STD LECTURE

Prof. C.S.S. BELLO

MB.BS (Lagos); FWACP (WA); MD (Zaria); Dip. Ven. (London);

FMCPATH (NIG); FRC-PATH (U.K.)

​

DEFINITION OF TERMS

• VD
• STD
• STI

MAJOR STDs IN MAN

Table 1

Sexually Transmitted Diseases in Man

�

​

REASONS FOR THE SPREAD OF STDs

• Table 2
• Some reasons for the Global Increase in STDs, including Nigeria.
•  
• 1. Difficulty in obtaining accurate information because of the stigma attached to STDs.
• 2. Failure to intercept transmission because of short incubation period.
• 3. Increase in societal permissiveness and promiscuity.
• 4. Rejection of traditional moral codes and principles.
• 5. Urbanization and industrialization.
• 6. Greater and easier mobility due to technological advancement.
• 7. Drug abuse and resistance to antibiotics.
• 8. Erosion of fear of pregnancy due to effective and cheap contraceptives.
• 9. Reservoir of infection in women.
• 10. Absence of vaccines.
• 11. Inadequate funding and facilities.
• 12. Ignorance.
•  
• �

CLASSIFICATION OF STDs

• Group 1. The old or classical STDs, which include gonorrhoea, syphilis, chancroid, lymphogranuloma venereum and granuloma inguinale. These five constitute the true or so-called “venereal diseases”.
• Group 2. All other STDs except HIV/AIDS
• Group 3. HIV/AIDS
• The newer the STD (or lower in the group above), the more difficult to diagnose and manage.

​

SOME BASIC EPIDEMIOLOGY OF STDs

• They are commoner :
• In sexually active adults – both males and females, usually between ages 15-40 years;
• In older children (by sexual abuse) and the younger children by vertical infection (i.e. from infected mother to child in utero).
• In Nigeria, ages 15-29 years are mostly affected by all STDs.

EPIDEMIOLOGY OF STDs Cont.

• The use of Condom lowers STD prevalence.
• The mode of infection could be by un-protected sex (vaginal or anal or oral), or vertically from an infected mother to her child (in-utero or trans-placental), or through blood and blood products.

​

​

EPIDEMIOLOGY OF STDs Cont.

• Globally, STDs are known to be twice as common in the age bracket 15-29 years than in any other age groups. Because females mature faster than males and therefore marry earlier than males and also because older males tend to go for younger females, STDs are higher in females than males between ages 10-19 years. However, in all ages above 20 years, STDs tend to be higher in males than females.

​

EPIDEMIOLOGY OF STDs Cont.

• Generally, STD risk is highest between ages 15-30 years and the incidence drops thereafter. Some of the reasons for this include 1. Maturity 2. Formation of stable relationships (marriage) and 3.Less sexual drive. On the other hand, STDs tend to be rare below age 14 years except for congenitally acquired infections and infections due to child abuse

EPIDEMIOLOGY OF STDs Cont.

• Some individuals in the community are at higher risk of acquiring STDs either because of their age, behaviour or occupation. Such groups include: the Youth, commercial sex workers and their clients; Long distance drivers; STD patients and their clients. Uniformed – services men and women; migrant workers and prisoners.

EPIDEMIOLOGY OF STDs Cont.

• The true global extent of STDs is unknown due to:
• 1. Asymptomatic infections esp. in females
• 2.Lack of access to STD facilities
• 3.Lack of routine screening
• 4.Fear of stigma.
• It is estimated by WHO that there are about 500Million new cases /year!

EPIDEMIOLOGY OF STDs Cont.

• The advent of HIV/AIDS has further worsened the STD scenario.
• HIV infects sixteen persons every minute worldwide while HIV-positive mothers double every two years.
• The spread of HIV is facilitated 2-9 times by the presence of STDs, especially the genital ulcer diseases.

​

EPIDEMIOLOGY OF STDs Cont.

• The causative agents of STDs produce serious symptoms and signs in the affected persons
• Also, they have serious economic and social effects on the community; for example, they are among the five commonest causes of out-patient attendance worldwide; they take up a chunk of some countries budget and they render spouses widows or widowers and children orphans.

EPIDEMIOLOGY OF STDs Cont.

• The effects and consequences of STDs are so profound that no nation can afford to treat them with levity.
• Control efforts should normally be carried out at primary, secondary and tertiary levels. The main objectives of STDs/HIV control should include:
• 1. Interruption of the transmission of the infections.
• 2. Prevention of the development of infection, complications and sequellae.
• 3. Reduction in the risk of HIV infection.

​

EPIDEMIOLOGY OF STDs Cont.

• Some medical effects of STDs on the population
•  
• A. In Males
• 1. Urethral stricture
• 2. Sub-fertility and infertility
• 3. Genital cancer
• 4. Death
• B. In Females
• 1. Pelvic inflammatory disease ( PID)
• 2. Sub-fertility and infertility
• 3. Ectopic pregnancy
• 4. Spontaneous abortion
• 5. Still birth
• 6. Cervical cancer
• 7. Death
• C. In Children
• 1. Severe sepsis
• 2. Eye infections ± blindness
• 3. Pneumonia
• 4. Growth retardation
• 5. Malformations
• 6. Death

​

EPIDEMIOLOGY OF STDs Cont.

• The increased use of condom has led to the reduction in both the HIV/AIDS and other STDs in Nigeria. In addition, with more counselling of patients, and improved contact-tracing, the incidence of HIV/AIDS and other STDs has gone down. There is also a reduction in stigmatization of patients and greater access to drugs.�