SEXUALLY TRANSMITTED INFECTIONS (STIs)

Introduction Sexually Transmitted Infections (STIs) and their complications belong to the top five disease categories for which adults seek health care in developing countries, according to WHO. STIs are a major global cause of acute illness, infertility, long term disability and death., with severe medical and psychological consequences for millions of men, women and children. Unlike HIV, many STIs can be treated and cured relatively easily and cheaply if diagnosed early enough. From among the sexually transmitted infections, the most common treatable STIs are: Chlamydia, Gonorrhea, Trichomonas, and Syphilis. From among these, Syphilis causes the most concern. The Philippines is currently considered a low prevalence country for HIV/AIDS because of the comprehensive health promotion interventions that government and non-government organizations implemented in the Philippines. The HIV situation has been checked but current socioeconomic and political uncertainties increase the vulnerability of some segments of society to high-risk behavior such as prostitutions and drug use. Sexual intercourse is the leading mode of transmission of HIV in the Philippines and STI shares a lot of at-risk behavior and social factors with HIV infection like multiple sexual partners, unprotected sexual intercourse, penetrative anal intercourse and clientele of sex workers, and sharing needles for injecting drug use. Reports from sentinel sites indicate high number STI especially among these atrisk groups. Studies have shown that the presence of STIs increases the chance of a person of acquiring and transmitting the HIV infection by a factor of up to 10. These diseases should be treated in their early stage as these can become chronic, spreading through the body and causing irreversible damage. Experience from other countries show that aggressive syndromic treatment of STI during the early phase of an epidemic is a cost-effective measure to prevent HIV infection. STI control and HIV prevention have a very closely linked relationship especially in areas where there is a high incidence if STI. As of the present time, the proven most important method to prevent transmission of sexually transmitted infections in risky sexual encounters is the consistent and correct use of condom.

A. GONORRHEA
Causative Agent: Bacteria: Neisseria gonorrhea. Typically passed by direct contact between the infectious mucous membranes, e.g. genitals, anus. And mouth of one person with the mucous membranes of another. Contaminated fingers can pass the organism from infected mucous membranes to the eyes. Incubation: Usually 2-10 days, possibly 3 days or more Signs and Symptoms: Genitals (penis or cervix) , anus, throat, and eyes can be infected. Males: burning urination and pus discharges from infection of urethra (5-10% have no symptoms). Females: may have vaginal discharge although up to 80% have no

symptoms foe cervical infection of rectum; often no symptoms or mild sore throat for gonorrhea of the throat. Infection of eyes is rare in adults. Diagnosis Gram staining Culture of cervical & urethral smear

Treatment: as prescribed Complications: Pelvic inflammatory disease (PID), sterility in both sexes, arthritis, blindness, meningitis, heart damage, kidney damage, skin rash, ectopic pregnancy and eye damage in newborns ( acquired from mothers vagina during childbirth).

B. SYPHILIS ( Sy, bad blood, the pox)

Causative agent: Treponema pallidum. Passed by direct contact with infectious sore. Incubation: ten days to 3 months, with average of 21 days. Signs and Symptoms: Primary stage: painless chancre (sore) at site of entry of germs, swollen glands. Secondary stage: symptoms usually appear 1week to 6 months after appearance Of chancre and may include rash, patchy hair loss, sore throat, and swollen glands. Primary and secondary sores will go away even without treatment, but the germs continue to spread throughout the body . latent syphilis may continue 5-20+ years with no symptoms, but the person is no longer infectious to other people. A pregnant woman can transmit the disease to her unborn child (congenital syphilis).

Late syphilis: varies from no symptons indication of damage to body organs Such as the brain and heart and liver. Diagnosis Dark field illumination test Kalm test Treatment: Antibiotics as prescribed Complications: Severe damage to nervous system and other body organs possible after many Years: heart disease, insanity, brain damage and severe illness or death of Newborns. C. CHYLAMYDIA (Chylamydia: Chylamydia trachomatis)

Causative Agent: Chylamydia tranchomatis. Passed during sexual contact: infants can become Infected during vaginal delivery. Highly contagious. Incubation:2-3 week for males; usually no symptoms in females. Sign and Symptoms: Symptoms tend to develop slowly and are often mild. Many cases have no Symptoms. Females: Sometimes a slight vaginal discharge; itching and burning of vaginal, painful Intercourse; abdominal pain; fever in later stages. Males: Discharge from penis; Burning and itching of urethral opening; burning sensation During urination. Diagnosis; Difficult to diagnose. Culture test can determine disease, but many private Doctors and hospitals do not have it. Diagnosis is often by ruling out gonorrhea With appropriate test. A more rapid test involving microscopic examination of Discharge from urethra or cervix has been recently developed. Treatment: Antibiotics as prescribed. Complications: If untreated, can cause sterility , pre-maturity and stillbirths, infant pneumonia and eye infections in infants, which can lead to blindness. D. GRADIANELLA VAGINITIS ( Nonspecific Vaginitis) causative agent: Varies Signs and Symptoms: Most persons do not have any symptoms, especially rare in males. Female Symptoms many include a slight grayish or yellow odorous vaginal discharge and Mild itching or burning sensation. Diagnosis: Microscopic slide, chemical analysis of vaginal material and culture test from Infection site. Treatment: Curable with antibiotics and vaginal creams or suppositories. Compications: Recently, this condition has been associated with prematurity and other abnormal Pregnancy outcomes. E. TRICHOMONIASIS (Trich)

Causative agent: Protozoan-trichomonas vaginalis. Usually passed by direct sexual contact. Can Be transmitted through contact with wet objects, such as towels, wash clothes And douching equipment. Incubation: 4 to 20 days with average being 7 days. Signs and symptoms: Many women and most men have no symptoms. Females: white or greenishYellow odorous discharge; Vaginal itching and soreness, painful urination. Males: Slight itching of penis, painful urination, clear discharge from penis. Diagnosis: Microscopic slide of discharge; culture tests: examination. Treatment: Curable with an oral medication. Complications: Long-term effects in adults not known. There is some evidence that infected Individuals are more likely to develop cervical cancer. F. HAPATITIS B Introduction Hepatitis is a disease of the liver which can be caused by viruses, bacteria, Protozoa, toxic chemical, drugs and alcohol. There are several types of viral hepatitis namely: Hepatitis A,B, non A and non B, (C) and D (delta), C, E. Of these, hepatitis B, a sexually transmitted disease is considered to be the most serious due To the possibility of severe complication such as massive liver damage and Hepatocarcinoma of the liver. Sign and Symptoms Loss of appetite Easy fatigability Malaise Joint and muscle pain (similar to influenza) Low grade fever Nausea and vomiting Right-sided abdominal pain Jaundice (yellowish discoloration of skin and sclera) Dark-colored urine Mode of transmission a. From person to person through: Contact with infected blood through broken skin and mucous membrane of the mouth, the rectum and the genitals. Sexual contact via the vaginal and seminal secretion; Sharing of personal items with an infected person which may cause skin Break (razor, nail clipper, toothbrush, etc.)

b. Parent transmission through: Blood and blood product by transmission of blood from carriers and nonCarriers. Use of contaminated instrument for injection, ear piercing, acupuncture and Tattooing. Use of contaminated hospital and laboratory equipment such as dialysis Apparatus and others. c. Perinatal Transmission This can occur during labor and delivery through leaks across the placenta And can be precipitated by injury during delivery. It may also occur through Exposure of the infant to maternal secretions in the birth canal. High risk Groups to hepatitis B Infection Newborns, infants and children of infected mothers. Children in localities where the occurrence of hepatitis B cases is high. Sexual and household contacts of acute cases and carriers. Health workers exposed to handling blood/blood products as doctors, dentists, Nurses, medical technologists, technicians and other. Persons requiring/undergoing frequent blood/plasma transfusion such as hemophiliacs sexual promiscuous individuals as active heterosexuals and homosexuals. Commercial sex workers ( hospitality girls) Drug addicts using intravenous drugs Possible Outcomes of Hepatitis B Infections Most people get well completely and develop life-long immunity. Some people do not get well and the hepatitis B virus remains in their blood. They become carriers of the virus and can transmit the disease to others. Almost 90% Of infected newborns become carriers. About 25% Of These carriers Develop fatal liver complications in adult life. Preventive Measures Immunization with hepatitis B vaccine especially among infants and high groups With negative HB sag test. Wear protected clothing as gowns, mask , gloves, eye cover, when dealing with Blood semen, vaginal fluids and secretion. Wash hands and other skin areas immediately and thoroughly after contact with These fluids and after removing gloves and gowns. Avoid injury with sharp instrument as needle, scalpel, blades, etc. Use disposable needle and syringes only once and discard properly or sterilize Non-disposable needles and syringes before and after user. Sterilize instrument used for circumcision, ear holing tattooing, acupuncture And those used for minor surgical-dental procedures. Avoid sharing of toothbrush, razors and other instruments that can become Contaminated with blood. Observe safe sex practices such as: Have sex with only one faithful partner/spouse. Avoid sexual practices which may break the skin like anal intercourse. User condom properly. Make sure that blood and blood products for transfusion have been properly Screened for hepatitis B. Observe good person hygiene. Have adequate sleep, rest, exercise and eat adequate nutritious foods to build and maintain body resistance.

Management and Treatment There is no specific treatment. It depends on ones natural body resistance to combat the disease. Symptomatic and supportive measures as analgesic-antipyretic (pain and fever) are given. Care of the skin and good personal hygiene is advocated. A diet high in carbohydrates is usually advised. HIV/AIDS Human Immunodeficiency Virus Infection/Acquired Immune Deficiency Syndrome (HIV/AIDS) HIV / AIDS first occurred in Africa and spread to the Caribbean Islands. It was reported in the 1981 and cases were soon described in other countries. This sexually transmitted disease spread so rapidly that it soon occurred in epidemic proportion in several countries of the world including the Philippines. It is currently pandemic. The first case of AIDS in the Philippines was reported in 1984. As of May 2000, based on the Philippine National AIDS Council (PNAC) records, there were 1,385 HIV positive and 464 AIDs cases. There had been 206 deaths. Causative Agent: Retrovirus Human T cell lymphotrophic virus 3 (HTLV-3) Mode of Transmission Sexual Contact Blood Transfusion Contaminated syringes, needles, nipper, razor blades Direct contact of open wound/mucous membrane with contaminated blood, body fluids, semen and viginal discharges. Incubation Period: Variable. Although the time from infection to the development of detachable antibodies is generally 1-3 months, the time from HIV infection to diagnosis of AIDS has an observed range of less than 1 year to 15 years or longer. Signs and Symptoms A. Physical Maculo-papular rashes Loss of appetite Weight loss Fever of unknown origin Malaise Persistent diarrhea Kaposis sarcoma (skin cancer) Pneumocystis carinii pneumonia Gaunt-looking, apprehensive B. Mental Early Stage Forgetfulness Loss of concentration Loss of libido Apathy Psychomotor-retardation Withdrawal

Later Stage Confusion Disorientation Seizures Mutism Loss of memory Coma Diagnosis: Enzyme Linked Immuno-Sorbent Assay (ELISA) presumptive test Western blot-confirmatory test Prevention: Maintain monogamous relationship Avoid promiscuous sexual contact Sterilize needles, syringes and instruments used for cutting operations Proper screening of blood donors Rigid examination of blood and other products for transfusion Avoid oral, anal contact and swallowing of semen Use of condoms and other protective device. HIV/AIDS Prevention and Control Program: Goal: Contain the transmission of HIV/AIDS and other reproductive tract infections and mitigate their impact.

Objectives: 1. Contain the prevalence of HIV/AIDS among the general population less than one year (1) per 100,000 population by the end of 2010. 2. Contain the prevalence of HIV/AIDS among the pregnant women ages 15-24 years. 3. Contain the prevalence of HIV/AIDS among the high risk or more in less than 3% 4. Reduce the incidence of gonorrhea among the high risk of more vulnerable population. 5. Reduce the transmission of STIs in the general population among the vulnerable group by 12% or less. And condom use rate at least high risk sex by 80%. Responsibilities and Functions of the Community Health Nurse in HIV/AIDs Prevention/Control The responsibilities and functions of the community health nurse are mostly along prevention, casefinding and supportive-care during management of AIDS cases. The nurse must be well-informed of signs and symptoms as well as the mode of transmission of the disease in order to give effective health education. The following precautions are given for health workers dealing with AIDS patients: Extreme care must be taken to avoid accidental wounds from sharp instrument contaminated with potentially infectious material from AIDS patients. Avoid contact of open skin lesions with material from AIDS patient. Gloves should be worn when handling blood specimens. Bloodsoiled items, body fluids, excretions and secretions as well as all surface materials and objects exposed to them. Gowns should be worn when clothing may be soiled with bode fluids, blood, secretions or excretions. Hands should be washed thoroughly and immediately if they become contaminated with blood and after removing gowns and gloves and before leaving the rooms of suspected or unknown AIDS patient. Blood and other specimens should be labeled prominently with a special warning, such as AIDS Precautions Blood spills should be cleaned up promptly with a disinfectant solution such as sodium hypochlorine ( household bleach)

 Articles soiled with blood should be placed in an improvised bags labeled in bold letters. AIDS Precautions being processed. Instruments with lenses should be sterilized after use on AIDS patients. Needles should not be bent after use, but should be promptly placed in a puncture-resistant container used solely for such disposal. Needles should not be re-inserted into their original sheaths before being discarded into the container since this is a common cause of needle injury. Disposable needled and syringes are preferred. Patients with active AIDS should be isolated. Masks are not routinely necessary but are recommended only for direct, sustained contact with patients who are coughing profusely. Care of thermometer-wash with warm soapy water. Soak in 70% alcohol for 10 minutes, dry and store. The thermometer should be reserved for patient use only. Personal articles- toothbrush, razor and razor blades should not be shared with other family members. Used razor blades may be discarded in the same manner as disposable needles and syringes.