Management of STDs and

HIV

By:- Kunwar utkarsh yadav

Syndromic management of STDs

 Syndromes in STDs are grouped as:-

• Genital ulcer
• Urethral discharge
• Vaginal discharge
• Inguinal bubo
• Painful scrotal swelling
• Lower abd. Pain
 Pt. complains of enlarged and/or painful
inguinal lymph node Management of
Inguinal bubo

Take history and examine for yes Use the flowchart for
genital ulcer? genital ulcers

Treat for LGV

Doxycycline 100mg orally BD x 14 days Return after 7 days for
Alternate regimen : follow up if pain persists
Erythromycin stearate 500 mg orally QID x14 days
A fluctuant bubo needs to be aspirated with wide bore in needle
and syringe every 2nd or 3rd day till there is no aspirate Responds to
treatment

no yes
Treat patner even if asymptomatic
Educate on safe sex, counsel, provide condom and
Refer to higher Reinforce education,
promote uses, refer to VCTC counsel,provide condom and
center
promte usescomplete the t/t
 Patient complain of painful scrotal swelling Management of
scrotal swelling
History of injury to scrotal Yes Refer to higher center

No
Examine scrotum
Reassure patient
Swelling of scrotum No
Provide condom & promte use
Yes

Testis rotated and Refer immediately to

Yes
retracted higher center

No
Treatment for gonorrhoea and chlamydia
azithromycin 2g single dose
Or azithromycin 1g + cefixime 400mg or
Azitrhromycin 1g +inj. Ceftriaxone 250mg IM
in single dose
Treat partner
Follow up after 7 days, counsel,
Provide condom & promte use
,educate on safe sex,refer to VCTC
Tenderness and swelling persists

No Yes
Cured Refer to higher center
Management Of HIV/AIDS

Antiretroviral Therapy

Occupational Post Exposure

Prophylaxis

Specific Prophylaxis
ANTIRETROVIRAL TREATMENT

Nucleoside reverse transcriptase inhibitors (NRTIs)

Zidovudine  Abacavir
Didanosine Emtricitabine
Zalcitabine Entecavir
Stavudine Apricitabine
Lamivudine
Nucleotide reverse transcriptase
inhibitors (NtRTIs)
Tenofovir
Adefovir

Non-nucleoside reverse transcriptase

inhibitors (NNRTIs)
Efavirenz
Nevirapine
Delavirdine
Etravirine
Protease inhibitor

Saquinavir Lopinavir
Ritonavir Atazanavir
Indinavir Fosamprenavir
Nelfinavir Tipranavir
Amprenavir Darunavir

Entry inhibitor
• Enfuvirtide
WHO recommendations for initiating Anti
Retroviral Therapy in adults and
adolescents
Who clinical stage CD4 testing not CD4 testing available
available

1 Do not start ART Start ART if CD4 is < 200/mm3

2 Do not start ART

3 Start ART Consider starting ART if CD4

<350/mm3,starting before it drops to
<200/mm3
Recommended for all HIV + pregnant
women if CD4 <350/mm3

4 Start ART Start all irrespective if CD4

WHO recommendations for initiating Anti Retroviral
Therapy in infants and children and adults

INFANTS 1st line regimen 2nd line regimen

Infant not exposed to NVP + 2NRTI LPV/r + 2NRTI

ARV

Infant exposed to ARV Boosted PI + 2NRTI NNRTI + 2NRTI

Infant with unknown ARV NVP + 2NRTI LPV/r + 2NRTI

exposure

CHILDREN

Children 3 yrs or over NNRTI + 2NRTI Boosted PI + 2NRTI

 Contd..
ADULT/ADOLESCEN 1st line regimen 2nd line regimen
TS

Adult or adolescent NVP+2NRTI Boosted PI + 2NRTI

Women starting ART in NVP+2NRTI Doesn’t apply

pregnancy

Women starting ART NVP+2NRTI Doesn’t apply

starting within 6 months Or 3NRTI
of single dose NVP
Recommended 1st line ART regimen for
pregnant women
Mother

 Antipartum AZT+3TC+NVP twice daily

 Intrapartum AZT+3TC+NVP twice daily

 Postpartum AZT+3TC+NVP twice daily

Recommended 1st line ART regimen for
prophylaxis in pregnant women not eligible for
ART

 Antipartum AZT starting at 28

weeks of pregnancy

 Intrapartum Sd-NVP + AZT/3TC

 Postpartum AZT/3TC x 7days

Occupational post exposure
prophylaxis

 Itconsists of :-
1.First aid care
2.Counselling and risk assessment
3.Hiv testing and counselling
4. Short term provision of antiretroviral
drugs and follow up
 Two Drug PEP Recommended
 exposure to asymptomatic HIV+ person by solid needle stick or
superficial injury that break the skin
 a mucous membrane exposure to a large volume of HIV infected
blood that's source is asymptomatic (consider for a lesser volume, a
few drops)
 a mucous membrane exposure to a small volume of HIV infected
blood that's source is symptomatic.

 Three Drug PEP Recommended

 exposure to asymptomatic HIV+ person via deep puncture from a
large bore hollow needle
 a puncture from a needle with visible blood on the needle
 a puncture from a needle used in a patient's vein or artery
Three or More Drug PEP Recommended
 any needle stick exposure from any type needle used on a
symptomatic HIV+ person
 a mucous membrane exposure to a large volume of HIV infected
blood whose source is symptomatic.
Preferred Two-Drug Regimen
 Option 1 - Retrovir (zidovudine, AZT)+ Epivir
(lamivudine) twice daily. Combivir (Retrovir + Epivir)twice
daily is typically substituted for ease of administration.
This twice a day regimen is a bit harder to take but is
recommended in pregnancy.
 Option 2 - Truvada (tenofovir + emtricitabine) taken
once daily. This one drug regimen is easier to take but
does have the risk of liver toxicity.
 Preferred Three-Drug Expanded
Regimen
 Basic two drug regimen option 1 or 2 above with the
addition of Kaletra (lopinavir + ritonavir) twice daily.
 Occupational PEP should be given to all
the workers who could be exposed while
performing their duties
 ARVs should be started within first few
hours not later than 72 hours
 HIV testing is recommended
 If first test is negative it should be
repeated after 3 and 6 month
Monitering the efficacy of ART
 CLINICAL IMPROVEMENT
-gain in the body wt
-decrease in the occurrence and
severity of HIV related disease
 Increase in the TLC
 Improvement in
-CD4 + T lymphocyte count
-plasma HIV RNA level
Specific prophylaxis
 P.carinii
pneumonia –trimethoprim
,sulfamethoxazole ,aerosolized
pentamidine and dapsone
 M.avium complex –rifabutin
 M.Tuberculosis -300mg isoniazid daily
for 9 month
 Kaposi sarcoma –interferon
,chemotherapy or radiation
 CMV retintis –ganciclovir
 Cryptococcal meningitis –fluconazole
 Esophageal candidiasis –fluconazole
 Herpes simplex and herpes zoster –
acyclovir or foscamet
 NATIONAL AIDS CONTROL
PROGRAMME
National aids control programme was launched in india in
1987.
 Milestones of the programme are -:
 1986- First case of HIV detected
• Aids task force set up by ICMR
• National aid committee established under the
ministry of health
 1990– Medium term plan launched for 4
states and 4 metros
 1992- NACP -1 launched to slow down the
spread of HIV infection
• National AIDS control board constituted
• NACO set-up
 1999- NACP-II begins focucing on behavior
change, increased decentralisation and
NGO involvement
State AIDS control societies establised
 2009- National AIDS control policy adopted
• National blood policy adopted
 2004- Antiretroviral treatment initiated
 2006- National council on AIDS constituted
under chairmanship of prime minister
 National policy on paediatric ART

formulated
 2007- NACP III launched for 5 years
NACP-III
 Prevent infections through saturation of
coverage of high-risk groups with targeted
interventions (TIs) and scaled up interventions
in the general population.
 Provide greater care, support and treatment to
larger number of PLHA
 Strengthen the infrastructure, systems and
human resources in prevention, care, support and
treatment programmes at district, state and
national levels.
 Strengthen the nationwide strategic information
management system.