STD (SEXUALLY TRANSMITTED

DISEASE)

DEFINITION

generally acquired by sexual contact

can also be transmitted non-sexually

CLASSIFICATION

Viral
Bacterial
Parasitic

VIRAL INFECTION

Human Papilloma Virus (HPV):The

human papilloma virus or HPV is the
most common viral infectio
Human Immunodeficiency Virus
(HIV):Human Immunodeficiency virus
or HIV/Aids attacks the bodys immune
system, leaving infected individuals
unable to fight off other illnes

Hepatitis B Virus:Hepatitis B or Hep

B, affects the liver.
Genital Herpes:Genital Herpes is
caused by the Herpes Simplex Virus.

BACTERIAL INFECTION

Syphilis- 3 stages
Gonorrhea- Gonorrhea is an infection
that often is transmitted at the same
time as Chlamydia and shares the
same symptoms.
Chlamydia:Chlamydia is one of the
most common STIs

PARASITIC

Trichomoniasis :This single-celled

organism can infect the urethra,
bladder, vagina, cervix or get under the
foreskin.
Pubic Lice: Public Lice live in pubic
hairs around the genitals
Scabies (Mites):Scabies are tiny
mites that dig little holes below the
surface of the skin where they lay eggs.

RISK FACTOR
-Unprotected sex
-Multiple sex partners
-History of STI
-Alcohol abuse
-Recreational drug abuse
-Infected pregnant female

SIGNS AND SYMPTOMS

-Often asymptomatic
-Infection may still be spread
-Signs and symptoms varies with type of infection

CHLAMYDIA SYMPTOMS
-Occurs 1-3 weeks after exposure
-Painful urination
-Lower abdominal pain
-Vaginal discharge in women
-Discharge from the penis in men
-Pain during sexual intercourse in women
-Bleeding between periods in women
-Testicular pain in men

GONORRHEA SYMPTOMS
-usually appear within 10 days of exposure
-Thick, cloudy or bloody discharge from the
penis or vagina
-Pain or burning sensation when urinating
-Heavy menstrual bleeding or bleeding
between periods
-Painful, swollen testicles
-Painful bowel movements
-Anal itching

TRICHOMONIASIS SYMPTOMS
-appear 5-28 days after exposure
-Clear, white, greenish or yellowish vaginal
discharge
-Discharge from the penis
-Strong vaginal odor
-Vaginal itching or irritation
-Itching or irritation inside the penis
-Pain during sexual intercourse
-Painful urination

HIV SYMPTOMS
Early symptoms
-appear 2-6 weeks after exposure
-Fever
-Headache
-Sore throat
-Swollen lymph glands
-Rash
-Fatigue
-Disappear within one month

Window period symptoms

-Swollen lymph nodes
-Diarrhoea
-Weight loss
-Fever
-Cough and shortness of breath

Late Symptoms
-Persistent, unexplained fatigue
-Soaking night sweats
-Shaking chills or fever higher than 100.4 F (38 C) for
several weeks
-Swelling of lymph nodes for more than three months
-Chronic diarrhoea
-Persistent headaches
-Unusual, opportunistic infections

GENITAL HERPES SYMPTOMS

-Pain or itching several weeks after exposure
-Small red bumps that rupture
-Ulcers that ooze or bleed
-Scab formation at external genitalia, anus,
buttock, thigh

HUMAN PAPILLOMA VIRUS SYMPTOMS

-Small, flesh-coloured or gray swellings in

genital area
-Several warts close together with cauliflower
shape
-Itching or discomfort in genital area
-Bleeding with intercourse

HEPATITIS SYMPTOMS
-Fatigue
-Nausea and vomiting
-Abdominal pain or discomfort, especially in
the area of your liver on right side beneath
lower ribs
-Loss of appetite
-Fever
-Dark urine
-Muscle or joint pain
-Itching
-Yellowing of skin and sclera(jaundice)

SYPHILIS SYMPTOMS
Primary Syphilis
-10 days 3 months after exposure
-Chancre on lips, tongue, genitals, anus
Secondary Syphilis
-Rash on palms and soles
-Fever
-Enlarged lymph nodes
-Fatigue and a vague feeling of discomfort
-Soreness and aching
Tertiary Syphilis
-Lack of coordination
-Numbness
-Paralysis
-Blindness

PATHOPHYSIOLOGY

Sexually transmitted diseases (STDs) are

transmitted via the mucous membranes of
the vagina, penis, urethra or rectum, during
sexual contact with an infected individual.
Transmission can also occur via membranes
of the throat, respiratory tract, mouth and
eyes.
The mucous membranes are thinner than
skin and allow microbes to cross them into
the body.

Minor breaks in the skin and mucous

membranes due to abrasions or cuts can
further increase the risk of infection.
The microbes are often present in fluids
secreted from the penis, vagina, saliva,
faeces, urine and sweat.
Sometimes, only a small amount of the
microbes can lead to transmission of an
STD.

Any sexual contact including oral sex

and deep kissing can lead to the
transmission of certain infections,
although the concentration of the
microbes is often lower in saliva than in
the genital fluids.
Non-sexual contact such as hugging
and shaking hands is not usually
responsible for transmitting infection.

CAUSATIVE AGENTS OF STDS

The causative agents of STDs include

bacteria, fungi, protozoa and viruses.
Some of the common types of infection
include: - Bacterial infections
- Viral infections
- Parasitic infections

BACTERIAL INFECTIONS

Chlamydia

This is one of the most common STDs.

There are often no symptoms of the infection
Symptoms that may manifest in women include
pain, vaginal discharge, bleeding and pain during or
after sexual intercourse and a burning sensation
while urinating.
In men, it can cause a white, cloudy, watery
discharge from the tip of the penis along with pain
during urination or sexual intercourse.
If left untreated, this infection may lead to infertility.

GONORRHOEA

This is a bacterial infection that can be transmitted

through any sort of unprotected sex.
While often symptomless, in women, the infection
may lead to pain, vaginal discharge (watery, yellowish
or green), bleeding and pain during or after sexual
intercourse and a burning sensation while urinating.
In men, it can cause a watery, yellowish or green
discharge from the tip of the penis along with pain
during urination or sex.
The infection may also affect the throat, eyes or
rectum.

SYPHILIS

This is a bacterial infection that has several phases

of development.
In the first stage, highly infectious sores on the
genitalia or mouth develop and persist for up to 6
weeks.
During the next stage, a rash, fever, and hair loss
may occur but subside in a few weeks.
In the late stage or tertiary stage, which may occur
years after the first two phases, there may be
serious destructive infection of the nervous system
that can lead to paralysis and blindness.

VIRAL INFECTIONS

Herpes

Herpes is caused by the herpes

simplex virus.
The infection causes painful, itchy
blisters or sores around the genital
area that make sexual intercourse
and urination painful.
The blisters may subside and remain
absent for a while, before flaring up
again.

VIRAL WARTS

These are painless but itchy warts that

develop across the genitalia as a result
of human papilloma virus (HPV)
infection.
Certain strains of HPV infection can
eventually lead to cervical cancer but
most infections pass without any
symptoms.

HIV INFECTION

The HIV virus attacks and damages the body's

immune system.
The symptoms may take a long time to appear.
The affected individuals often unaware they
have the infection and therefore at risk of
unknowingly passing the virus onto other
people through unprotected sex.
Other modes of transmission include needle
sharing, blood transfusion, or mother-to-baby
transmission during childbirth.

VIRAL HEPATITIS

Viral hepatitis is a serious liver disease

that can be caused by several different
viruses, which can be transmitted
through sexual contact.

Hepatitis B

(HBV) causes a serious liver disease that can result in

both immediate illness and lifelong infection leading to
permanent liver cirrhosis, cancer, liver failure, and death.
HBV spreads through both heterosexual and homosexual
contact as well as through contact with other bodily fluids,
such as blood, through shared contaminated needles
used for injecting intravenous (IV) drugs, tattooing, and
piercing.
Pregnant women with HBV can transmit the virus to their
infants during delivery.
HBV infection is preventable through vaccination.

PARASITIC INFECTIONS

Trichomonas vaginalis

This is caused by a parasite that is

transmitted during unprotected sex.
In women, the infection leads to pain and a
frothy, yellow or watery vaginal discharge.
In men, there may be a burning pain or no
symptoms at all.

LICE OR CRABS

Pubic lice can also spread via

unprotected sexual contact.
These lice can also live in underarm
hair, body hair and beards

SCABIES

This is caused by mites that burrow into

the skin and can be picked up through
sexual or intimate contact or from
using clothing and towels in which
mites are present.
Scabies causes intense itching in
affected areas, particularly at night.

DIAGNOSIS AND MANAGEMENT

HIV

Diagnosis
When clinicians suspect acute infection (e.g., in a
patient with a report of recent risk behaviour in
association with symptoms and signs of the acute
retroviral syndrome), a test for HIV RNA should be
performed.
High levels of HIV RNA detected in plasma through use
of sensitive amplification assays (PCR, bDNA, or
NASBA), in combination with a negative or
indeterminate HIV antibody test, support the diagnosis
of acute HIV infection.
Low-level positive PCR results (<5000 copies/mL) are
often not diagnostic of acute HIV infection and should
be repeated to exclude a false-positive result.

HIV

RNA levels tend to be very high in acute

infection; however, a low value may represent any
point on the upward or downward slope of the
viremia associated with acute infection.
Plasma HIV RNA levels during sero-conversion do
not appear significantly different in patients who
have acute symptoms versus those who are
asymptomatic.
Viremia occurs approximately 2 weeks prior to the
detection of a specific immune response.
Patients diagnosed with acute HIV infection by HIV
RNA testing still require antibody testing with
confirmatory Western blot 3 to 6 weeks later.

Management
Offer

assistance with partner notification, or

refer patients to other sources for partner
notification assistance (Partner Services or
CNAP).
Counsel patients about the increased risk of
transmitting HIV during acute HIV infection.
Obtain baseline genotypic testing in the setting
of acute infection, regardless of whether ARV
therapy is being initiated.

As

part of the management of acute HIV infection,

clinicians should:
Consult with a provider who has extensive
experience in HIV treatment to determine whether to
initiate treatment and to discuss possible ARV
regimens.
Refer for research opportunities as appropriate.
Counsel patients regarding potential advantages
and limitations of ARV therapy during acute infection.
If the clinician and patient have made a decision to
initiate ARV therapy to treat acute HIV infection,
then:
Treatment should be implemented with the goal of
suppressing plasma HIV RNA to below detectable levels.
Therapy should not be withheld while awaiting the results of
recommended resistance testing; adjustments may be made
to the regimen once resistance results are available.

HERPES
Diagnosis
Clinical
Typical herpetic genital lesions and symptoms such
as prodrome (Ex: burning, itching, or tingling at site
where lesions occur), paraesthesia, vesicles, followed
by single/multiple and painful shallow ulcers, and
healing with crusting scabs.
Atypical lesions are common and a high clinical
suspicion should be maintained followed by
appropriate testing.
Confirmed
Both HSV type 1 and type 2 can infect the genitals
and testing should be type specific.

Nucleic Acid Amplification Test

Note: NAAT refers to Nucleic Acid Amplification Test,
such as PCR
swab specimen from an infected site
type specific Polymerase Chain Reaction ( PCR) for
HSV DNAe.
Failure to detect HSV by culture or PCR does not rule
out HSV infection, because viral shedding is
intermittent.

HSV Serology
HSV serology for IgM and IgG is routinely available
the sensitivity and specificity of IgG may be between
95 to 97% depending on the specific assay
screening with serology is not routinely
recommended
use of this test may be indicated in certain clinical
settings such as
recurrent genital symptoms without diagnosis
partners of HSV infected persons wishing to know.

Management
No treatment is available to eradicate the virus.
First episode
antiviral therapy should be commenced at time of clinical
presentation, prior to result availability and within 72 hours of
most recent symptom onset
there may be value in starting therapy even if lesions have
been present for more than 48 to 72 hours if new lesions are
developing
higher dose therapy may be required in patients with
moderate to severe symptoms
a first episode may have systemic symptoms and new lesions
may develop after initial consultation
a first episode may take longer to resolve and treatment
should be sufficient duration.
Standard therapy
Famciclovir 250 mg orally 8 hourly for 7 to 14 days.
Valaciclovir 500 or 1000 mg orally 12 hourly for 7 to 14 days.

Recurrent herpes
Episodic therapy
episodic therapy can decrease the duration and
severity of symptoms
early treatment during prodrome may abort an
attack
treatment should be instituted as soon as possible
after symptom onset
short course therapy (1 to 3 days) is preferred.
Standard therapy
Famciclovir 500 mg orally stat followed by 250 mg 12
hourly for a further three doses
Valaciclovir 500 mg orally 12 hourly for 3 days
Famciclovir 1000 mg orally 12 hourly for 2 doses
In human immunodeficiency virus (HIV) infection
Famciclovir 500 mg orally 12 hourly for 5 to 10 days

SYPHILIS
Diagnosis
DARK-FIELD MICROSCOPY

Specific technique for diagnosing early primary syphilis when an

active chancre or condyloma latum is present.

T. pallidum is identified by its characteristic corkscrew

appearance.

Some laboratories may also offer PCR tests to detectT. pallidum.

Serological testing for the disease can be divided into two general
categories: non treponemal tests (VDRL,RPR) and treponemal
tests (FTA-ABS, TP-PA, EIA).

As each test has limitations, and the possibility of false positives,

more than one type of serological test (non treponemal and
treponemal) is needed for diagnosis.

If neurosyphilis is suspected, CSF can be tested using VDRL. If

CSF-VDRL is positive and there is no significant contamination
with blood, it is considered diagnostic of neurosyphilis.

NONTREPONEMAL TESTS
Syphilitic infection leads to the production of nonspecific antibodies that react to cardiolipin.
With non-treponemal tests, false-positive reactions
can occur because of pregnancy, autoimmune
disorders, and infections.
However, their usefulness is limited by decreased
sensitivity in early primary syphilis and during late
syphilis, when up to one third of untreated patients
may be nonreactive.
After adequate treatment of syphilis, non-treponemal
tests eventually become nonreactive.
However, even with sufficient treatment, patients
sometimes have a persistent low-level positive nontreponemal test (referred to as a serofast reaction).

TREPONEMAL-SPECIFIC TESTS
Treponemal-specific tests detect antibodies to antigenic
components of T. pallidum.
These tests are used to confirm the diagnosis of syphilis in patients
with a reactive non-treponemal test.
Enzyme immunoassay (EIA) test for anti-treponemal IgG may be
used for screening.
Treponemal-specific tests includes:
EIA for anti-treponemal IgG.
T. pallidum hemagglutination (TPHA) test
microhemagglutination test with T. pallidum antigen.
The fluorescent treponemal antibody-absorption test (FTA-abs).
Enzyme-linked immunosorbent assay.
This test are more difficult and expensive to perform.
False-positive results can occur, especially when the FTA-abs test is
used in patients with systemic lupus erythematosus or Lyme
disease.
Unlike non-treponemal tests, which show a decline in titres or
become nonreactive with effective treatment, treponemal-specific
tests usually remain reactive for life.

MANAGEMENT SYPHILIS

GONORRHEA
Diagnosis
In a symptomatic male, a gram stain of a urethral
specimen showing polymorphonuclear leukocytes
(PMNs) with intracellular gram negative diplococci is
diagnostic for infection.
However, a gram stain in an asymptomatic male is not
sufficient to rule out infection.
Culture and testing can be performed on female
endocervical or male urethral swab specimens.
NAATs are FDA cleared for use on endocervical swabs,
vaginal swabs, male urethral swabs, and male or
female urine specimens.

Management
Patients infected with gonorrhea are assumed to be coinfected with chlamydia and should be treated
routinely with a regimen effective against both
gonorrhea and chlamydia.2Recommended treatment
of uncomplicated infection of cervix, urethra, or
rectum:
Ceftriaxone 250mg IM in a single dose or (if not an
option) cefixime 400mg po in a single dose (gonorrhea
coverage) plus
Azithromycin 1 gm po x 1 or doxycycline 100 mg po
BID x 7 days (chlamydia coverage)

Treatment of Partners

Patients should be instructed to refer their sex partners for

evaluation and treatment.

Anyone with whom the gonorrhoea patient has had sex within 60
days of onset of patient symptoms, should be treated.

If the patients last sexual intercourse was more than 60 days prior,
then his/her most recent partner should be treated.
Special populations

Patients who are HIV-positive and infected with gonorrhoea should

receive the same treatment as HIV-negative patients.

Pregnant women should be treated with a recommended

cephalosporin (ceftriaxone or cefixime) and chlamydial coverage.

Azithromycin 2 gm can be considered for women who cannot

tolerate a cephalosporin.

HEPATITIS B
Diagnosis
Evaluation of the patient's blood for HBsAg, hepatitis
B surface antibody (HBsAb), and hepatitis B core
antibody (HBcAb).
Although the presence of HBsAg indicates that the
person is infectious, the presence of HBsAb indicates
recovery and immunity from HBV infection or
successful immunization against HBV.
HBcAb appears at the onset of acute HBV infection,
but may also indicate chronic HBV infection.
Interpretation of HBV immunologic markers is shown
inHBV DNA sometimes may be the only marker
present in early infections.

Management
People with acute hepatitis B do not require treatment.
Getting bed rest, drinking lots of fluids.
Treatment is only recommended for people with chronic
hepatitis B.
The goal of therapy is to prevent cirrhosis, liver failure
and liver cancer by reducing HBV viral load and the loss
of HBeAg (either with or without detection of anti-HBe)
while improving liver enzyme levels.

MANAGEMENT

KAARTHIGAN RAMAIAH

PREVENTION OF STDS

INTRODUCTION TO PREVENTION OF
STDS

The determinants of STD epidemiology are as

multifaceted as the approaches to prevention and
care should be. The interventions for preventing the
spread of STDs and HIV should take into
consideration the role of human physiology, human
behavioural patterns and sociocultural influences.
STD and HIV prevention cannot be addressed by
behaviour and barrier methods alone. Other factors
such as family units and values, provision of housing
to minimize disruption of family life, employment,
education, religion, culture, age, gender and so on
need to be kept in mind at all times.

Although coverage of these determinants is

beyond the scope of this document,
governments and programme managers
need to address these issues in the planning
and establishment of STD prevention and
care programmes
Prevention can be divided into two which is
primary
prevention
and
secondary
prevention.

PRIMARY PREVENTION

Primary prevention activities are essentially the same for classic

STDs as for sexually transmitted HIV because the primary mode of
transmission for both is sexual intercourse. The primary prevention
activities and the audiences are the same. It is logical that there
should be close coordination between those responsible for
AIDS/HIV prevention and those responsible for STD prevention
activities. Indeed, it is recommended that there should be full
integration.
In primary prevention the aim is to prevent the acquisition of
infection and disease. This can be done by promoting:
safer sexual behaviour;
the use of condoms for penetrative sexual acts.
Only primary prevention activities can have an effect on those
presently incurable STDs resulting from viral infections.

Primary prevention activities will be the responsibility of integrated or

coordinated AIDS/STD programmes. Providing STD clinical care offers an
important opportunity for primary prevention by providing education,
treatment and effective cure to persons who are, by definition, at
increased risk of infection and of transmitting infection. One persons
treatment and cure for an STD is primary prevention for a potential
contact.
In most countries the National AIDS Programme (NAP) is developing
prevention strategies and has interventions already in place. It is
important that these interventions include education on STDs. It is
probable that this will be mutually beneficial; for instance, education on
possible STD complications such as infertility may be persuasive in
reducing risk activity for STDs, including HIV. In low AIDS/HIV settings,
STDs may seem more relevant to people than HIV.
In some places existing STD programmes have developed expertise in
primary prevention which can be shared with the NAP.

Most of the prevention messages will apply to both

HIV and conventional STDs but the educational
messages which specifically relate to STDs will
include:
information that many STDs can be treated and
cured;
information that early treatment is necessary to
avoid
complications and permanent sequelae
information that symptoms and signs may not
be
noticed, particularly in women, until
complications appear
description of recognizable signs and symptoms

 a list of places where STD advice may be obtained

(i.e. basic health care services) and, where
available, categorical STD clinics and voluntary
centres;
assurance that wherever services are obtained in
the public sector privacy, confidentiality and
respect are guaranteed;
advice on assessing ones personal risk of having
acquired an STD, and also that of sexual partner(s).
(If the assessment suggests a possibility of STD,
attendance for STD advice is indicated).

In order to provide realistic, acceptable and

culturally appropriate STD messages it is
important to appreciate the knowledge,
attitudes and practices of the audience.
Simple research will be needed to obtain
information from communities including:
knowledge and perceptions of the
importance of STDs;
health care seeking behaviour;
constraints to seeking STD care.

SECONDARY PREVENTION

Secondary prevention entails the provision of treatment

and care for infected and affected persons. The activities
should include:
promotion of health care seeking behaviour directed not
only at those with symptoms of STDs, but also at those at
increased risk of acquiring STDs, including HIV infection;
the provision of clinical services that are accessible,
acceptable and effective, and which offer diagnosis and
effective treatment for both symptomatic and
asymptomatic patients with STDs, and their partners;
support and counselling services for both STD and HIV
patients

Knowledge and experience in promoting

health care-seeking behaviour for women,
men and young people in relation to STDs is
limited.
UNAIDS and WHO recognize as a priority the
development of best methods for different
settings in this area.
Guidance will be provided as information is
acquired. More operational research is needed
in this area of STD care.

PREVENTION METHODS

ABSTINENCE

The most reliable way to avoid infection

is to not have sex (i.e., anal, vaginal or
oral).

VACCINATION

Vaccines are safe, effective, and recommended ways

to prevent hepatitis B and HPV.HPV vaccinesfor
males and females can protect against some of the
most common types of HPV. It is best to get all three
doses (shots)before becoming sexually active.
However, HPV vaccines are recommended for all
teen girls and women through age 26 and all teen
boys and men through age 21, who did not get all
three doses of the vaccine when they were younger.
You should also getvaccinated for hepatitis Bif you
were not vaccinated when you were younger.

MUTUAL MONOGAMY

Mutual monogamy means that you agree to be

sexually active with only one person, who has
agreed to be sexually active only with you.
Being in a long-term mutually monogamous
relationship with an uninfected partner is one
of the most reliable ways to avoid STDs.
But you must both be certain you are not
infected with STDs. It is important to have an
open and honest conversation with your
partner.

REDUCED NUMBER OF SEX PARTNERS

Reducing your number of sex partners

can decrease your risk for STDs. It is
still important that you and your
partner get tested, and that you share
your test results with one another.

CONDOMS

Correct and consistent use of themale

latex condomis highly effective in
reducing STD transmission.
Use a condom every time you have
anal, vaginal, or oral sex.

FEMALE CONDOMS
Volunteers explain the use of the female
condom in India.

SCREENING

GENERAL SCREENING

Routine laboratory screening for common STDs is

indicated for sexually active adolescents. The
following screening recommendations summarize
published federal agency and medical professional
organizations clinical guidelines for sexually
active adolescents:

Routine screening for C. trachomatis of all sexually active

females aged 25 years is recommended annually.
Evidence is insufficient to recommend routine screening
for C. trachomatis in sexually active young men based on
feasibility, efficacy, and cost-effectiveness. However,
screening of sexually active young men should be
considered in clinical settings associated with high
prevalence of chlamydia (e.g., adolescent clinics,
correctional facilities, and STD clinics).

 Routine screening for N. gonorrhoeae in all sexually active

women at risk for infection is recommended annually.
Women aged <25 years are at highest risk for gonorrhea
infection. Other risk factors that place women at increased
risk include a previous gonorrhea infection, the presence of
other STDs, new or multiple sex partners, inconsistent
condom use, commercial sex work, and drug use.
HIV screening should be discussed with all adolescents
and encouraged for those who are sexually active and those
who use injection drugs.
The routine screening of adolescents who are
asymptomatic for certain STDs (e.g., syphilis,
trichomoniasis, BV, HSV, HPV, HAV, and HBV) is not
recommended. However, YMSM and pregnant adolescent
females might require more thorough evaluation.

Guidelines from USPSTF and ACOG

recommend that cervical cancer screening
begin at age 21 years, a recommendation
based on the low incidence of cervical cancer
and limited utility of screening for younger
adolescents . However, the American Cancer
Society (ACS) recommends that women start
cervical screening with Pap tests 3 years after
initiating sexual activity, but by no later than
age 21 years.

CHLAMYDIA AND GONORRHEA SCREENING

Universal screening of adolescent

females for chlamydia and gonorrhea
should be conducted at intake in
juvenile detention or jail facilities.
Universal screening of adult females
should be conducted at intake among
adult females up to 35 years of age (or
on the basis of local institutional
prevalence data).

SYPHILIS SCREENING

Universal
screening
should
be
conducted on the basis of the local
area and institutional prevalence of
early (primary, secondary, and early
latent) infectious syphilis.

CONTACT TRACING

The process of identifying relevant contacts of a

person with an infectious disease and ensuring that
they are aware of their exposure. For sexually
transmitted infections (STIs), relevant contacts
include those with whom the case has had sex
during the infectious period, as well as babies with
infected mothers. The particular sexual practices of
importance vary for different STIs.
For blood-borne infections (HIV, hepatitis B and C)
needle and drug equipment sharing contacts,
transfusion recipients, and those who may have
been accidentally exposed to blood by other means
are also relevant.

The term partner notification has

sometimes been used synonymously with
contact tracing in the context of HIV,
however it is important to consider contacts
for whom the term partner may be
inappropriate, such as needle sharing
contacts, transfusion recipients and children
born to infected women.

SomeAIDSactivists have argued that contact

tracing is counter-productive in that it would
lead persons to avoidHIV testingfor fear that
it would breach their right to privacy.
By tracing the sexual partners of infected
individuals, testing them for infection,
treating the infected and tracing their
contacts in turn, STI clinics could be very
effective at suppressing infections in the
general population.

In the 1980s, first genital herpes and then AIDS emerged

into the public consciousness as sexually transmitted
diseases that could not be cured by modern medicine.
AIDS in particular has a long asymptomatic period
during which time HIV (the human immunodeficiency
virus, which causes AIDS) can replicate and the disease
can be transmitted to othersfollowed by a symptomatic
period, which leads rapidly to death unless treated.
For example, HIV/AIDS entered the United States in
about 1969 likely through a single infected immigrant
from Haiti. Recognition that AIDS threatened a global
pandemic led to public information campaigns and the
development of treatments that allow AIDS to be
managed by suppressing the replication of HIV for as
long as possible. Contact tracing continues to be an
important measure, even when diseases are incurable,
as it helps to contain infection.

REFERENCES

http://www.cdc.gov/std/
http://emedicine.medscape.com/article/775507-overvi
ew#a3
https://www.nichd.nih.gov/health/topics/stds/conditionin
fo/Pages/types.aspx
www.nhs.uk/.../Introduction.aspx
www.nlm.nih.gov/.../hp079105.pdf
http://www.cumc.columbia.edu/student/health/pdf/R-S/S
TDs.pdf
www.unaids.org/.../una97-6_en.pdf
http://www.who.int/vaccine_research/documents/STDs.pd
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