STDs 2 PDF

Gonorrhoea D. Eman Mohamed Ahmed Clinical MD Dermatology and Venereology SMSB Causative : Neisseria gonorrhoea Gram - ve diplococci (in pairs) Intracellular, kidney shaped Three layers envelope enclosing cytoplasm Pilli on the surface of virulent types1&2 Transmissi...

Gonorrhoea D. Eman Mohamed Ahmed Clinical MD Dermatology and Venereology SMSB Causative : Neisseria gonorrhoea Gram - ve diplococci (in pairs) Intracellular, kidney shaped Three layers envelope enclosing cytoplasm Pilli on the surface of virulent types1&2 Transmission : Mainly sexual High prevalance in homosexual Vertical transmission from infected mother to neonate Rarely accidental non venerial transmission through towels and lavatory seats Pathogenesis Incubation period 2-7 days N. gonorrhoea infects mucosal epithelium, mainly Columner cells, while transitional and stratified squamous epithelium are more resistent to infection, so bladder,upper urinery tract, vulva and uterus are less affected. Clinical Manifestations Males: affects anterior urethra, prostate, rectum, seminal vesicles. Mainly presents with dysuria and mucopurulent(yellowish_green) discharge, profuce and creamy and frequency of micturition (ant urethritis) Mild general symptoms may develop:fever,malaise,... In females Commonly asymptomic (50%) Vaginal discharge, dysuria, menstrual irregularity and lower abdominal pain. Gonococcal vulvovaginitis is female children indicate sexual abuse Neonates: Ophthalmia neonatorum Important cause of blindness in developing countries. Infection is got through birth canal Symptoms develop within 1st wk of birth(2-5ds) Inflamed eyes, profuse purulent discharge, eodematous lids and intense conjuctivitis, if non treated keratitis and corneal ulcers may develop Extragenital gonorrhoea : Anorectal gonorrhoea:rectal sex, direct spread Oropharengeal gonorrhoea : oral sex, tonsisilitis, pharingitis Gonococcal conjuctivitis :contamination with genital discharge Dissiminated gonorrhoea, Septiceamia: rare,more in females, 2-3wks after 1ry infection, bacteramia assossiated with systemic symptoms, septic artheritis and dermatitis. Complications: in males Tysonitis, Littritis Periurethral abscess Urethral stricture Prostitis Epididimitis Seminal vesiclulitis Complications in females Skenitis Bartholinitis Pelvic inflamatory disease-------> ectopic pregnancy or infertility. Salpingitis -- - - - > Perihepatitis (Fitz-Hugh-Curtis syndrome) - - - - - > adhesions (violin string) Investigations Gram stain:urethral discharge or endocervical.1 smear under microscopy show: G-ve kidney shaped diplococci within polymorhs cells. Inv: 2. Culture : in selective media Thayer-Marten medium Differential diagnosis : Non Gonococcal urithritis : clamidial urethritis Non specific urethritis :ureaplasma urealyticum. Treatment of gonorrhoea : General: Avoid sex Avoid self examination Avoid local antiseptics---->chemical urethritis Trace and treat sexual partener/s Treatment :uncomplicated gonorrhoea Procaine Penicillin 2-4 million units IM + probenecid 1gm orally. or Ampicillin/Amoxicillin 3gm single oral dose+probenecid 1gm orally Adv:cheap,single dose, safe in pregnanc Dis-adv: allergic reaction,resistant strains, not effective for NGU Penicillin allergy: Dissiminated gonorrhoea : Admission to hospital Trace and treat partener/s Benzyle penicillin 10 million units IV daily for 3 days then Amoxicillin 500mg orally for 4 days. Ceftrixone 1gm IM/IV or Ciprofloxacin 500mg twice /day... both for 7 days in case of penicillin allergy Gonococcal meningitis - - - >2 wks Gonococcal endocarditis - - - > 4 wks Non Gonococcal urithritis Is inflamation of the urethra due to factors other than Gonococci. Causes: Chlamidia Trachomatis Ureaplasma urealyticum Trichomonas vaginalis Candida spp Bacteria like group B sterptococci Some cases no cause is detected : Nonspecific Urethritis Chlamydial Infection Obligatory Intracellular parasite 3 spechies: C. Trachomatis.1 C. Psittaci.2 C. Pneumoniae.3 Clamidia urethritis is caused by C. Trachomatis serotypes D---->K Chlamydial urethritis: Transmission : sexual, through birth canal I. P: 2---3 wks Clinically :mild urethritis, mucoid, worse in morning. In females commonly asymptomatic. Tendancy for chronicity and reccurency. Complications In males : Prostitis, epididimitis, urethral stricture and infertility. In females : PID, Perihepatitis, cervical intrepethelial neoplasia, decrease fertility, abortions, prematurity and stillbirth Neonatal chlamidial infection Conjectivities: 7---14 days after birth.1 Infantile pneumonia 4----12 wks.2 Otitis media.3 Investigations: Gram stain : polymorhs + high epithelial cells without identificatiin of bacteria Culture in tissue media :McCoy cells Antigen detection tests:Elisa Antichlamidial Ab detection. Treatment : General mangments Tetracycline 500 mg 4 times daily, or Doxycycline 100 mg orally twice daily for 7 days Azithromycin 1gm orally single dose Pregnancy :Erythromycin 500mg 4 times daily for 7 days