DEMOGRAPHIC FACTORS:

Population explosion with increase in

number of young people.
Rural urban migration.
Higher educational opportunities for
women delaying their marriage.
 SOCIAL FACTORS

Prostitution- Acts as reservoir of infection

Broken homes- The promiscuous women are
drawn from broken homes.
Sexual disharmony- Married people with
strained relations, divorced & separated
persons are victims of STD.
Easy money- Prostitution provides an
occupation for earning easy money.
Emotional immaturity- Acts as a social factors
 Urbanization & industrialization- It includes
long working hours & relative isolation from
family.
Social stigma- It includes not disclosing the
sources of contact, dropping out before
treatment is complete.
 Social disruption- Caused by disaster, war have
caused increase in STD.
International travel- Travellers can import &
export infection.
Changing behavioural patterns- Includes ideas
of independence, freedom from supervision &
equal rights for both sexes.
CLINICAL FEATURES
 GONORRHEA INFECTION

Caused by Neisseria gonorrhoeae

Overall rates falling, but incidence in certain
groups remains high
Most common in the reproductive age group
(menarche to menopause)
Incubation period -2 to 10 days
Resistance to medication is an spreading
problem
 Gonorrhea Infections

Men: urethral infection, epididymitis.

Usually gives pain with urination and heavy,
thick penile discharge.
Women: cervical infection, PID.
have pain with urination, vaginal discharge
or bleeding.
Other sites of infection: throat, rectum, eye
Neonates: eye and skin infections.
 COMPLICATIONS IN WOMEN

Ectopic
9% pregnancy
Untreated 20-50% Acute PID
genital GC 18% Chronic
infection Silent PID pelvic pain

14-20% Infertility
 SYPHILIS

Caused by Trepenoma pallidum.

28 U.S. counties account for 50% of the
reported cases.
If not treated Syphilis can be very
dangerous and can cause brain damage
and other serious health problems.
 It causes ulceration of uro-genital tract,
mouth or rectum.
Other signs are skin eruption,
cardiovascular & nervous system
complication.
Distribution of the Organism
 Primary Syphilis

Photos: Dr. Joseph Engelman, San Francisco City Clinic

Rash of Secondary Syphilis
 CHLAMYDIA INFECTION

Most common reportable disease in the

U.S.
Estimated 3million cases annually.
Most infections are asymptomatic.
Leading cause of preventable infertility in women
or vertical transmission during child birth leads
to conjenctivitis in newborn.
Men : urethritis with possible epiddidymitis.
 Chlamydia Infections

Genitals Genitals Eye

(Urethritis) (conjunctivitis)
Cervicitis
(Epididymitis) Lungs
PID
Rectum(Proctitis) (pneumonia)
Urethritis Throat (Pharyngitis)
Eye (Conjunctivitis) Eye (Conjunctivitis)
Throat (Pharyngitis) Systemic
Rectum (Reiters Syndrome)
(Proctitis)
 TRICHOMONIASIS

Caused by Trichomonas vaginalis.

In women, causes yellow-grey discharge with
irritation and itching.
Causes adverse outcome in pregnancy like low
birth weight & premature rupture of membrane.
In men, usually gives no symptoms but can cause
urethritis.
 GENITAL HERPES

Caused by Herpes Simplex Viruses 2

Both symptomatic & asymptomatic
infections are common.
It can be recognized by presence of typical
papular lesions that progress to multiple
blisters & ulcers.
Asymptomatic shedding is well documented.
Major routes: sexual & mother-to-infant.
 Psychological Impact

A diagnosis of herpes can cause significant

psychological distress
Depression
Anger
Fear of rejection/discord in relationship
Fear of passing infection to sex partners or
infants
Frustration regarding lack of a cure
 CONTROL
The aim of control programme is the
prevention of resulting ill health through
prevention of infection & minimizing the
adverse health effects of infection.
It is done through:
Initial Planning
Intervention Strategies
Support components
Monitoring & Evaluation
 INITIAL PLANNING

Problem definition
Establishing priorities
Setting objectives
Considering strategies
 INTERVENTION
STRATEGIES
Case detection: Screening
Contact tracing
Cluster testing
Case holding & treatment
Epidemiological treatment
Personal prophylaxis: Contraceptives
Vaccines
Health education
 SUPPORT COMPONETNS

STD clinic
Lab services
Primary health care
Information system
Legislation
Social welfare measures
 MONITORING & EVALUATION
A critical aspect of effective management is the monitoring of disease trend &
evaluating programme activities.
HOMOEOPATHIC
THERAPEUTICS
 MERCURIOUS SOLUBILIS
Mercurius has a marked affinity for right side.
Herpes of right forearm, wrist & hand. Herpes
prepucialis of the right side extending across the
abdomen. There is itching which changes to burning
on scratching & shooting pains which are worse at
night & in cold damp weather. Herpetic eruptions
which are surrounded by small pimples. Herpes with
a tendency to suppurate especially in persons with
profuse sweat.
Nervous affections after suppressed discharges
especially in psoric patients.
 THUJA
Thin, watery, greenish discharge from the male
urethra with dysuria and sensation as if drops
trickled down the canal after urinating.
Severe cutting at close of urination, itching in the
urethra. Frequent micturation accompanying pains.
Desire sudden and urgent, which cannot be
controlled.
Fig warts gonorrhea.
Gonorrhea which has been mal-treated or
suppressed which has been treated by local
medication.
 SILICEA
Long standing cases of gonorrhea; slight, shreddy
discharge; gonorrhea, with thick, foeted pus,
especially after exertion. Dry herpes affecting the
chin. Eruptions are inclined to suppurate. Suited to
malnourished persons with unhealthy easily
suppurating skin.
NATRUM MUR
Chronic gonorrhea; gleet; discharge of yellow pus;
cutting pain in urethra.
 CANNABIS SATIVA
Gonorrhea, acute stage; urethra very sensitive;
burning while urination, extending to bladder;
stitches in urethra, with spasmodic closure of
sphincter.
HYDRASTIS
Gonorrhea acute or chronic; copious, persistent
discharge without pain or soreness in urethra,
discharge thick, yellow or green.
NITRIC ACID
Gonorrhea with chancres and warts; urethra
burns; smarting during urination; discharge from
urethra sometimes bloody.