RTIs & STIs

M2/1

Definitions 



Reproductive Tract Infections (RTIs): Any infection of reproductive tract in male and female

Sexually Transmitted Infections (STIs): STIs are infections caused by germs such as bacteria, viruses, or protozoa that are ed from one person to another through sexual .

RTIs 





M2/4

RTIs in both men and women include:  STIs RTIs in women also include:  Disruption of normal vaginal flora (candida and bacterial vaginosis)  Postpartum and postabortion infections  Infections following procedures (e.g. IUD insertion)

RTIs in men also include:  Prostatitis and epididymitis

HIV and AIDS 

HIV



AIDS



HIV is an STI



Transmitted through same behaviour (85% sexual route)



Risk of STI = Risk of HIV

M2/5

Factor contributing to RTI/STI spread       



M2/9

Human behaviour Lack of access to healthcare Lack of awareness about STIs Migrating population Healthcare providers not adequately trained Poor medical services Hygiene and environmental factors Hormonal and other factors

High risk & Vulnerable groups High risk groups  Women who have multiple partners  Sex workers and their clients  Men and women who has to stay away from families for long  Men having sex with men including transgender  Partners of various high risk groups

Vulnerable groups  Adolescent boys and girls  Street children M2/10

Factors increasing risk of transmission 





Biological  Age  Sex  Immune status Behavioural  Personal sexual behaviour  Other non-sexual personal behaviour  Even without any risk behaviour Social   

M2/11

Status of women in society Sexual violence Child marriages

Why women are at a higher risk? Biological differences  Thin lining of vaginal mucosa  Larger exposed area  Genital fluids stay in for longer time  Young women- Immature genital tract, cervical ectopy  Symptoms less reliable indicator  Use of vaginal douches  Influence of hormonal contraceptives  Different sociocultural norms for men and women 

M2/12

RTIs/STIs – A Public Health Problem 

Major cause of ill health in country



Cause serious complications in men and women



Increases risk of HIV transmission



Responsible for reproductive loss



Increases cost to health system

M2/13

Barriers – System and providers side Failure to recognize magnitude  Not all seek treatment form trained providers  Overemphasis on lab based diagnosis  Irrational use of drugs  No standardized treatment regimen by all providers  Less emphasis on patient education and counseling  Specialized clinics carry stigma 

M2/17

Barriers – Client side 

  

  



M2/18

Lack of knowledge Misconceptions Asymptomatic infections Where to go/Knowledge about service sites Reluctance to discuss sexual matters Stigma Fear of judgmental attitude of providers Reluctance for physical examination

RTI/STI Control Strategies 



Preventive Curative Prevents complications

Effective management of STIs

Decreases spread and re-infection

M2/23

Opportunity for patient education

Implications for us (doctors) …… 





M2/24

RTI/STI control needs both curative as well as preventive strategies working in tandem. We (the doctors) can play a major role in addressing either strategies. We must keep in mind the strong link between STIs and HIV while managing any RTI/STI case.

To sum up …. 





 

M2/16

RTIs/STIs are a major public health problem in India They cause serious complication in men, women and newborn Affect disease and financial burden to country There is a strong link between STIs and HIV There are bottlenecks in implementation and unless addressed quality services can't be provided

Common RTIs/STIs and their Complications

M3/1

Common sites for RTIs/STIs

M3/3

Common RTIs/STIs  Male and female

 HIV

 Gonorrhoea

 HBV

 Chlamydia

 Scabies

 Syphilis

 Pubic lice

 Chancroid

 Molluscum contagiosum

 Genital herpes  Lymphogranuloma venerium  Trichomonas  Genital warts  Candidiasis M3/4

Common RTIs/STIs 

Only in Males: 



Epididymitis/Orchitis

Only in Females

Pelvic Inflammatory disease (PID)  Bacterial vaginosis 

M3/5

Symptoms and signs of RTIs/STIs in Men    



   M3/6

Urethral Discharge Burning or pain during micturation or urination. Genital Itching Inguinal swelling/Scrotal Swelling /swollen and painful testicles Blisters or ulcers on the genitals, anus or surrounding area, mouth, lips Itching or tingling in genital area. Warts on genitals, anus or surrounding area. Fever, body ache, muscle ache, dark coloured urine, jaundice.

Symptoms and signs of RTIs/STIs in Women 

Unusual Vaginal Discharge



Genital Itching



Abnormal and/or heavy vaginal bleeding



Dyspareunia

 M3/7

Lower abdominal pain (pain below the belly button, pelvic pain)

Symptoms and signs of RTIs/STIs in Women 



Burning micturation



Itching or tingling in genital area.



Warts on genitals, anus or surrounding area.

 M3/8

Blisters/ulcers on the genitals, anus or surrounding area, mouth, lips

Fever, body ache, muscle ache, dark coloured urine, jaundice.

Ways of classifying RTIs/STIs

M3/10



According to causative organisms



According to modes of transmission



According to most common presenting symptoms

According to causative organisms 









M3/11

Bacterial:  Examples: Gonorrhoea, Chlamydia, syphilis Viral:  Example: Herpes, HPV, HIV Protozoal:  Example:Trichomonas Fungal:  Example: candidiasis Mixed:  Example:PID, epididymitis

According to modes of transmission 





M3/12

Endogenous infection:  Examples: yeast infection, vaginosis Sexually Transmitted Infections:  Examples: Gonorrhoea, chlamydia, syphilis Iatrogenic Infections:  Examples: PID following abortion or transcervical procedure

Complications in Men 

  

 

M3/13

Urethral stricture Phimosis/paraphimosis Disfigurement of genitals Infertility Cardiovascular complications (syphilis) Neurosyphilis

Complications inWomen 

  

  

  M3/14

Pelvic Inflammatory Disease (PID) Infertility Ectopic pregnancy Spontaneous abortions Stillbirths Low birth weight babies Increased susceptibility to opportunistic infections Cervical cancer Chronic pelvic pain

Complication in neonates      

M3/11

Congenital eye infections – Syphilis, Chlamydia, gonorrhea Sepsis Arthritis Meningitis Infant pneumonias Mental retardation

Systemic complications       

M3/15

Gastrointestinal: Proctitis, proctocolitis Renal: Acute membranous granulonephritis Neurological: GPI, Tabes dorsalis Cardiovascular: Myocarditis, aortitis Ophthalmic: Iritis, coroidoretinitis Musculoskeletal: Osteomyelitis, arthritis Septicemia

To sum up ……. 



M3/16

The RTIs/STIs  occur both in men and women , infect the reproductive organs.  Classified according to the causative organisms and modes of transmission.  Classification by presenting symptoms is practical for providers in easy and quick syndromic diagnosis management of STIs.  Besides HIV infection, many other dreaded complications of STIs in men, women and neonates. Therefore, the healthcare providers must not waste any opportunity of treating RTIs/STIs at the first visit.