MODULE I

INTRODUCTION TO STI

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 Module Objectives
Identify common STIs and the factors
that influence STI prevention and control
Explain:
The magnitude of STI
The public health impact of STI
The relationship of STIs and HIV/AIDS
Strategies on prevention and control of
STI
Challenges in the STIs prevention and
control
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 Brain storming session

What is STI?

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 Introduction…
STIs are infectious disease that are
transmitted by intimate contact
mainly sexual intercourse .

STIs are caused by more than 30

different pathogens including
bacteria, viruses, protozoa, fungus
and ecto-parasites.

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 THE TRANSMISSION OF
STIs

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The Transmission of STIs
The most common mode of
transmission is unprotected sex
Other forms of transmission are
 Mother to child
During pregnancy (HIV & syphillis)
At delivery (gonorrhea ,chlamydia &HIV)
Through breast feeding
 Unsafe (unsterile ) use of needles or
injections
 Contact with blood or blood products
6 (syphilis, HIV &hepatitis )
 Factors increasing transmission of
STIs
• Biological factors
– Age, young age more susceptible
– Sex, women more easily infected than
males
– Immune status
• Behavioral factors
– changing sexual partners frequently
– having more than one sexual partner
– having sex with ‘casual’ partners, sex-
workers or their clients
– having unprotected sexual intercourse
– use of alcohol or other drugs before or
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 Factors increasing transmission of STIs
• Socio-cultural factors
– in most cultures women have very little
decision-making power over sexual practices
and choices, including use of condoms
– women tend to be economically dependent on

their male partners and are therefore more

likely to tolerate men’s risky behaviour
– in some societies the girl-child tends to be

married off to an adult male at a very young

age, thus exposing the girl to infections
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Socio-cultural factors cont..
In some societies a permissive attitude is

taken towards men allowing them to have

more than one sexual partner.
Harmful traditional practices

Skin-piercing

 Use of unsterile needles to give injections or

tattoos
Scarification or body piercing

Circumcision using shared knives

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STI transmission dynamics at population level

General population

Bridging population

Core
transmitters

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 EPIDEMIOLOGY OF STIs

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 Epidemiology of STIs
• Global
• STIs are a major public health problem in all
countries, but are especially in developing
countries where access to adequate
diagnostic and treatment facilities is very
limited or non-existent.
• WHO 2020, among adolescents and
adults aged 15–49 years age group had.
• an estimated 128.5 million new cases of
chlamydia and
• 82.4 million new cases of gonorrhea
• Geographically, the largest proportion of
patients is in the region of south and south-
east Asia followed by sub Saharan Africa
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(SSA), and Latin American and the
Caribbean.
 Epidemiology continued
• Ethiopia
• According to 2016 EDHS
• About 4% of women and men aged 15–49
reported having an STI and/or STI symptoms in
the 12 months preceding the survey.
• About 2.6% of women and 2.2% of men reported
experiencing abnormal genital discharge.
• Similarly, 2.2% of women and 1.6% of men
reported having a genital sore or ulcer within the
past 12 months.
• These numbers may be underestimates
because respondents may be
embarrassed or ashamed to admit to
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having STIs.
 Epidemiology continued
 Another STI sentinel surveillance study done in 2013 at

8 health facilities located in three regions (Amhara,

Oromia and Addis Ababa) by EPHI and CDC-Ethiopia, a
total of 636 STI cases were reported.

• The commonest syndrome was

• Vaginal discharge 50%

• Urethral discharge 31%,

• Genital ulcerative disease 9%

• Lower abdominal pain 7.3%and

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• Presented with two syndrome.3%
 Epidemiology continued
• About 16% of the STI patients were co-

infected with HIV (8.1% male and 21%female)

• HIV prevalence is higher on STI patients with

lower abdominal pain (41% ) and genital ulcer

(24.5%).

• Young people (20-34yrs) are highly affected

(68.2%), with a larger proportion of

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females( 61%).
 Epidemiology continued
A more recent 2024 STI EPHI survey, across all regions
of Ethiopia, assessed 1,428 participants who reported
being diagnosed with an STI in the past 12 months.
Among them:
60.66% of females reported experiencing unusual
vaginal discharge.
54.44% of males reported experiencing unusual
urethral discharge.
Among key and priority populations (KPPs) (n=1,916)
who had been diagnosed with an STI in the previous 12
months:
60.19% of females reported unusual vaginal
discharge.
62.12% of males reported unusual urethral
1 discharge.
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 Epidemiology continued
large proportion of STIs are asymptomatic and
most symptomatic patients seek treatment
from traditional healers, pharmacies, drug
vendors, shops and marketplaces.
According to 2016 EDHS,
Only 32% of men and women sought STI-
related care from a clinic, hospital, or
healthcare professional.
0.9% of women and 2.6% of men sought
advice or medication from drug retail outlets.
66.7% of women and 65.7% of men with STI
symptoms in the previous 12 months did not
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seek any advice or treatment.
 Operational model of STI in
the community

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 Epidemiology continued
Implications of the model for STI
Control:
Reduce risk through education to
communities and specific groups
Condoms promotion through improving
their availability to the sexually active
Case finding through partners’
notification and screening programs
Promotion of health seeking behavior
through early STI symptom recognition.
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 Epidemiology continued
Provision of user-friendly services
 Innovative approaches for STI
service delivery e.g. training
pharmacists, traditional healers, in STI
recognition and referral.
Improve STI case management in
health facilities
Provision of full package of STI case
management including partner
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notification
 The accuracy of STI statistics
• Reasons for underestimation:
– People with asymptomatic STIs do not
seek treatment
– Health facilities offering treatment for
STIs may be too far away for many
people
– People seeking other health care such
as antenatal services may not be
routinely screened for STIs
– Many patients perceive a stigma in
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attending clinics
 The accuracy of STI statistics
Reasons continued….
Many people may choose to go to
alternative providers, both in the
formal and informal sectors, who
do not report case numbers.
Lack of uniformity of reporting
Cost of services

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 The accuracy of STI statistics cont….

Symptomatic

Asymptomatic

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 Public health impacts of STI

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 Public health impacts of STI
• Failure to diagnose and treat STIs at an early stage

may result in serious complications and sequelae.

• The most serious health consequences of STIs,

other than HIV/AIDS, tend to occur in women and

newborn children.
• Complications in women include :
• Cervical cancer, pelvic inflammatory disease
• Infertility, chronic abdominal pain
• Ectopic pregnancy, preterm labor and related

maternal mortality
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 Public health impacts of STI continued

• Complications in newborns include

• Congenital syphilis

• Gonococcal infection of the conjunctiva - a

potentially blinding condition

• Chlamydial pneumonia and perinatal

hepatitis B infection
• Premature deliveries, low birth weight,

growth retardation.
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 Public health impacts of STI
continued
• Complications in men:

• Urethral stricture

• Infertility

• Majority of the complications of

STIs are preventable if the patient

is diagnosed and treated early.

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 Public health impacts of STI
continued
• STIs have also enormous social and economic

consequences.
• In developing countries, it account for 17% of
economic losses.
• Marital disharmony may occur when one partner
develops STI or infertility.
• The costs of STI drugs may place a heavy financial

burden on families, communities and the country at

large.
• Antimicrobial resistance has rendered some low-cost
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regimens ineffective
 The relation ship between STI
and HIV AIDS

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The relation ship between STI and
HIV AIDS

• The relationship between STIs and

HIV/transmission has been described as
an epidemiological synergy and share
the same risk factors.
1.STIs enhance the sexual
transmission of HIV through:
• Disrupting integrity of the skin barrier
• The presence of genital ulcers is known to
increase the risk of HIV transmission 3-5 folds
• Inducing inflammation
3 • Increasing viral shedding
 The relation ship between STI
and HIV AIDS continued
2. HIV infection affects STIs through:
• Increased susceptibility to STIs among
immuno suppressed individuals
• Altering susceptibility of STI pathogens to

antibiotics →decreasing effectiveness of

treatment. (This has been reported for
chancroid and syphilis)
• The clinical features of various types of STIs
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are influenced by co-infection with HIV.
 STRATEGIES FOR STIs
PREVENTION AND CONTROL

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 The Main Aims of STIs Prevention
and Control are:-
Interrupting the transmission of STIs
Prevent development of disease and
complications
Reducing the risk of acquiring and
transmitting HIV

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 Prevention and Control of STIs
Involves
Promotion of safer sexual behavior
Promotion of health care-seeking
behavior
Early diagnosis and treatment
Targeting vulnerable groups

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 Primary prevention
Safer sexual behaviors
Abstinence from sexual activity
altogether/ delaying the age of
sexual debut
Life-long mutual monogamy
Correct and consistent use of
condoms .

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 Secondary prevention
Promoting STI care-seeking behavior,
through:
Public education campaigns
Providing non-stigmatizing and non-
discriminatory health facilities
Counseling for partner/s treatment
Ensuring a continuous supply of
highly effective drugs
Ensuring a continuous supply of
38 condoms
 Secondary prevention
continued
• Early diagnosis and prompt and correct
treatment using comprehensive STI
syndromic management
• Case finding and screening:
– Examining asymptomatic women attending
clinics for maternal and child health and
family planning,
– Regular screening of PLHIV client, FSWs
– Partner notification and treatment
– Testing of blood donors for syphilis, HIV and
hepatitis B
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 CHALLENGES OF
CONTROLLING STIs

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 Brainstorming session

• What makes the control of STI so

difficult? What can we do to
control STI?’’

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 Challenges are due to:
Health system factors
Biological factors
Socio-cultural & behavioral factors

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 Health System Factors
Health service may be
 Too far away
 Expensive (in case of private setup)
 ill equipped
 Not user friendly or considered
stigmatizing
There may be little emphasis on education
Difficulty of partner/s management
Services may not be integrated within
primary care clinics: maternal, child health,
43family planning and ART clinics
 Socio-cultural & behavioral
factors
Reluctance to seek health care
Ignorance or misinformation
A preference for alternative health care
service
Reluctance to follow safe sex practices
The social stigma often attached to STI
Failure to take full prescribed course of
treatment
Difficulty of notifying sexual partners
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 Biological factors

70%-80% of infected women may be

asymptomatic and so will not seek
treatment

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 Questions?

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 Thank you!!!

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