RTIs & STIs

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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 passed from one person to another through sexual contact.

RTIs

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

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HIV and AIDS

HIV AIDS

HIV is an STI
Transmitted through same behaviour (85% sexual route) Risk of STI = Risk of HIV

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Factor contributing to RTI/STI spread

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

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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

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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

Status of women in society Sexual violence Child marriages

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Why women are at a higher risk?

Biological differences Thin lining of vaginal mucosa Larger exposed area Genital fluids stay in contact 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

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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

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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

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Barriers Client side

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

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RTI/STI Control Strategies

Preventive Curative
Prevents complications

Effective management of STIs

Decreases spread and re-infection

Opportunity for patient education

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Implications for us (doctors)

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.

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To sum up .

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

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Common RTIs/STIs and their Complications

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Common sites for RTIs/STIs

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Common RTIs/STIs
Male and female Gonorrhoea HIV HBV

Chlamydia
Syphilis Chancroid

Scabies
Pubic lice Molluscum contagiosum

Genital herpes
Lymphogranuloma venerium Trichomonas Genital warts Candidiasis
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Common RTIs/STIs

Only in Males:

Epididymitis/Orchitis

Only in Females

Pelvic Inflammatory disease (PID) Bacterial vaginosis

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Symptoms and signs of RTIs/STIs in Men

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

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Symptoms and signs of RTIs/STIs in Women

Blisters/ulcers on the genitals, anus or surrounding area, mouth, lips Burning micturation Itching or tingling in genital area. Warts on genitals, anus or surrounding area. Fever, body ache, muscle ache, dark coloured urine, jaundice.

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Ways of classifying RTIs/STIs

According to causative organisms According to modes of transmission According to most common presenting symptoms

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According to causative organisms

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

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According to modes of transmission

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

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Complications in Men

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

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Complications inWomen

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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

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

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Systemic complications

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

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To sum up .

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.

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