STIs - Sexually transmitted infections

STIs (Sexually transmitted infections )

INTRODUCTION

Sexually transmitted infections or sexually transmitted infections (STIs) is a disorder / disease that is transmitted from one person to another through sexual contact or genito either genital, oro-genital and ano-genital.

STIs are caused by many pathogenic microorganisms and remains a major public health problem in much of the world. Failure in terms of diagnosing and treating STIs at an early stage, will lead to serious complications and sequelae, including infertile, kehmilan ectopic, anogenital cancer, and premature death, as well as neonatal and infant infections.

World Health Organization (WHO) estimates that 340 million new cases of syphilis, gonorrhea, trichomoniasis klamidiadan happening around the world in the year 19995. Indonesia increased every year, research conducted saifuddin.AB, STIs is most often found in Indonesia is IGNS (36.66%) 6. While in Aceh on research conducted Aulia M, found cases of STIs in the year 2008 - 2010 amounted to 113 cases.

Emergence HIV and AIDS have focused greater attention on controlling STIs3. There is a strong relationship between the spread of STIs and HIV transmission, and the type of ulcerative STIs and non-ulcerative both been found to be an increased risk of sexual HIV transmission. The emergence of the spread of HIV and AIDS infekis also cause difficulties in the management of STIs and various complications arise. For example, due to immunosuppression caused by HIV, treatment becomes more difficult especially in the areas with a high prevalence of HIV infection. Antimicrobial resistance in some pathogens become increasingly prevalent STIs. New agents, such as third-generation cephalosporins and fluoroquinolones, capable of treating infection by resistant strains, antimicrobial is available but expensive. however, the high initial costs should consider the possibility of inadequate treatment, including complications, relapse and further spread of infection.

Prevention and control of STIs is based on five key strategies as follows: 1) education and counseling to people who are at risk for ways to avoid STIs through sexual behavior change;  

2) identification of asymptomatically infection in people without symptoms to seek diagnostic and treatment;  

3) effective diagnosis and adequate treatment of the infected person;

4) evaluation, treatment, and counseling of sex partners of people infected with STIs, and

5) preexposure vaccination of persons at risk of STIs.

DEFINITION

Sexually transmitted infections or sexually transmitted infections (STIs) is a disorder / disease that is transmitted from one person to another through sexual contact or intercourse either genito genital, oro-genital and ano-genital.

Epidemiology

World Health Organization (WHO) estimates that 340 million new cases of syphilis, gonorrhea, trichomoniasis klamidiadan happening around the world in 1999 in men and women aged 15-45 years. The largest number of infections occurred in the south and south east asia, followed by sub-Saharan Africa and Latin America as well as karibia.

Almost all patients with STIs in Indonesia every year there is an increase, it can be seen from the results of research conducted by saifuddin.AB, STIs are most often found in Indonesia is IGNS (36.66%) followed by candidiasis (22.00%), condiloma acuminata (9.47%), gonorhe (7.00), genital herpes (2.48%), syphilis (2.33%), and HIV (0.1%) .

Meanwhile in Aceh on a study conducted by aulia M, on dr.Zainoel Abidin General Hospital in Banda Aceh obtained in cases of STIs 2008 - 2010 amounted to 113 cases, 20 cases in 2008, 36 cases in 2009 and 56 cases in 2010. STIs are most often found in RSUDZA is gonorrhea (40.7%) .

Overall it can be seen that many factors can affect the increasing incidence of STIs, among others: the extraordinary demographic changes, changes in attitudes and actions, abnormalities in the delivery of health education, especially sex, feeling safe in patients due to use of antiboitik and contraception, emerging antibiotic resistance , inadequate health facilities, many of his cases asimtomatik.

Etiology

Sexually transmitted infections or sexually transmitted infections (STIs) are caused by many pathogenic microorganisms (Table 1)

Table 1 Sexually Transmissible Pathogens and Associated Disease Syndromes2

Pathogen Bacteria	Associated Disease or Syndrome
Neisseria gonorrhoeae	Urethritis, epididymitis, proctitis, cervicitis, endometritis, salpingitis, perihepatitis, bartholinitis, pharyngitis, conjunctivitis, prepubertal vaginitis, prostatitis, accessory gland infection, disseminated gonococcal infection (DGI), chorioamnionitis, premature rupture of membranes, premature delivery, amniotic infection syndrome
Chlamydia trachomatis	All of the above except DGI, plus otitis media, rhinitis, and pneumonia in infants, and Reiter’s syndrome
Ureaplasma urealyticum	Nongonococcal urethritis (NGU)
Mycoplasma genitalium	(?) Nongonococcal urethritis
M. hominis	Postpartum fever, salpingitis (?)
Treponema pallidum	Syphilis
Gardnerella vaginalis	Bacterial (“nonspecific”) vaginosis (in conjunction with Mycoplasma hominis and vaginal anaerobes, such as Mobiluncus spp.)
Mobiluncus curtisii	Bacterial vaginosis
M. mulieris	Bacterial vaginosis
Haemophilus ducreyi	Chancroid
Calymmatobacterium granulomatis	Donovanosis (granuloma inguinale)
Shigella spp.	Shigellosis in men who have sex with men (MSM)
Campylobacter spp.	Enteritis, proctocolitis in MSM
Helicobacter cinaedi	(?) Proctocolitis; dermatitis, bacteremia in AIDS
H. fenneliae	(?) Proctocolitis; dermatitis, bacteremia in AIDS
Viruses
HIV-1 and -2	HIV disease, AIDS
HSV types 1 and 2	Initial and recurrent genital herpes, aseptic meningitis, neonatal herpes
HPV	Condyloma acuminata; laryngeal papilloma; intraepithelial neoplasia and carcinoma of the cervix, vagina, vulva, anus, penis
Hepatitis A virus (HAV)	Acute hepatitis A
Hepatitis B virus (HBV)	Acute hepatitis B, chronic hepatitis B, hepatocellular carcinoma, polyarteritis nodosa, chronic membranous glomerulonephritis, mixed cryoglobulinemia (?), polymyalgia rheumatica (?)
Hepatitis C virus (HCV)	Acute hepatitis C, chronic hepatitis C, hepatocellular carcinoma, mixed cryoglobulinemia, chronic glomerulonephritis
Cytomegalovirus (CMV)	Heterophil-negative infectious mononucleosis; congenital CMV infection with gross birth defects and infant mortality, cognitive impairment (e.g., mental retardation, sensorineural deafness); protean manifestations in the immunosuppressed host
Molluscum contagiosum virus (MCV)	Genital molluscum contagiosum
Human T cell lymphotrophic virus (HTLV-I)	Human T cell leukemia or lymphoma, tropical spastic paraparesis
Human herpes virus type 8 (HHV-8)	Kaposi’s sarcoma, body cavity lymphoma, multicentric Castleman’s disease
Protozoa
Trichomonas vaginalis	Vaginal trichomoniasis, NGU
Entamoeba histolytica	Amebiasis in MSM
Giardia lamblia	Giardiasis in MSM
Fungi
Candida albicans	Vulvovaginitis, balanitis
Ectoparasites
Phthirus pubis	Pubic lice infestation
Sarcoptes scabiei	Scabies

SOURCES: Adapted from W Cates, Jr, KK Holmes, in JM Last, RB Wallace (eds): Maxcy-Rosenau-Last, Public Health and Preventive Medicine, 14th ed. Norwalk, CT. Appleton & Lange, 1998, pp 137–155; and KK. Holmes, HH Handsfield, in A Fauci, E Braunwald, KJ Isselbacher, JD Wilson, JB Martin, DL Kasper, SL Hauser, DL Longo (eds): Harrison’s Principles of Internal Medicine, 14th ed. New York, McGraw-Hill, 1998.

ISEASE TYPE STIs

Disease with characteristics of urethral discharge Patients complain men are urethral discgarge or dysuria should be checked with certainty until we find a visible discharge. If there is no current inspection. Perform the massage technique of ventral penile urethra toward the meatus. Discharge is then examined microscopically. If it shows an increase in the number of polymorphonuclear leukocytes and Gram staining showed gonococci. In men, more than 5 polymorphonuclear leukocytes per high power fi eld (x1000) indicates urethritis. The main pathogenic microbes that cause urethral discharge are Neisseria and Chlamydia Trachomatis gonnorrhoeae. In syndromic management, treatment of patients with urethral discharge should adequately cover two organism. Where a reliable laboratory facilities are available, a distinction can be made between the two organisms and specific treatment can taken.

Table 2. Therapeutic recommendations on the urethra discharge .

Treatment options for Gonorrhoea	Treatment options for Chlamydia
Ciprofloxacin	Doxycycline
Ceftriaxone	Azithromycin
Cefixime
Spectinomycin
Alternatives
Amoxycillin
Erythromycin (if Tetracycline contraindicated)
Ofloxacin
Tetracycline

Note

■ Patients should be advised to return if symptoms persist 7 day after the start of therapy.

■ WHO recommends the use of single-dose therapy With genital ulcer disease characteristics

The prevalence of genital ulcer-causing organisms vary in different parts of the world and dramaris changed from time to time. Differential clinical diagnosis of genital ulcer inaccurate, especially in determining multiple etiologies that often causes genital ulcers. Clinical manifestations and patterns of genital ulcers may be more change if accompanied by infection HIV8. After examination for mengkomfirmasi the genital ulcers, treatment appropriately to causa cause with adequate antimicrobial administration should immediately diberikan9. In areas where syphilis and chancroid are common, patients with genital ulcers should be managed as both conditions gejala3 start at the beginning, to ensure adequate therapy in case of loss to follow-up. In the area of ​​either granuloma inguinala or lymphogranuloma venereum (LGV) are common, treatment for one or both conditions must be included for reasons sama10. Recent reports from parts of Africa, Asia and Latin America show that more frequent genital ulcers caused by HSV-211 pathogen infection.

Table 3. Recommendations on ulcer therapy genitalia

Drug options for syphilis	Drug options for chancroid	Drug options for granuloma inguinale	Drug options for LGV	Drug options for genital herpes
Benzathine benzylpenicillin	Ciprofloxacin Azithromycin Erythromycin	Azithromycin Doxycycline	Doxycycline Erythromycin	Acyclovir Valaciclovir Famciclovir
Alternatives	Alternatives	Alternatives	Alternatives	Alternatives
Procaine benzylpenicillin	Ceftriaxone	Erythromycin Tetracycline Trimethoprim/ sulfamethoxazole	Tetracycline
Penicillin allergy and non-pregnant
Doxycycline Tetracycline

Disease with characteristic Vaginal Discharge

Vaginitis is usually characterized by vaginal discharge and / or vulvar itching and irritation, as well as common vaginal odor. The three diseases most frequently associated with vaginal discharge is bacterial vaginosis (change of normal vaginal flora by an overgrowth of anaerobic microorganisms, mycoplasmas, and Gardnerella vaginalis), trichomoniasis (T. vaginalis), and candidiasis (caused by Candida albicans). Cervicitis can sometimes cause vaginal discharge discharge. Although vulvovaginalis candidiasis (VVC) usually is not transmitted sexually, but is included in section because STIs are diagnosed in women being evaluated for STIs. Various diagnostic methods are available to identify the etiology of vaginal discharge. Laboratory testing failed to identify the cause of vaginitis in a minority of women. The cause of vaginal symptoms can usually be determined by pH and microscopic examination. The pH of the vaginal fluid can be determined with pH paper; higher pH (ie,> 4.5) is usually caused by bacterial vaginosis or trichomoniasis but may not be very specific. Discharge can be further examined by diluting one sample in one to two drops of 0.9% normal saline solution on one slide and a second sample with a solution of potassium hydroxide (KOH) 10%. Amine odor detected immediately after applying KOH suggests Bacterial vaginosis. Cover examined under a microscope. Motile T. vaginalis or clue cells (epithelial cells with borders obscured by small bacteria), which is characteristic of Bacterial Vaginosis, usually identified easily in the saline specimen. WBCs without evidence of trichomonads or yeast usually indicate cervicitis. Yeast or pseudohyphae of Candida species more easily identified in specimens KOH2. However, the absence of trichomonads or pseudohyphae not rule out this infection because several studies have shown the presence of pathogens in culture or PCR after a negative microscopic examination. Presence of objective signs of vulvar inflammation in the absence of vaginal pathogens, along with a minimal amount of discharge, suggests the possibility of non-infectious irritable mechanical, chemical, allergic, or others of the vulva. culture for T. vaginalis is more sensitive than microscopic examination.

Table 4. Therapeutic recommendations on discharege vagina

Drug options for BV	Drug options for T. Vaginalis	Drug options for candida
Metronidazole	Metronidazole	Miconazole
	Tinidazole	Clotrimazole
		Fluconazole
Alternatives		Alternatives
Clindamycin		Nystatin
Metronidazole gel
Clindamycin vaginal cream

CLINICAL GUIDELINES FOR PREVENTION

Prevention and control of STIs is based on five key strategies as follows:

1) education and counseling to people who are at risk for ways to avoid STIs through sexual behavior change;

2) identification of asymptomatically infection in people without symptoms to seek diagnostic and treatment;

3) effective diagnosis and adequate treatment of the infected person;

4) evaluation, treatment, and counseling of sex partners of people infected with STIs, and

5) preexposure vaccination of persons at risk of STIs.

Primary prevention of STIs begins with changing the sexual behavior that puts people at risk for infection. Provision of health care have a unique opportunity to provide education and counseling to patients. As part of the clinical interview, the provision of health services should be routinely and regularly obtain sexual histories from patients. Skilled counseling, marked by respect, compassion, and an attitude of respect for all patients, it is important to obtain a thorough sexual history and to provide effective prevention messages. Key in facilitating effective relationships with patients, including the use of

1) open-ended questions (eg, "Tell me about any of your new sexual partner since your last visit" and "what is your experience with menggunkaan condom?"),

2) understandable language ("have you ever had a scab or sore on your penis?"), And

3) normalizing language ("some of my patients have difficulty using a condom with every act of sex. How about you?"). Approach to the patient to get all the information has been dringkas in one approach using the Six Ps: Partners, Prevention of Pregnancy, Protection from STDs, Practices, Past History of STIs . Patients should be believed that the treatment will be given regardless indibidu circumstances (eg, ability to pay, citizenship or immigration status, language spoken or certain sexual practices)

4. Methods of Prevention Through Intervention to Reduce Sexual Transmission of STIs / HIV and unwanted pregnancies vulnerable and Reduction of Number of Sex Partners

The most reliable way to avoid transmission of STIs is abstain from sexual intercourse (ie, oral, vaginal, or anal sex) or to be in a long term monogamous relationship with a partner who does not terinfeksi2. Counseling for sex is not very important for people who are being treated with STIs (or partners who are undergoing treatment) and for people who want to avoid the possible consequences of sex entirely (eg, STIs / HIV and unwanted pregnancy).

Vaccination

Preexposure vaccination is one of the most effective methods for preventing the transmission of some STIs. For example, due to infection with hepatitis B virus, hepatitis B vaksinisasi recommended for all unvaccinated. Quadrivalent vaccine against human papillomavirus (HPV types 6, 11, 16, 18) are now available and licensed for girls aged 9-26 years. Another Vaksinisasi for STIs is under research.

Condom

When used consistently and correctly, condoms are highly effective in preventing transmission of HIV infection and may reduce the risk of other sexually transmitted diseases, including chlamydia, gonorrhea, and trichomoniasis, and may reduce the risk of women developing pelvic inflammatory disease (PID).

Using condoms can reduce the risk of transmission of herpes simplex virus-2 (HSV-2), although the data for this effect is more limited. The use of condoms can reduce the risk of HPV-related diseases (eg, genital rashes and cancer seviks and reduce the adverse consequences of HPV infection, as has been associated with high rates of regression of cervical intraepithelial neoplasia (CIN), and the regression of HPV-associated penile lesions in male .

Limited number of prospective studies have shown a protective effect of condoms on genital HPV; a prospective study recently among sexually active female college who recently showed that consistent condom use was associated with a 70% risk for HPV infection.

Levels condom breakage during sexual intercourse and withdrawal approximately two broken condoms per 100 condoms used in the United States. Failure of condoms to protect against STD transmission or unintended pregnancy usually results from the use of inconsistent or incorrect condom instead. Patients should be informed that condoms must be used consistently and correctly to be effective in preventing STDs, and they should be instructed in the correct use of condoms.

Special Populations

Pregnant Women

Intrauterine STIs have very severe effects on pregnant women, sexual partners and fetuses. All pregnant women and their sex partners should ask about STIs, counseling regarding the possibility of perinatal infections and ensure access to treatment, if necessary, Population screening recommendations:

o All pregnant women in the United States should be tested for HIV infection.

o Serologic tests for syphilis should be performed on all of the first prenatal visit.

o All pregnant women should be routinely tested for hepatitis B antigen at the first antenatal visit in each pregnancy, even if it had been previously vaccinated.

o All pregnant women should be routinely tested Chlamydia trachomatis at the first antenatal visit.

o All pregnant women at risk for gonorrhea or living area where a high prevalence of Neisseria gonorrhoeae should be tested at the first prenatal visit for N. gonorrhoeae.

o All pregnant women at high risk for infection with hepatitis C should be tested for hepatitis C antibodies at the first prenatal visit.

o Evaluation of bacterial vaginosis (BV) may be done during the first prenatal visit for asymptomatic patients who are at high risk for preterm delivery (ie, those with a previous history of preterm labor).

Adolescent

STIs disease was highest in older age groups. For example, most chlamydia and gonorrhea cases found among women aged 15-19 years, and many people get HPV infection during their adolescent years. Among adolescents with acute HBV infection, the most common risk factors reported having sexual contact with an infected person with a chronic or multiple sex partners, or reported homosexual. As part of a comprehensive strategy to eliminate HBV transmission in the United States, ACIP has recommended that all children and youth are given the hepatitis B vaccine.

Younger

adolescents (ie, persons aged Approval for vaksinisasi law differs in each country in adolescents. Several states consider provision of vaccine similar to treatment of STIs and provide vaccination services without parental consent. Due to a very important secret, health care providers must follow a policy that provides confidentiality and comply with state laws for STIs services.

Tags:

sexually transmitted infections (STIs) , ISEASE TYPE STIs , HPV infection, HBV infection, bacterial vaginosis (BV), cervical intraepithelial neoplasia (CIN), gonorrhea, HBV transmission in the United States, Evaluation of bacterial vaginosis (BV), Venereal Disease , STIs Venereal Disease

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