Genitourinary problem This problem is of genitals and urinary system.

1. • Presented By:
Nouman Munir & M.Tahoor
Genitourinary
Problems

2. Learning Objectives
• Understand the importance of sexually transmitted infections in
gynecology.
• Describe the testing ,diagnosis and transmission of common STIs and
blood borne viruses.
• Understand that support is needed for patients to enable them to
undertake screening.

3. Objectives
• Appreciate that HIV has changed from from life limiting into chronic
manageable condition.
• Learn how to take sexual history.
• Understand the diagnosis of and screening of HIV.
• Describe the care for the HIV positive mother and child.

4. Importance of sexually transmitted infections
• understanding of STIs and their complications is crucially important in
gynecological practice. The subject is frequently misunderstood and
the impact syphilis have also affected women, their partners and at
times their children may be considerable. STIs are often
asymptomatic, but can still be transmitted to others and significant
problems at the time of infection in the future; for example, human
papillomavirus EPV) infection and cervical cancer

5. Importance of sexually transmitted infections
• . STIs disproportionately affect younger people, but increasingly are
identified in older people, in whom the diagnosis is often not
considered and so can be missed. STls often coexist and when one is
found, screening if they have others are required.

6. Importance of sexually transmitted infections
• Tests for STIs have hugely improved in recent years, with the advent
of highly sensitive and accurate molecular tests that are very easy to
use and can detect several infections on a single swab or urine
sample. In addition, serological tests for BBVs and syphilis have also
increased in accuracy, and can be performed sooner after possible
exposure than in the past. Women are often diagnosed first when
they have young families and they attend for reproductive health care
and are offered screening

7. Importance of sexually transmitted infections
• . They require support to inform present (and where necessary)
previous partners, so they can also receive testing and treatment for
their own health to prevent reinfection and/or on-going transmission
within the community. Children may also require testing and
treatment if they have been exposed during pregnancy, birth or
breastfeeding.

8. Importance of sexually transmitted infections
• This aspect of managing STIs can be: very challenging
but is crucially important. The connection may lead to
a consideration of safeguarding women and girls who
may be exposed to sexual or domestic violence,
abuse, coercion or exploitation, which may only
become apparent in this context.
• Respecting and maintaining patient’s confidentiality is
vital when managing women with STI pr HIV
diagnosis.

9. Testing Of Common STIs
• Here are the tests or assessments to check for common STIs:
• Chlamydia: Swab of the affected area or urine sample
• Gonorrhea: Swab of the affected area or urine sample

10. Testing Of Common STIs
• HIV:
Blood sample sent to the lab.
Rapid testing is offered at some clinics. This involves
a quick finger poke to obtain a blood sample which
is used for a point of care (POC) test. Initial results
are available in minutes. If the HIV POC test is
positive then a confirmatory is required (blood
sample collected and sent to the lab)

11. Testing Of Common STIs
• Genital herpes (with symptoms): Swab of the affected area
• Syphilis: Blood test sent to the lab or swab of the affected area
• Trichomoniasis (Trich): Swab of the infected area

12. Diagnosis of STIs
• Healthcare providers diagnose STDs through physical
examination, blood tests, or swabbed cultures. Diagnosis of
STDs by self-obtained vaginal swabs was the focus of an
NIAID-supported workshop. However, many people infected by
an STD have little or no symptoms of the infection.

13. Transmission of STIs
• STDs pass from one person to another through vaginal, oral,
and anal sex. They also can spread through intimate physical
contact like heavy petting, though this is not very common.
STDs don't always cause symptoms or may only cause mild
symptoms. Therefore, it is possible to have an infection and not
know it.

14. Transmission of Blood borne viruses
• BBVs are mainly transmitted sexually or by direct exposure to
infected blood or other body fluids contaminated with infected
blood. In the workplace, direct exposure can happen through
accidental contamination by a sharp instrument, such as a
needle or broken glass.

15. Support needed for patients for screening
• Times have changed. Now, most people don't die from the
virus. Thanks to continuing medical advances in medications,
HIV can now be seen as a chronic disease. People who have it
can enjoy long careers, get married, and raise families.

16. Support needed for patients for screening
• Then in 1996 it was discovered that a combination of HIV
medications could suppress the virus' replication, or
spread, allowing the immune system to recover and fight
off other infections like pneumonia. This was a life-changing
breakthrough

17. Management
How is HIV manageable?
• HIV treatment (antiretroviral therapy or ART) involves taking
medicine as prescribed by a health care provider. HIV
treatment reduces the amount of HIV in your body and helps
you stay healthy. There is no cure for HIV, but you can control it
with HIV treatment.

18. Principles involved in taking sexual history
•Ensure privacy and
confidentiality.
•Be professional.
•Be open minded and non-
judgmental.
•Recognise non-verbal cues.

19. Principles involved in taking sexual history
• Ask only appropriate questions.
• Explain procedures and treatments thoroughly.
• Use the time to promote risk reduction and sexual
health.

20. Sexual history taking: an example of a
structured approach
• When did you last have sexual intercourse?
• With a man or a woman?
• Were they a casual or regular partner?
• Where were they from?
• In which country did you have sex?
• What kind of sex did you engage in?

21. Sexual history taking: an example of a
structured approach
• For each type—for example, oral/vaginal/anal—
did you use a condom? (For heterosexual sex:
was any contraception used? Relate to risk of
pregnancy when inquiring about last menstrual
period in gynaecology history).
• Does your partner have any symptoms?
• Have you had any other partners in the last six
weeks? If so, return to question 2. Offer questions
which may lead to other problem identification.
• Did you have pain during or after intercourse?

22. Sexual history taking: an example of a
structured approach
• Have you ever had any previous STIs (may require
information or counselling)?
• Have you ever had a sexual health check up before
(explain and offer)?
• Have you ever had an HIV/hepatitis/syphilis test before
(explain and offer, pre-test counsel if appropriate)?
• Have you been vaccinated against hepatitis A/B or have
you ever had hepatitis (assess risk and offer if appropriate)?

23. Diagnosis and screening of HIV
• HIV antibody tests look for HIV antibodies in your blood, saliva
(spit), or urine (pee). HIV antibodies are disease-fighting
proteins that your immune system makes when you have an
HIV infection. Some people make antibodies faster than others.
An antibody test may find HIV antibodies as early as 23 days
after infection, but it may take as long as 90 days before
your body makes enough antibodies to show up on this test.

24. Diagnosis and screening of HIV
• Antibody tests can be done in different ways:Lab tests use
a blood sample taken from a vein. In general, lab tests can
find antibodies sooner after infection than other HIV
antibody tests. Test results are usually ready a few days
after your blood sample is taken.
• Rapid tests use blood from your finger, saliva, or urine.
They provide results in about 30 minutes.

25. Diagnosis and screening of HIV
• At-home tests include rapid self-test kits with everything you
need to collect and test a sample of saliva on your own. With
mail-in tests, you collect a drop of blood from your finger to
send to a lab for testing
• HIV antibody/antigen tests are the most commonly used HIV
tests. They look for HIV antibodies and antigens in your blood.
An antigen is the part of the HIV virus that triggers your immune
system to fight the infection. After an HIV exposure, antigens
will show up in your blood sooner than antibodies

26. Diagnosis and screening of HIV
• :Lab tests that use a blood sample from a vein can find an HIV
infection as soon as 18 to 45 days after you were infected.
• Rapid tests use a drop of blood from your finger. This test
can find HIV infections starting between 18 days to 90 days
after you were infected.
• At-home tests, or mail-in tests, allow you to collect blood
from your finger at home to send to a lab for testing. Like
rapid tests, these tests can start finding HIV 18 to 90 days
after infection.

27. Diagnosis and screening of HIV
• NAT tests (nucleic acid tests) look for HIV in a sample of your
blood taken from a vein and tested in a lab. These tests may
also be called "viral load tests." They can usually find an HIV
infection as soon as 10 to 33 days after infection. But they are
mostly used for monitoring HIV treatment and not for routine
screening, because they are expensive. Ask your provider
about having a NAT test as soon as possible if you:

28. Diagnosis and screening of HIV
• May have been exposed to HIV and have symptoms, such
as:
• Flu-like symptoms, including fever, chills, aches
• Extreme fatigue
• Swollen lymph nodes (in your neck, groin, or armpit)
• Rash
• Sores in your mouth

29. Diagnosis and screening of HIV
• Know you were exposed to HIV or were very likely exposed

30. Care for the HIV positive Mother and Chlid
• All pregnant women must know their current HIV status, and those
who are positive require access to high-quality medical and obstetric
care. Effective information from the UK national study of HIV in
pregnancy and childhood, which clearly demonstrates this. Most
mother-to-child transmission (MTCT) occurs during birth or
breastfeeding

31. Care for the HIV positive Mother and Chlid
• Intrauterine an intervention that disrupts the placenta (for example
amniocentesis).Delivery of prolabor caesarean section further
reduces MTCT rates when the HIV viral load is detectable. Obstetric
risk factors that increase the risk of transmission include prolonged
rupture of membranes, procedures that breach the infant’s skin or
increase maternal blood in the birth canal.

32. Care for the HIV positive Mother and Chlid
• Even in the presence of well controlled HIV ,transmission rates to the
infant during breastfeeding are up to 3% so in circumstances where
formula feeding is safe this is preferable.
• Exclusive breastfeeding fir the first 6 months with rapid weaning so
that no mixed feeding occurs is the safest option ,as mixed feeding
results in the highest rate MTCT.

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THANK YOU !