Sexual Transmitted Infections (STI) PDF

Sexually transmitted infections (STI)  Sexually transmitted infections (STI) Venereal diseases (VD), are illnesses that have a significant probability of transmission between humans by means of human sexual behavior.  Bacterial STI STI with genital Ulceration. STI with genita...

Sexually transmitted infections (STI)  Sexually transmitted infections (STI) Venereal diseases (VD), are illnesses that have a significant probability of transmission between humans by means of human sexual behavior.  Bacterial STI STI with genital Ulceration. STI with genital Discharge.  Bacterial STI STI with genital ulceration. Syphilis → treponema – pallidum. Chancroid → haemophilus – ducreyi. Lymphogranuloma – venereum (LGV) → chlamydia trachomatis L1,L2,L3. Granuloma inguinale – (Donovanosis)→ klebsiella granulomatis  Bacterial STI STI with genital discharge: Gonorrhea (Gonococcal – urethritis) → neisseria gonorrhoea. Non gonococcal urethritis: Chlamydia trachomatis (D to K). – Mycoplasma genetalium. – Mycoplasma homminis. –  Syphilis A primarily venereal disease (sexually transmitted) disease. It remains prevalent in many developing countries; mainly Caribbean and sub-Saharan Africa and Southeast Asia. Increased number of reported cases is due to; Increases in Intravenous drug users. – Indiscriminate sex. – Multiple sexual partners. –  Syphilis Transmission: Sexual contacts. – Transplacental (congenital syphilis). – Blood transfusion. – Direct inoculation to the skin. –  Syphilis: pathogenesis Penetration of the spirochetes through mucosal membranes and abrasions on epithelial surfaces. Primary lesions occur at the primary site of inoculation. Characterized by mononuclear leukocytic infiltration, macrophages, and lymphocytes. Focal endarteritis and periarteritis.  Types and stages Primary syphilis. Secondary syphilis. Latent syphilis. Tertiary syphilis. Quaternary syphilis. Congenital syphilis.  Primary Syphilis Hard Chancre: a firm, painless skin – ulceration localized at the point of initial exposure to the treponema, often on the glans penis and vulva. Appear 10–90 days after the – initial exposure (average 21 days). persist for 4 to 6 weeks and – usually heals spontaneously. Associated with local lymphadenoapthy. Hard Chancre Soft Chancre Caused by Caused by Treponema haemophilus pallidum ducreyi Painless Painful Long incubation Short incubation grey or yellow non-exudative purulent exudate (clean) (dirty) Hard, indurated, Soft depressed raised edge edge Depressed center Raised center heal spontaneously Can lead to Bubos within three to six and inguinal weeks abscesses  Secondary syphilis 6 months (commonly 6 to 8 weeks) after the primary infection. Symmetrical reddish- – pink maculopapular non-itchy rash on the trunk and extremities. Condyloma latum (full – of treponema pallidum).  Secondary syphilis Muccous patches (snail – track ulcer). Generalized – lymphadenopathy. Fever ,sore throat – ,weight loss.  Latent syphilis Defined as having serologic proof of infection without signs or symptoms of disease.  Latent syphilis Defined as having serologic proof of infection without Early latent signs or Late latent symptoms Persist one to two years of disease. More than two years treated with a Single treated with a long-acting intramuscular injection penicillin of a long-acting three weekly penicillin Serological tests Serological tests negative positive Noninfectious but intrauterine Infectious infection can happen Can relapse to Can progress to Tertiary Secondary syphilis syphilis  Tertiary syphilis Gummatous syphilis. Occurs 1–10 years after the initial infection. characterized by the formation of Gumma: soft, rubbery tumor-like balls – of destructive granulomas. Found on skin, liver ,blood – vessel, nervous system and skeleton.  Cardiovascular syphilis Resulting in aortic aneurysm. Aortic regurgitation  Neurosyphilis loss of mental (dementia and hallucination) and impaired physical functions and is accompanied by mood alterations. Meningovascular syphilis. – General paresis of insane – (GPI). Tabes dorsalis: affect – posterior column tract within spinal cord  Congenital syphilis Early. Still birth. – Hepatosplenomegaly. – Jaundice. – Anemia. –  Congenital syphilis Late: Prominent frontal bones. – depression of nasal – bridge (saddle nose) Clutton joints (arthritis of – both knees) Hutchinson incisors. – anterior tibial bowing – (Saber’s shin).  Quaternary syphilis has been disregarded for some time now. however, with the advent of AIDS-related syphilis cases, this stage is being reintroduced. an aggressive form of neurosyphilis, where there is necrotizing encephalitis in patients with AIDS  Diagnosis of syphilis Microscopy (sample from chancre and condylomata lata): Dark-field – microscopy. Fluorescent – microscopy.  Serologic test for syphilis Non treponemal tests (screening tests): VDRL (Venereal Disease Research – Laboratory). Rapid Plasma Reagin (RPR). – ELISA.  V.D.R.L and RPR Principle: patient with syphilis can produce antibodies (IgM, IgG and IgA) that can agglutinate Cardiolepin (anti cadiolipin= reagin). screening for syphilis. – assess response to therapy. – detect CNS involvement. – diagnosis of congenital – syphilis  Treatment Penicillin: Benzathine penicillin and for 1ry and – 2dry and tertiary syphilis. Procaine penicillin for latent syphilis – and neurosyphilis. Azithromycin and tetracycline as alternative. Neisseria gonorrhoeae: infections Gonorrhea: Sexually transmitted – infection. Usually symptomatic in – males and asymptomatic in females. asymptomatic patient are – major reservoir for continued spread of the disease. Neisseria gonorrhoeae: infections Pathogenesis: Attachment to non- – ciliated urogenital mucosal cells. Endocytosis. – Invasion. – Flux of PMNC. – The Organism is – resistant to intracellular killing.  Neisseria gonorrhoeae: infections Common sites: Urethra (urethritis). – Endocervix – (endocervicitis) Other sites: Rectum (proctitis). – Pharynx (pharyngitis). – Eye (conjunctivitis) –  Neisseria gonorrhoeae: infections Clinically: Male: Dysuria. – Purulent Urethral – discharge. Complications: Epididymitis. – Urethral stricture – (fibrosis). Neisseria gonorrhoeae: infections Clinically: Female: localized infection Purulent vaginal – discharge. vulvovaginitis – Endocervicitis. – Abscess of the – Bartholin’s gland. Neisseria gonorrhoeae: infections Clinically: Female: Ascending infection Endometritis. – Salpingitis. – Pelvic inflammatory – disease.(PID).  Neisseria gonorrhoeae: infections Clinically: Female: Complications Tubo-ovarian abscess. – Ectopic pregnancy. – Infertility. – Pelvic Peritonitis. – Post gonococcal – perihepatitis: Fitz-Hugh Curtis syndrome  Neisseria gonorrhoeae: infections Clinically: Ophthalmia neonatorum: Neonatal conjunctivitis. – Infection of the newborn – conjunctiva that is acquired during passage through the mother infected birth canal. Complications: Corneal – scarring and blindness.  Neisseria gonorrhoeae: infections Clinically: Disseminated infection: Patients having deficiency in – complement C5 →C9. Bacteremia. Septic arthritis. Teno-synovitis. Dermatitis. Rarely: endocarditis, meningitis. Reiter’s syndrome: Reactive Arthritis, urethritis and – conjunctivitis. Immunemediated. – Neisseria gonorrhoeae: diagnosis Specimen: Endocervical swab. – Urethral swab. – Eye swab. – Transport medium: e.g Amies transport medium Neisseria gonorrhoeae: diagnosis Staining: Gram negative – intracellular diplococci. Neisseria gonorrhoeae: diagnosis Culture: Selective Media Thayer-Martin – New york City – medium: Chocolate medium: Chocolate blood agar with blood agar with addition of addition of Antibiotics Antibiotics (Vancomycin + (Vancomycin + Colistin +Nystatin). Colistin +Nystatin + Trimethoprim). Neisseria gonorrhoeae : Treatment Showed resistance to penicillin by production of penicillinase (Penicillinase producing Neisseria Gonnorrhoeae PPNG). Plasmid encoded. Spectinomycin. 3rd generation Cephalosporin (Ceftrixon, Cefotaxaem). Ciprofloxacin. Treatment of Concomitant STD e.g Chlamydia, by addition of Doxycycline  Chlamydiae Members: Chlamydia: Chlamydia trachomatis. – Has “serovars”: A, B, Ba,C causes Trachoma. D-K causes non-gonococcal urethritis, inclusion cojunctivitis. L1, L2, L3 causes lymphogranuloma venereum. (LGV) Chlamydophila: – Chlamydophila pneumoniae (TWAR strains) causes atypical pneumonia). Chlamydophila psittaci: causes Psittachosis.  chlamydia trachomatis serovars D-K Non-gonococcal urethritis: Most common bacterial sexual – transmitted infection. Usually asymptomatic. – Main manifestation: Dysuria and – clear urethral discharge. Can result in pelvic inflammatory – disease in females. Associated with Reiter’s syndrome. – Chlamydial Infections  Chlamydial Infections Serovars D-K L1 - L3 C. trachomatis - Spread of the Disease  C. trachomatis - Diagnosis Diagnostic Methods Cell Cultures - chicken embryonic cells / HeLa cells/ McCoy cells [7,8]  C. trachomatis - Diagnosis II Molecular Methods NAATs - Nucleic Acid Amplification Tests (PCR) Antigen Detection (ELISA) Serology - Anti-Chlamydial Antibodies - Not particularly useful in acute infections [Chernesky, 2005]  Viral STD Genital tract or rectal mucosa HSV2 (and HSV1) – CMV – HBV – HPV – HIV – Herpes genitalis  Herpetic ulcer (Genital herpes) Viral STD characterized by painful genital vesicles & sores. Caused by: HSV-2 >70% (lumbosacral – latency) HSV-1 50 % of vaginal discharge. predisposing factors: PREG, DM, OCP PREG, DM produce acidic vagina that supress normal flora & promote candidal growth less common in premenarche & postmenop.more bet.15—45 yr. 62 05/06/1446  oedematous ,red,itchy vaginal walls with pseudomembrane. creamy,thick, odourless vag. discharge. candida palanitis in male: vesicular eruption in glans penis CONSIDERED STIs more in uncircumcised male, DM , immunocompromised patients.  Treatment:- Vaginal candidasis: - Pessaries "clotrimazole vaginal pessaries". - Oral "micostatin tab. - Topical "clotrimazole  Trichomonas vaginalis Trichomonas vaginalis is an anaerobic, flagellated protozoan parasite and the causative agent of trichomoniasis. It is the most common pathogenic protozoan infection of humans in industrialized countries.  What are the symptoms of trichomoniasis in females? Women with trichomoniasis may notice: Itching, burning, redness or soreness of the genitals; Discomfort with urination; A change in their vaginal discharge (i.e., thin discharge or increased volume) that can be clear, white, yellowish, or greenish with an unusual fishy smell.  What will happen if trichomoniasis is left untreated? Left untreated, trichomoniasis can lead to severe health problems. Trichomonas infection is closely tied to co- infection with HIV, easing transmission of the virus that causes AIDS. Is trichomoniasis completely curable? Trichomonas infection can be treated and cured with antibiotic medications. Antibiotics cure the infection, but it may come back (recurr). If trichomoniasis is not treated the infection can persist over the long term. There are no effective home remedies for trichomoniasis infection. Single-dose therapy with azithromycin is as effective as a seven- day course of doxycycline (Vibramycin)