FCM III GROUP

DAVID, John Albert G. SOLIMAN, Maria Lourdes SUNGA, Ann Bernadette TORRES, Doris Katrina M. VAGILIDAD, Ann Josell B. VIRATA, Fiel Ann P. YUMANG, Maria Corazon ZUNIGA, Ann Bernadette E. YUMOL, Jerik V.

HIV/AIDS

OBJECTIVES
Enumerate the goal, objective andHIV infections Enumerate the measures against strategies & thrusts of the program. and AIDS trasmission. Overview of the goal and national responses to Explain the rationale of the program. HIV infection and AIDS. Explain the process of diagnosingto the diagnosis Explain the syndromic approach a patient with HIV infection. and management of STDs. Explain the medical management of patients with Plan a health education activity to increase awareness on the infection. HIV prevention and control of reproductive tract infection.

HIV
a retrovirus that leads to acquired immune deficiency syndrome or AIDS. HIV-1 and HIV-2 destroys specific blood cells called the CD4+ T cells, which are crucial to help the body fight diseases.

Time Graph showing HIV copies and CD4 counts over course of HIV infection.

Acquired Immune Deficiency Syndrome (AIDS)

late stage of HIV infection when a persons immune system is severely damaged and has difficulty fighting diseases and certain cancers.

Spread of the Infection

sexual intercourse rinse water, or other equipment used to Sharing needles, syringes,
prepare illicit drugs for injection unprotected anal sex is riskier than unprotected vaginal sex receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with with other men, Among men who have sex HIV unprotected receptive anal sex is riskier than being born to an infected insertive anal sex unprotected mother being bitten by a person withsex partners or the presence of Having multiple HIV other sexually transmitted diseases (STDs) can increase the risk wounds, or mucous contact between broken skin, of infection during sex membranes and HIV-infected blood or bloodcontaminated body fluidsoral sex can also be a risk for HIV Unprotected transmission, but it is a much lower risk than anal or vaginal sex.

Philippine National Aids Council (PNAC)

PNAC History & Overview

PNAC is a multisectoral body composed of 13 government agencies: Department of by Executive created in 1992Foreign Affairs order No. 39 as an ... and 7 non-governmentand Local Government Department ofto the office of the President on all Interior agencies advisory bodySocial Studies and Action Institute for of Justice Department matters relatedTourism Department of to AIDS The Library Foundation Department Pamilyang Pilipino Kabalikat ngof Social Welfare and Development Philippine Information Agency HIV/AIDS Network Philippines Senate Committee on Health Pinoy Plus by virtue of Republic Act 8504 as the reconstituted Congress Health Care Health Department of Labor and WomensCommittee onFoundation central advisory, planning and policy making body on Employment Health Action Information Network theDepartment Budget and Management and AIDS in the prevention and control of HIV DepEd country Department of Health

PNAC History & Overview

PNAC technical working group (TWG) composed of the technical staff of the PNAC members acts as the working body of the PNAC that researches policy issues for the Council

The PNAC and its TWG functions to set the national agenda regarding AIDS/STI prevention and control and oversees the implementation and evaluation of the Medium Term Plan

Mission

PNAC shall lead in developing and sustaining an enabling environment where individuals and sectors can appropriately, effectively and expeditiously respond to the many challenges of HIV/AIDS.

Vision

A fully empowered nation where different individuals and sectors work in partnership to prevent HIV transmission and to lessen its impact on affected persons in particular, and society in general.

National AIDS/STD Prevention and Control Program (NAPCP)

Policy statement under DOH AO 7-C Series of 1995 Prevention of HIV infection shall be the priority of the National AIDS/STD Prevention and Control Program.

5th AIDS Medium Term Plan (5th-AMTP) 2011-2016

5th AIDS Medium Term Plan 2011-2016

stipulated in the implementing rules and regulations of the AIDS Prevention and Control Act or R.A. 8504. It seeks to:

To enable lead agencies and other partners to anchor their To promote the cost-effective, efficient, and harmonized HIV respective HIV and AIDS strategies ona more coherent and and AIDS initiatives toward achieving a common rationale; effective multi-sector response; and
To guide technical working groups, institutions, organizations, and LGUs in structuring and formulating their respective HIV and AIDS operational plans; To provide the basis for monitoring and evaluating the national

response.
To arm advocates and technical assistance providers with the basis for promoting the prioritization of HIV and AIDS among national and local high-level stakeholders;

5th AMTP: Guiding Principles

1. Rights-Based : Underscore rights as an entitlement of the people as claim-holders and the states obligation to respect, protect, and promote peoples rights as duty bearers

2. Community Participation : Invoke the rights of citizens to actively participate and engage the state in addressing their needs and concerns.

5th AMTP: Guiding Principles

3. Integrated Development : Incorporate the (AMTP) into the overall national development plans (through the Medium-Term Development Plan) and local development/investment plans. 4. Comprehensive Interventions : Provide gender-responsive, age-sensitive and responsive, context-specific, and culturally appropriate comprehensive packages of interventions for HIV prevention and treatment, care, and support.

5th AMTP: Guiding Principles

5. Universal Access : Ensure that citizens have broad access to promotive, preventive, and curative health services.

6. Evidence-Based : Ensure the generation, analysis, and use of strategic information for evidence-based improvement of plan implementation and policy development.

5th AMTP: Guiding Principles

7. Policy Compliance : Ensure that all national and local governments understand and fulfill their constitutional and legal obligations with regard to HIV and AIDS and implement relevant governance and development responses. 8. Equal Access : Promote universal distribution of services and the availability of adequate support systems especially for HIV-infected and affected individuals in all LGUs.

5th AMTP: Guiding Principles

9. Equity : Ensure equitable distribution of services in a manner that is non-discriminatory among individuals infected or affected by HIV and those not infected or affected by HIV and AIDS in all areas. 10. Flexibility : Adopt a differentiated approach that determines current response levels, build on strengths, and tailor-fit interventions to meet local needs.

5th AMTP: Guiding Principles

11. Incrementalism : Roll out programs and other interventions in a progressive manner over time.

12. Capacity Building and Leadership : Promote and develop appropriate competencies among all role players to carry out their responsibilities in responding to the HIV and AIDS challenge.

5th AMTP: Vision

To halt to the present rate of HIV infection in the Philippines by preventing the further spread of HIV infection and reducing the impact of the disease on individuals, families, communities, and various sectors

5th AMTP: Goal

By 2016, the country will have prevented further spread of HIV infection by maintaining the prevalence of less than 66 HIV cases per 100,000 populations and reduce the impact of the disease on individuals, families, sectors and communities.

5th AMTP: Strategic Objectives

1. HIV prevention programs : To improve the coverage and quality of prevention programs for persons most at risk for, vulnerable to, and living with HIV.

2. Treatment, care, and support programs : To improve the coverage and quality of treatment, care, and support programs for persons living with HIV and their families.

5th AMTP: Strategic Objectives

3. HIV and AIDS policy environment : To enhance policies for scaling-up implementation, effective management, and coordination of HIV programs at all levels.

4. Philippine National AIDS Council (PNAC) : To strengthen the capacities of PNAC member agencies to oversee the implementation of the 5th AMTP.

5th AMTP: Strategic Objectives

5. Partnerships on HIV and AIDS : To expand, strengthen, and build the capacity of partners in the national response including local governments, the private sector, and communities-at-risk, vulnerable, and living with HIV for the implementation of the 5th AMTP.

5th AMTP: Outcomes of Change

1. Persons at risk for, vulnerable to, and living with HIV avoid risky behaviors to prevent HIV infection.

2. People living with HIV live longer and more productive lives.
3. The Country AIDS Response is well governed and accountable.

5th AMTP: Indicators for Monitoring & Evaluation

- Number of reported new HIV infections - HIV prevalence among people in prostitution (PIP) - HIV prevalence among men having sex with men (MSM) - HIV prevalence among persons who inject drugs (PWID) - HIV prevalence among male clients of female sex workers (SW) - Percentage of young people aged 15-24 who are HIV-infected - Number of people living with HIV (PLHIV) still alive after 12 months of anti-retroviral treatment (ART) - Percentage of PLHIV gainfully employed (working for wages) - Percentage of PLHIV engaged in livelihood or income-generating activities - Amount allocated for AMTP-5 by Government of the Philippines - Amount spent on AMTP-5

MANILA HEALTH DEPARTMENT

Goal
To maintain HIV/AIDS and STI prevalence rate of less than 1%.

To maintain HIV/AIDS and STI prevalence rate among vulnerable population (sex worker, homosexuals, and etc.) of <3%.

PROGRAM INTERVENTION
comprehensive STI case management for primary public health facilities etiologic management of STI condom use program VCCT (PICT & CICT)

IHBSS

support intervention advocacy program

Legend: VCCT = voluntary confidential counceling and testing PICT = provider initiated counceling and testing (offered by MHD) CICT = client initiated counceling and testing (volunteer) IHBSS = integrated HIV behavior serologic surveillance

Support Intervention Advocacy Program

Organize / strengthening of local AIDS council
Outreach for Most at risk population AIDS candlelight ceremony AIDS awareness campaign World aids day

STI AND HIV/AIDS CASE STAT (2009-2010)

STI GONORR HEA SYPHILIS HIV

2009 2010

33% 17.9%

9.9% 5.5%

3% 1.8%

2.64% 3.47%

STI AND HIV/AIDS CASE STAT (2009-2010)

35% 33% 30%

25%

20% 17.90% 15%

STI GONORRHEA SYPHILIS HIV

10%

9.90%

5% 3% 2.64%

5.50% 3.47% 1.80% 2010

0%
2009

STI cases are now considered latent phase or declining however HIV cases before was hidden with low and slow rate of growth but now it is expanding and accelerating

RATIONALE
To enable health facilities to provide acceptable, affordable, and effective management of HIV/AIDS cases To provide health care workers, with a standard protocol on the management of HIV/AIDS in children which is consistent with the national HIV/AIDS Case Management Guidelines issued by the DOH. To improve case finding and management of asymptomatic women with HIV/AIDS

Newly diagnosed HIV cases in the Philippines Table 1. Quick Facts

Demographic data Total reported cases Asymptomatic cases AIDS cases Males Females May 2011 Jan-May 2011 1984-2011

184 182

838 826

6853 5984

Youth (15 to 24 y/o) Children <15 y/o

Reported deaths due to AIDS

2 169 15 51
0 1

12 777 61 231
2 2

869 5476 1366 1444

57 325

Table 2. Reported Mode of HIV Transmission

Mode of May 2011 n=184 May 2010 n=153 transmission Sexual contact 168 122 Heterosexual 29 (17%) 16 (13%) Homosexual 75 (45%) 56 (46%) Bisexual 64 (38%) 50 (41%) Blood/Blood 0 0 products Injecting drug 13 28 use Needle prick 0 0 injury Mother-to-child 0 0 No data 3 3 available Cumulative N=6853 6206 2630 (42%) 2229 (36%) 1347 (22%) 20 172 3 54 398

AIDS Cases
Of the newly reported HIV positive cases, two were reported as AIDS cases Last years data shows no reports of AIDS cases no incidence of AIDS related deaths last year As of May of this year, there was one reported death.

Of the 838 HIV positive cases in 2011, twelve were reported as AIDS cases

AIDS Cases
92% males Age range: 22-59 years old (median 36) All acquired the infection through sexual contact (80% through MSM) 1984 to 2011, there were 869 AIDS cases reported, 71% (621) were males

Median age was 35 years (range 1-72 years)

AIDS Cases
Of the AIDS cases, there were 325 (37%) deaths during the reported period Sexual contact was the most common mode of HIV transmission, accounting for 93% (808) of all AIDS cases More than half of sexual transmission was through: heterosexual contact homosexual contact bisexual contact

Male Cases Female Cases

HIV Detection and Testing

HIV Testing is voluntary, confidential and anonymous, with pre and post-test counseling. The window period for testing is 6 months from the last exposure with HIV. There is NO vaccine and NO cure for HIV. Anti-retroviral medication (ARVs) may only slow down the replication of the virus.

ANTIRETROVIRAL THERAPY FOR ADULTS AND ADOLESCENTS When to start All adolescents and adults including pregnant women should start regardless of the presence or absence of clinical symptoms What to use in first-line therapy Consist of an NNRTI + two NRTIs, one of which should be Zidovudine (AZT) or Tenofovir (TDF) Second line therapy Consist of ritonavir-boosted protease inhibitor (PI) plus two NRTIs, one of which should be AZT of TDF Laboratory monitoring All patients should have access to CD4 cell-counting testing to optomize pre-ART care and ART management HIV/TB coinfection Should start ART as soon as possible after starting TB treatment HIV/HBV coinfection Patients who require HBV infection should start ART

ANTIRETROVIRAL THERAPY FOR PREGNANT WOMEN AND FOR PREVENTING HIV IN INFANTS

ANTIRETROVIRAL THERAPY FOR CHILDREN AND INFANTS

Enumerate the measures against HIV infection and AIDS transmission

Presently, there are no known cure and vaccine for human immunodeficiency virus (HIV) infection Anti-retroviral drugs only aim to slow down the replication of virus

The A-B-C-D-E of AIDS prevention

Abstinence To screen all blood donors for HIV infection Treatment of HIV infected mothers Be faithful Avoidance of breastfeeding Careful Sex Dont share needles/sterilized needle Education and Information

The National Response

Mechanisms
One National AIDS Coordinating Authority Philippine National AIDS Council (PNAC) One Agreed Strategic Framework Goal: prevent further spread of HIV infection and reduce impact of AIDS on individuals, families, and communities One Agreed National Monitoring and Evaluation (M&E) System was developed Tasks: generation of precise, accessible, and timely data as the evidence base for program planning, which includes such critical tools as the geographic vulnerability mapping and the Integrated HIV Behavioral Serologic Survey (IHBSS), and research studies to build evidence for future program thrusts and priorities

PNAC renewed its efforts toward creation of the Local AIDS Council and the enforcement of local AIDS legislations in at least 32 LGUs

From 2008 to 2009, the DOH successfully established the following guidelines and protocols: Policies and Guidelines on the Prevention of Mother-toChild Transmission of HIV (PMTCT); Guidelines on Anti-Retroviral Therapy (ART) among adults and adolescents with HIV; Policies and Guidelines in the collaborative approach to TB and HIV prevention and control; Anti-Retroviral Therapy (ART) for HIV infection, recommendations for adults in the Philippines

The Local Response

To date, 32 LGUs (Cities and Municipalities) have local AIDS ordinances with corresponding budgetary allocations and functional Local AIDS Councils (LACs) that direct and oversee the local response, with five more LGUs having concrete local responses

Provinces of Albay, Cavite, Aklan, and Bohol each have a Provincial AIDS Council
Condom use is implemented 100 percent in 15 LGU sites, and public voluntary counseling and treatment have expanded to 75 such areas

All treatment hubs, selected social hygiene clinics, and civil society have been trained on Prevention of Mother-to-Child Transmission of HIV (PMTCT)

Encouraging innovations partnership mechanisms for treatment, care, and support (TCS) for Persons Living with HIV (PLHIV) and their affected families resource mobilization undertaken by a broad-based, multisectoral provincial AIDS Council to prevent the spread of the infection, and treatment and care for those already infected sustainability projects for young people of poor families who are at risk for and vulnerable to HIV infection, including development of entrepreneurship skills and undertaking of income-generating projects

The 5th AMTP continues to focus on the Most-At-Risk Populations (MARPs), utilizing population-level measures to address the current drivers of the epidemic between Men having Sex with Men (MSM) and persons who inject drugs (PWIDs) At the same time, it recognizes the emerging opportunities for more targeted and tailored interventions to be more responsive to the varying contexts and subcultures within these populations

For a national Strategic Plan to be both realistic and sustainable, it will rely on the balance of population-level measures with targeted interventions

It likewise strongly enjoins local government units to know and make an assessment of the extent and level of the epidemic in their respective jurisdictions and formulate their local responses accordingly

SEXUALLY TRANSMITTED DISEASE

Introduction
Sexually Transmitted Diseases (STDs - also known as Sexually Transmitted Infections) present a major public health concern in both industrialised and developing countries.

Introduction
It is thought that many reports substantially underestimate the number of new STD cases because social stigma and other factors prevent people seeking health care.

Introduction
The WHO estimates that 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occurred throughout the world in 1999 in men and women aged 15-49 years.

Estimated prevalence and annual incidence of curable STDs by region, 1999

Region North America Western Europe North Africa & Middle East Eastern Europe & Central Europe Sub-Saharan Africa South & Southeast Asia East Asia & Pacfic Australia & New Zealand Latin America & Carribean Total Adult population (millions)1 156 203 165 205 269 955 815 11 260 3040 Infected adults (millions) 3 4 3.5 6 32 48 6 0.3 18.5 116.5 Infected adults per 1,000 population 19 20 21 29 119 50 7 27 71 New infections in 1999 (millions) 14 17 10 22 69 151 18 1 38 340

STD Cases in the Philippines

1987 : 26,450 STD cases 1991: 75,550 STD cases
274 % increased attributed to an improved training program of health personnel conducted

Primarily females : ages 15 to 25

Definition of Terms
Sexually Transmitted Disease (STD)
infections transmitted sexually which includes the acute disease process, complications which may occur and the longer term permanent sequelae which may result.
Eg: sexually transmitted infection, gonorrhea, results in a disease, cervicitis, which may lead to a complication salphingitis, permanently impaired fertility will be a sequelae

Definition of Terms
Reproductive Tract Infection (RTI)
infections affecting the lower and upper reproductive tracts in males and females. These include STD, endogenous infections, iatrogenic infections and unsterile insertion of IUDs.

Definition of Terms
Asymptomatic women with RTI/STD: woman infected with RTI/STD with no obvious signs and symptoms presented or with minimal symptoms perceived as normal.

Definition of Terms
Syndromic approach to STD case management
management of STD patients based on the identification of consistent groups of symptoms and easily recognized signs and the provision of treatment that will deal with the majority of organism responsible for producing the syndrome.

Definition of Terms
Risk assessment
assessment made by the health care worker as to whether a woman is likely to have a sexually acquired infection causing cervical infection by asking a set of questions on demographic, behavorial and related factors.

Rationale of the Programme

To enable health facilities to provide acceptable, affordable, and effective management of STD cases

Rationale of the Programme

To provide health care workers, with a standard protocol on the management of STDs in children which is consistent with the national STD Case Management Guidelines issued by the DOH

Rationale of the Programme

To improve case finding and management of asymptomatic women with RTI/STD

Objectives
To provide directions on early case finding of asymptomatic women with RTI/ STD in order to provide early treatment and prevent RTI/ STD complications To establish standards for risk assessment, training, referral for managing asymptomatic women with RTI/ STD

Objectives
To provide health care workers in all levels of the health system guidance and a standard approach in managing STI

Objectives
To enable all health care workers at all levels of the health system to provide effective, acceptable, and affordable STI management To make recommendations on the best drugs to use

THE DISEASE

Sexually transmitted infections (STIs) are infections that are spread primarily through person-to-person sexual contact. There are more than 30 different sexually transmissible bacteria, viruses, and parasites. Several, in particular HIV and syphilis, can also be transmitted from mother to child during pregnancy and childbirth, and through blood products and tissue transfer.

THE DISEASE

Most common bacterial agents:

Neisseria gonorrhoeae (gonorrhea or gonococcal infection) Chlamydia trachomatis (chlamydial infections) Treponema pallidum (syphilis) Haemophilus ducreyi (chancroid) Klebsiella granulomatis (granuloma inguinale or donovanosis)

THE DISEASE

Most common viral agents:

Human immunodeficiency virus (AIDS) Herpes simplex virus type 2 (genital herpes) Human papillomavirus (genital warts and certain subtypes lead to cervical cancer in women) Hepatitis B virus (hepatitis and chronic cases may lead to cancer of the liver) Cytomegalovirus (inflammation in a number of organs including the brain, eye, and colon)

THE DISEASE

Most common parasitic agents:

Trichomonas vaginalis, protozoa (vaginal trichomoniasis) Candida albicans, fungi (vulvovaginitis in women, balanoposthitis in men)

THE DISEASE

Some STIs often exist without symptoms. For example, up to 70% of women and a significant proportion of men with gonococcal and/or chlamydial infections may experience no symptoms at all. Both symptomatic and asymptomatic infections can lead to the development of serious complications.

THE DISEASE

Although many different pathogens cause STIs, some of them give rise to similar or overlapping clinical appearances. Some of these signs and symptoms are easily recognizable and consistent, giving what is known as a syndrome that signals the presence of one or a number of pathogens. For example, a discharge from the urethra in men can be caused by gonorrhea alone, chlamydia alone, or both together.

THE DISEASE

The syndrome of common STIs include:

Urethral discharge Genital ulcers Inguinal swellings Scrotal swelling Vaginal discharge Lower abdominal pain Neonatal eye infections

THE GLOBAL PICTURE

Infection rates can vary enormously between countries in the same region and between urban and rural populations. In general, however, the prevalence of STDs tends to be higher: in urban residents, in unmarried individuals, and in young adults.

THE GLOBAL PICTURE

340 million new cases of curable STIs (syphilis, gonorrhoea, chlamydia, and trichomoniasis) occur annually throughout the world in adults aged 15-49 years. In developing countries, STIs and their complications rank in the top five disease categories for which adults seek health care. The largest number of new infections occurred in the region of South & Southeast Asia, followed by sub-Saharan Africa and Latin America & the Caribbean. The highest rate of new cases per 1,000 population occurred in sub-Saharan Africa.

GLOBAL PICTURE
Region North America Western Europe North Africa & Middle East Eastern Europe & Central Europe Sub-Saharan Africa South & Southeast Asia Adult population (millions) 156 203 165 205 269 955 Infected adults (millions) 3 4 3.5 6 32 48 Infected adults per 1,000 population 19 20 21 29 119 50 New infections (millions) 14 17 10 22 69 151

East Asia & Pacfic

Australia & New Zealand Latin America & Carribean Total

815
11 260 3040

6
0.3 18.5 116.5

7
27 71 -

18
1 38 340

THE NATIONAL PICTURE

The quality of the data on STIs in the Philippines is problematic.

Most of the data are obtained from female commercial sex workers. Private practitioners are reluctant to report STIs to DOH. Many problems with the data result from inadequate training of doctors, nurses, and midwives and a lack of equipment and reagents for STI testing. Furthermore, because the social hygiene clinics do not have the capability to do syphilis testing, syphilis is known to be underreported. Poor contact tracing is also a problem in STI identification and management.

THE NATIONAL PICTURE

In 1987, there were 26,450 new cases of STIs reported in the Philippines. By 1991, 75,550 new cases were reported, an increase of over 274%.

Part of this increase in STI cases reported may be attributed to an improved training program of health personnel conducted in 1989 and 1990.

Non-gonococcal urethritis accounted for 69% and gonorrhea for 24% of the total STIs reported in 1991. Other STDs reported were candidiasis, trichomoniasis, human papillomavirus and syphilis, each representing less than 3% of the total cases. Approximately 62% of clients (primarily females) were between the ages of 15 and 25.

Goal and Objectives of the Program

Prevention and Management of STDs at all levels of health care system nationwide in order to lessen complications and consequences and reduce the spread of HIV

Roles of Implementing Agencies

Role of Department of Health and Nature of Assistance

Provide technically sound recommendations as the need arise to improve STI case management at all levels of health care. Provide training of trainers on STI case management. Develop standardized training modules and materials. Monitor and conduct evaluation of the quality of STI case management and training

Role of Department of Health and Nature of Assistance

Advocate to policy makers, local government units the importance of providing adequate STI services to generate resources, sustain the implementation of activities and develop local policies that are consistent with national policies. Coordinate the implementation of activities at the different levels of health care system to ensure proper utilization of limited resources, prevent duplication of function and render adequate referral mechanism. Develop methodologies and procedures for referral.

Role of the Local Government Unit and Nature of Assistance

Implement guidelines for the management of STI. Provide adequate resources and environment for the provision of STI services. Ensure that effective, acceptable STI services are available at the local health unit. Legislative support to include the review, amendment and enactment of ordinances that will improve STI case management in accordance with the Department of Health guidelines.

GUIDELINES AND PROCEDURES

To ensure a more cost effective approach in the management of STI in the Philippines the following guidelines and flowcharts are being recommended:

Patient with vaginal discharge

Management of Women with Vaginal Discharge

Take history

Sexual partner with urethral discharge in past 3 months

NO 2.

1. Review history Examine with speculum

D One clinical and one behavioral positive? YES 1. Treat for vaginitis 2. 3 Cs

G 1. 2. Treat for cervicitis Treat for vaginitis 3. 4 Cs YES

4 Cs Counseling Condom Compliance Contact Tracing 3 Cs Counseling Condom Compliance 2 Cs Counseling Condoms

Patient with vaginal discharge

Take history

B C 1. 2. Review history Examine with speculum Whiff test and wet mount

In the presence laboratory support (microscope, KOH 10% and trained health workers, and facilities for genital examination) the following flowchart is recommended for the management of vaginal discharge

Sexual partner with urethral discharge in past 3 months

NO

3.

One clinical and one behavioral positive?

NO

Whiff test positive ?

Budding yeast or pseudohyphae present? H

NO

1. 2.

Reassure 2 Cs

YES

1. 2.

Treat for TV/BV 4 Cs

I 1. 2.
NO

Treat for candidiasis 2 Cs F

1. 2. 3.

Treat for cervicitis Treat for vaginitis 4 Cs

Whiff test positive?

YES

Budding yeast or pseudohyphae present

1. 2.

Treat for candidiasis 2 Cs

1.
2. 3.

Treat for cervicitis Treat for TB/TV 4 Cs

F/H

F/H

1.
2. 3.

Treat for cervicitis Treat for candidiasis 4 Cs

Management of Men with Urethral Discharge

Patient complains of urethral discharge and/or burning A

Take history and examine milk urethra if necessary

C Discharge present? NO Reassure 2Cs

YES

1. 2. 3.

Treat for gonorrhea Treat for chlamydia 4Cs

7 DAYS Symptom persist? YES Refer

Management of Genital Ulcer Disease

Patient complains with genital sore(s)

Take history and examine A A single ulcer? NO Start as vesicular lesions and recurrent in same place

F Reassure 2 Cs

G YES B 1. 2. 3. 1. 2. 3. Treat for herpes Symptomatic relief Reassure 4Cs Treat for syphilis 4 Cs See 1 week D

Painful?

E
1. 2. 3. Treat for herpes Symptomatic relief Reassure 4Cs C 4 Cs Resolving? NO Refer 4 Cs Resolving? YES NO Refer

Management of Men with Scrotal Swelling

Patient complains with scrotal swelling/pain Take history and examine

Swelling/ tenderness confirmed?

NO Reassure 2 Cs

YES A D 1. 2. 3. 4. 5. Treat for gonorrhea Treat for chlamydia 4 Cs Advice support for scrotum Return in 5-6 days

History of trauma? Testis rotated or elevated?

YES Refer to Surgeon Immediately B NO Improving? Refer

1.
2.

Complete remaining treatment 4 Cs

Patient complains with lower abdominal pain

Take history Examine abdomen Do speculum examination Do bimanual examination

Management of Women with Lower Abdominal Pain

YES B C Missed or overdue periods? And/or recent delivery/ abortion? And/or abdominal guarding? And/or rebound tenderness? And/or Vaginal bleeding? And/or palpable, painful masses? Fever >38? And/or pain on moving cervix? And/or vaginal discharge?

NO

Follow up if pain persist

YES D 1. 2. 3. Treat for PID 4 Cs Follow-up in 3-7 days depending on severity

Improving? NO YES

Refer

Continue treatment to complete 14 days

Plan a Health Education Activity to Increase Awareness about STIs

contact individuals and organizations who are interested or those who are knowledgeable about reproductive tract infections

establish partnerships like the Local Government Units and secure funds or donations to support our program. Public symposium where the speakers would be from the Department of Health or the National AIDS council. distribution of flyers, brochures about STIs in the community Film showing activities Exhibits and posters containing facts about STIs could be displayed for public viewing. Seek the help of the church, temples or mosques in giving STI brochures to their members.

THANK YOU!!!