SEXUALLY TRANSMITTED DISEASE (STD)

STDs

What are sexually transmitted infections and how are they transmitted?

STIs are caused by more than 30 different bacteria, viruses and parasites and are spread predominantly by sexual contact, including vaginal, anal and oral sex.

Some STIs may be spread via skin-to-skin sexual contact. The organisms causing STIs can also be spread through non-sexual means such as blood products and tissue transfer. Many STIs including chlamydia, gonorrhoea, hepatitis B, HIV, HPV, HSV2 and syphilis can also be transmitted from mother to child during pregnancy and childbirth.

A person can have an STI without having obvious symptoms of disease. Therefore, the term “sexually transmitted infection” is a broader term than “sexually transmitted disease” (STD). Common symptoms of STDs include vaginal discharge, urethral discharge in men, genital ulcers, and abdominal pain.

Eight of the more than 30 pathogens known to be transmitted through sexual contact have been linked to the greatest incidence of illness. Of these 8 infections, 4 are currently curable: syphilis, gonorrhoea, chlamydia and trichomoniasis. The other four are viral infections and are incurable, but can be mitigated or modulated through treatment: hepatitis B, herpes, HIV, and HPV.

STIs can have serious consequences beyond the immediate impact of the infection itself.

• Some STIs can increase the risk of HIV acquisition three-fold or more.
• Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low-birth-weight and prematurity, sepsis, pneumonia, neonatal conjunctivitis, and congenital deformities. Syphilis in pregnancy leads to approximately 305 000 fetal and neonatal deaths every year and leaves 215 000 infants at increased risk of dying from prematurity, low-birth-weight or congenital disease.
• HPV infection causes 530 000 cases of cervical cancer and 275 000 cervical cancer deaths each year.
• STIs such as gonorrhoea and chlamydia are major causes of pelvic inflammatory disease, adverse pregnancy outcomes and infertility.

Prevention of STIs

a)Counselling and behavioural approaches

Counselling and behavioural interventions offer primary prevention against STIs (including HIV), as well as against unintended pregnancies. These include:

v  comprehensive sexuality education, STI and HIV pre- and post-test counselling;

v  safer sex/risk-reduction counselling, condom promotion; and

v  interventions targeted at key and vulnerable populations, such as adolescents, sex workers, men who have sex with men and people who inject drugs.

In addition, counselling can improve people’s ability to recognize the symptoms of STIs and increase the likelihood they will seek care or encourage a sexual partner to do so. Unfortunately, lack of public awareness, lack of training of health workers, and long-standing, widespread stigma around STIs remain barriers to greater and more effective use of these interventions.

b)Barrier methods

When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms.

Diagnosis of STIs

Accurate diagnostic tests for STIs are widely used in high-income countries. These are especially useful for the diagnosis of asymptomatic infections. However, in low- and middle-income countries, diagnostic tests are largely unavailable. Where testing is available, it is often expensive and geographically inaccessible; and patients often need to wait a long time (or need to return) to receive results. As a result, follow up can be impeded and care or treatment can be incomplete.

The only inexpensive, rapid blood test currently available for an STI is for syphilis. This test is already in use in some resource-limited settings. The test is accurate, can provide results in 15 to 20 minutes, and is easy to use with minimal training. Rapid syphilis tests have been shown to increase the number of pregnant women tested for syphilis. However, increased efforts are still needed in most low- and middle-income countries to ensure that all pregnant women receive a syphilis test.

Several rapid tests for other STIs are under development and have the potential to improve STI diagnosis and treatment, especially in resource-limited settings.

Treatment of STIs

Effective treatment is currently available for several STIs.

v  Three bacterial STIs (chlamydia, gonorrhoea and syphilis) and one parasitic STI (trichomoniasis) are generally curable with existing, effective single-dose regimens of antibiotics.

v  For herpes and HIV, the most effective medications available are antivirals that can modulate the course of the disease, though they cannot cure the disease.

v  For hepatitis B, immune system modulators (interferon) and antiviral medications can help to fight the virus and slow damage to the liver.

Resistance of STIs—in particular gonorrhoea—to antibiotics has increased rapidly in recent years and has reduced treatment options. The emergence of decreased susceptibility of gonorrhoea to the “last line” treatment option (oral and injectable cephalosporins) together with antimicrobial resistance already shown to penicillins, sulphonamides, tetracyclines, quinolones and macrolides make gonorrhoea a multidrug-resistant organism. Antimicrobial resistance for other STIs, though less common, also exists, making prevention and prompt treatment critical.

REFERENCE : STD

  

SYMPTOMS

LEPROSY

LEPROSY

Leprosy, also called Hansen's disease, is a chronic infectious disease that primarily affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract, and the eyes. Leprosy can lead to progressive permanent damage of these structures, and the resulting devastating disfigurement and disability has led to the historical social stigma and isolation (leper colonies) of those affected by the disease.

Leprosy Causes

Leprosy is an acquired infectious disease that can affect individuals of all ages. It is caused by the acid-fast, rod-shaped bacteria Mycobacterium leprae, which was discovered in 1873 by G.A. Hansen.

v  Because the bacterium multiplies very slowly, the signs and symptoms of leprosy may not develop until much later after exposure to M. leprae (ranging from several weeks to 20 years or more).

v  Though humans are the major reservoir and host for infection with M. leprae, other animals such as armadillos, chimpanzees, and mangabey monkeys also serve as reservoirs of infection.

v  Leprosy is thought to be transmitted via droplets from the nose and mouth during close prolonged contact with affected individuals, though the exact route of transmission has yet to be proven definitively.

v  Not all individuals infected with M. leprae will go on to develop leprosy, because only 5%-10% of the population is thought to be susceptible to the infection because of immunological reasons.

SIGNS AND SYMPTOMS

The signs and symptoms of leprosy can vary depending on the individual's immune response to M. leprae. The WHO classification system uses clinical manifestations (the number of skin lesions and nerve involvement) as well as skin smear results to distinguish between forms of the disease. The two major WHO classifications are paucibacillary (PB) leprosy and multibacillary (MB) leprosy. However, within the WHO's simplified classification there can be a fairly wide range of patient presentations.

• Paucibacillary leprosy
• Two to five skin lesions with negative skin smear results at all sites
• Paucibacillary single lesion leprosy
• One skin lesion with negative skin smear results at all sites
• Multibacillary leprosy
• More than five skin lesions or positive skin smear results at any site

The Ridley-Jopling classification is another classification system that is used globally in evaluating patients in clinical studies and contains five different classifications of leprosy that further define the patient's severity of symptoms and disease progression. The five different categories, in order of increasing severity of disease, include indeterminate leprosy, tuberculoid leprosy, borderline tuberculoid leprosy, mid-borderline leprosy, borderline lepromatous leprosy, and lepromatous leprosy.

In general, the signs and symptoms of leprosy may vary with the form of the disease and include the following:

• Flat or raised skin lesions or nodules, often less pigmented than the surrounding skin, though they may reddish or copper colored
• Single or multiple skin lesions that are often found on cooler parts of the body such as the face, buttocks, and extremities
• Thickening of the skin and peripheral nerves
• Ulcerations of the skin
• Peripheral nerve involvement leading to loss of sensation
• Peripheral nerve involvement leading to muscle weakness (for example, clawed hand deformities, contractures, and foot drop)
• Hoarseness
• Testicular involvement leading to sexual dysfunction or sterility
• Eye involvement including eye pain, eye redness, inability to close the eyelids, corneal ulcers, and blindness
• Loss of eyebrows and eyelashes
• Destruction of the nasal cartilage

PREVENTION

The prevention of leprosy ultimately lies in the early diagnosis and treatment of those individuals suspected or diagnosed as having leprosy, thereby preventing further transmission of the disease to others.

v  Public education and community awareness are crucial to encourage individuals with leprosy and their families to undergo evaluation and treatment with MDT.

v  Household contacts of patients with leprosy should be monitored closely for the development of leprosy signs and symptoms.

v  A study demonstrated that prophylaxis with a single dose of rifampicin was 57% effective in preventing leprosy for the first two years in individuals who have close contact with newly diagnosed patients with leprosy.

v  There is currently no widely used standard for using medications for the prevention of leprosy.

v  Currently, there is no single commercial vaccine that confers complete immunity against leprosy in all individuals.

v  Several vaccines, including the BCG vaccine, provide variable levels of protection against leprosy in certain populations.

        

     REFERENCE : LEPROSY 

SYMPTOM

TUBERCULOSIS (TB)

TUBERCULOSIS (TB)

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.

TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.

About one-third of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease.

People infected with TB bacteria have a lifetime risk of falling ill with TB of 10%. However persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.

When a person develops active TB (disease), the symptoms (cough, fever, night sweats, weight loss etc.) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People ill with TB can infect up to 10-15 other people through close contact over the course of a year. Without proper treatment up to two thirds of people ill with TB will die.

Who is most at risk?

v  Tuberculosis mostly affects young adults, in their most productive years. However, all age groups are at risk. Over 95% of cases and deaths are in developing countries.

v  People who are infected with HIV are 26 to 31 times more likely to become sick with TB (see TB and HIV section). Risk of active TB is also greater in persons suffering from other conditions that impair the immune system.

v  Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide are attributable to smoking.

Symptoms and diagnosis

v  Common symptoms of active lung TB are cough with sputum and blood at times

v  Chest pains

v  Weakness

v  Weight loss

v   Fever

v   Night sweats

Treatment

TB is a treatable and curable disease. Active, drug-sensitive TB disease is treated with a standard six-month course of four antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. Without such supervision and support, treatment adherence can be difficult and the disease can spread. The vast majority of TB cases can be cured when medicines are provided and taken properly.

TB and HIV

At least one-third of people living with HIV worldwide in 2013 were infected with TB bacteria, although they did not become ill with active TB. People living with HIV are 26 to 31 times more likely to develop active TB disease than people without HIV.

HIV and TB form a lethal combination, each speeding the other's progress. In 2013 about 360 000 people died of HIV-associated TB. Approximately 25% of deaths among HIV-positive people are due to TB. In 2013 there were an estimated 1.1 million new cases of TB amongst people who were HIV-positive, 78% of whom were living in Africa.

WHO recommends a 12-component approach of collaborative TB-HIV activities, including actions for prevention and treatment of infection and disease, to reduce deaths.

Multidrug-resistant TB

Standard anti-TB drugs have been used for decades, and resistance to the medicines is widespread. Disease strains that are resistant to a single anti-TB drug have been documented in every country surveyed.

Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to, at least, isoniazid and rifampicin, the two most powerful, first-line (or standard) anti-TB drugs.

The primary cause of MDR-TB is inappropriate treatment. Inappropriate or incorrect use of anti-TB drugs, or use of poor quality medicines, can all cause drug resistance.

Disease caused by resistant bacteria fails to respond to conventional, first-line treatment. MDR-TB is treatable and curable by using second-line drugs. However second-line treatment options are limited and recommended medicines are not always available. The extensive chemotherapy required (up to two years of treatment) is more costly and can produce severe adverse drug reactions in patients.

In some cases more severe drug resistance can develop. Extensively drug-resistant TB, XDR-TB, is a form of multi-drug resistant tuberculosis that responds to even fewer available medicines, including the most effective second-line anti-TB drugs.

About 480 000 people developed MDR-TB in the world in 2013. More than half of these cases were in India, China and the Russian Federation. It is estimated that about 9.0% of MDR-TB cases had XDR-TB.

PREVENTION

If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won't transmit tuberculosis to anyone else.

Protect your family and friends

If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you're not contagious anymore. Follow these tips to help keep your friends and family from getting sick:

• Stay home. Don't go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis.
• Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn't move. If it's not too cold outdoors, open the windows and use a fan to blow indoor air outside.
• Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.
• Wear a mask. Wearing a surgical mask when you're around other people during the first three weeks of treatment may help lessen the risk of transmission.

Finish your entire course of medication

This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.

Vaccinations

In countries where tuberculosis is more common, infants often are vaccinated with bacille Calmette-Guerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn't recommended for general use in the United States because it isn't very effective in adults. Dozens of new TB vaccines are in various stages of development and testing.

REFERENCES : TUBERCULOSIS 

AGENT

SYMPTOMS

MEASLES

MEASLES

Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.

The disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 145 700 people died from measles in 2013 – mostly children under the age of 5.

Measles is caused by a virus in the paramyxovirus family and it is normally passed through direct contact and through the air. The virus infects the mucous membranes, then spreads throughout the body. Measles is a human disease and is not known to occur in animals.

Signs and symptoms

v  The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts 4 to 7 days.

v  A runny nose

v  A cough

v  Red and watery eyes

v  Small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about 3 days, the rash spreads, eventually reaching the hands and feet. The rash lasts for 5 to 6 days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of 7 to 18 days).

Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of 5, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.

In populations with high levels of malnutrition and a lack of adequate health care, up to 10% of measles cases result in death. Women infected while pregnant are also at risk of severe complications and the pregnancy may end in miscarriage or preterm delivery. People who recover from measles are immune for the rest of their lives.

Who is at risk?

v  Unvaccinated young children are at highest risk of measles and its complications, including death.

v   Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.

Measles is still common in many developing countries – particularly in parts of Africa and Asia. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

Transmission

v  The highly contagious virus is spread by coughing and sneezing

v  Close personal contact or direct contact with infected nasal or throat secretions.

The virus remains active and contagious in the air or on infected surfaces for up to 2 hours. It can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts.

Treatment

No specific antiviral treatment exists for measles virus.

Severe complications from measles can be avoided through supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.

All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This treatment restores low vitamin A levels during measles that occur even in well-nourished children and can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.

Prevention

Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive. It costs approximately one US dollar to immunize a child against measles.

The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form. Adding rubella to measles vaccine increases the cost only slightly, and allows for shared delivery and administration costs.

In 2013, about 84% of the world's children received 1 dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000. Two doses of the vaccine are recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose.

REFERENCE : MEASLES

SYMPTOM

HAND,FOOT AND MOUTH DISEASE(HFMD)

HFMD

HAND,FOOT, AND MOUTH DISEASE

What is hand,foot and mouth disease?

Hand, foot and mouth disease (HFMD) is a common infectious disease of infants and children. It is characterized by fever, painful sores in the mouth, and a rash with blisters on hands, feet and also buttocks. It is prevalent in many Asian countries.

Is it the same as foot-and-mouth disease in animals?

No, HFMD is not to be confused with foot-and-mouth (also called hoof-and-mouth) disease which is caused by a different virus and affects cattle, sheep, and pigs.

Where does HFMD occur?

Individual cases and outbreaks of HFMD occur worldwide. In tropical and subtropical countries, outbreaks often occur year-round.

Outbreaks of HFMD occur every few years in different parts of the world, but in recent years these have occurred more in Asia. Countries with recent large increases in the number of reported cases in Asia include: China, Japan, Hong Kong (China), Republic of Korea, Malaysia, Singapore, Thailand, Taiwan (China) and Vietnam.

What causes HFMD?

Viruses from the group called enteroviruses cause HFMD. There are many different types in the group including polioviruses, coxsackieviruses, echoviruses and other enteroviruses.

HFMD is most commonly caused by coxsackievirus A16 which usually results in a mild self-limiting disease with few complications. However, HFMD is also caused by Enteroviruses, including enterovirus 71 (EV71) which has been associated with serious complications, and may be fatal.

How serious is HFMD?

Most people with HFMD recover fully after the acute illness.

1. HFMD is usually a mild disease, and nearly all patients recover in 7 to 10 days without medical treatment and complications are uncommon.

v  Dehydration is the most common complication of HFMD infection caused by coxsackieviruses; it can occur if intake of liquids is limited due to painful sores in the mouth.

v  Rarely, patients develop "aseptic" or viral meningitis, in which the person has fever, headache, stiff neck, or back pain, and may need to be hospitalized for a few days.

2. HFMD caused by EV71 has been associated with meningitis and encephalitis, and on occasion can cause severe complications, including neurological, cardiovascular and respiratory problems. Cases of fatal EV71 encephalitis have occurred during outbreaks.

How soon after exposure do symptoms appear?

v  The usual period from infection to onset of symptoms is 3–7 days.

v  Fever, lasting 24-48 hours, is often the first symptom of HFMD.

What are the symptoms?

The disease usually begins with a fever, poor appetite, malaise, and frequently with a sore throat.

v  One or 2 days after fever onset, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks.

v  A non-itchy skin rash develops over 1–2 days with flat or raised red spots, some with blisters. The rash is usually located on the palms of the hands and soles of the feet; it may also appear on the buttocks and/or genitalia.

v  A person with HFMD may not have symptoms, or may have only the rash or only mouth ulcers.

v  In a small number of cases, children may experience a brief illness, present with mixed neurological and respiratory symptoms and succumb rapidly to the disease.

How do you get HFMD?

HFMD virus is contagious and infection is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. Infected persons are most contagious during the first week of the illness, but the period of communicability can last for several weeks (as the virus persists in stool).

HFMD is not transmitted to or from pets or other animals.

Who is at risk for HFMD?

v  Everyone who has not already been infected is at risk of infection, but not everyone who is infected becomes ill.

v  HFMD occurs mainly in children under 10 years old, but most commonly in children younger than 5 years of age. Younger children tend to have worse symptoms.

v  Children are more likely to be susceptible to infection and illness from these viruses, because they are less likely than adults to have antibodies and be immune from previous exposures to them. Most adults are immune, but cases in adolescents and adults are not unusual.

Can you be infected with HFMD more than once?

Yes, infection only results in immunity to one specific virus, other episodes may occur following infection with a different virus type.

What about pregnant women?

Ideally pregnant women should avoid close contact with anyone with HFMD and pay particular attention to measures that prevent transmission.

Enterovirus infections, including HFMD are common and pregnant women are frequently exposed to them. They may cause mild or no illness in the pregnant woman and currently there is no clear evidence that maternal enterovirus infection, including HFMD, is associated with any particular adverse outcomes of pregnancy (such as abortion, stillbirth or congenital defects). However, pregnant women may pass the virus to the baby if they are infected shortly before delivery or have symptoms at the time of delivery.

Most newborns infected with an enterovirus have mild illness, but rarely may develop an overwhelming infection of many organs, including liver and heart, and die from the infection. The risk of this severe illness is higher for newborns infected during the first two weeks of life.

How is HFMD treated?

Presently, there is no specific treatment available for HFMD. Patients should drink plenty of water and may require symptomatic treatment to reduce fever and pain from ulcers.

Can HFMD be prevented?

There are no specific antiviral drugs or vaccines available against non-polio enteroviruses causing HFMD. The risk of infection can be lowered by good, hygiene practices and prompt medical attention for children showing severe symptoms.

Preventive measures include:

v  frequent handwashing with soap and water especially after touching any blister or sore, before preparing food and eating, before feeding young infants, after using the toilet and after changing diapers;

v  cleaning contaminated surfaces and soiled items (including toys) first with soap and water, and then disinfecting them using a dilute solution of chlorine-containing bleach;

v  avoiding close contact (kissing, hugging, sharing utensils, etc.) with children with HFMD may also help to reduce of the risk of infection;

v  keeping infants and sick children away from kindergarten, nursery, school or gatherings until they are well;

v  monitoring the sick child's condition closely and seeking prompt medical attention if persistent high fever, decrease in alertness or deterioration in general condition occurs;

v  covering mouth and nose when sneezing and coughing;

v  disposing properly of used tissues and nappies into waste bins that close properly;

maintaining cleanliness of home, child care centre, kindergartens or schools.

REFERENCE: HFMD 

SYMPTOMS