Sexually Transmitted Diseases (STDs) Lecture Notes PDF

Sexually Transmitted Diseases (STDs) Definition These are the diseases transmitted by sexual contact. Classification According to the causative organism, it is classified to Bacterial Viral N. Gonorrhoea: Herpes Simplex Virus (HSV)....

Sexually Transmitted Diseases (STDs) Definition These are the diseases transmitted by sexual contact. Classification According to the causative organism, it is classified to Bacterial Viral N. Gonorrhoea: Herpes Simplex Virus (HSV). Gonorrhoea. Human Papilloma Virus (HPV). Treponema Pallidum: AIDS Virus (HIV). Syphilis. Cytomegalovirus (CMV). Chlamydia Trachomatis: Hepatitis B Virus. Chlamydia. Mullascum Contagiosum. Haemophilus Ducreyi: Chancroid. Fungal Genital Mycoplasma. Candidiasis. Protozoal: Parasitic: Trichomonas vaginalis. Scabies. Giardia lamblia. Pediculosis.  Gonorrhea Causative Organism ▪ It is gram -ve intracellular diplococci (Neisseria gonorrhoea). Incubation Period: 2 to 8 days Sites of Affection ▪ It affects areas lined by thin epithelium (columnar) not stratified epithelium. ▪ It may cause: urethritis, bartholinitis, cervicitis, salpingitis ect.... Gonorrhea  Gonorrhea Symptoms ▪ It may be asymptomatic (carrier). ▪ Purulent vaginal discharge. ▪ Dysuria and frequency. ▪ Symptoms of PID. ▪ Artheritis through hematogenous spread. Signs ▪ Urethritis, skenitis, bartholinitis, cervicitis, signs of PID.  Gonorrhea Treatment ▪ The recommended regimens is to treat gonorrhoea and chlamydia at the same time because they are STDs. Cefotaxime 250 mg IM as a single dose + Doxycycline. Ciprofloxacin 500 mg by mouth as single dose + Doxycycline. Azithromycin as a single dose. Doxycycline 100 mg twice daily for 7 days. During pregnancy: Erythromycin 500 mg 4 times daily for 7 days + Cefotaxime. ▪ The sexual partner should be treated at the same time.  Chlamydial Infections Causative Organism ▪ It is an obligate intra-cellular bacterium (bacteria like). ▪ There are 15 serotypes, L-strain causes LGV while strains from D to K cause genital infections. ▪ Nowadays, C. Trachomatis is the most common sexually transmitted disease among sexually active women.  Chlamydial Infections Sites of Affection It causes cervicitis, urethritis, salpingitis and PID. It does not cause vaginitis but it is among the commonest causes of vaginal discharge. Symptoms Yellowish mucopurulent vaginal discharge. Dysuria and frequency.  Chlamydial Infections Diagnosis It should be suspected when microscopic examination of the saline smear reveals many white blood cells in the absence of clue cells, yeast and Trichomonas Vaginalis. By tissue culture. Detection of Chlamydial antigens by monoclonal antibodies & ELISA.  Chlamydial Infections Treatment Doxycycline 100 mg twice daily for one week. Erythromycin 500 mg 4 times daily for one week. Azithromycin 1 gm as a single dose. Because it is sexually TD, the sexual partner should be treated.  Syphilis Causative Organism It is caused by a spirocheate called "Treponema Pallidum". It may be congenital or acquired (STD). Incubation Period: 2 to 6 weeks.  Syphilis Clinical Phases: There are three clinical phases Primary syphilis or hard chancre: Painless ulcer with indurated base. It may appear on the genital or extra-genital regions (mouth- anus). Associated with lymph nodes enlargement.  Syphilis Secondary syphilis: Hematogenous dissemination results in systemic manifestations. Classical rash of red macules and papules on the palms and soles of feet. Condylomata lata, or large raised gray areas on vulva or other mucus membranes. Lymphadenopathy is common in the second stage. The latent stage of syphilis which follows untreated second stage can last from 2 to 20 years  Syphilis Tertiary syphilis: Associated with cardio-vascular or neurological manifestations. The characteristic lesion is Gumma (necrotic abscesses) of the skin and bones.  Syphilis Diagnosis The definitive diagnosis is made by "dark field microscopy" of the discharge to reveal the spirochetes.  Syphilis Serologic screening tests A. Non specific tests: ▪ Venereal Disease Research Laboratory test (VDRL). ▪ Rapid Plasma Reagin (RPR). B. Specific tests: ▪ Flourescent Treponema Antibody Absorption Test (FTA-ABS). ▪ Treponema Pallidum Immobilisation Test. Syphilis  Syphilis Treatment For women with more than one year duration of the disease, lumbar puncture is essential to rule out neurosyphilis by FTA-ABS for the cerebrospinal fluid. According to the Centre for Disease Control, Penicillin is the drug of choice and there are different regimens for the different stages of the disease.  Syphilis 1. Primary and secondary syphilis: The recommended regimen is Benzathine penicillin G2.4 million units IM as a single dose. In the presence of penicillin allergy (non pregnant), Doxycycline 100 mg orally twice daily for 2 weeks. During pregnancy Erythromycin 500 mg orally every 6 hrs for 2 weeks.  Syphilis 2. Latent syphilis Early latent syphilis is treated as the primary and secondary syphilis. Late latent disease or neurosyphilis is treated by Benzathine penicillin G, 7.2 million units divided as three doses, 2.4 million units / week for 3 weeks. Penicillin allergic women should be desensitized and treated with penicillin in late latent syphilis or neurosyphilis.  Lymphogranuloma Venereum It is a chronic infection of lymphatic tissues in the genital region including the vulva, urethra, rectum and cervix. It is common in tropical areas. Causative Organism Chlamydia Trachomatis Incubation Period: From 3 to 4 days.  Lymphogranuloma Venereum Clinical picture ▪ Primary infection: With shallow painless ulcers on the labia. Secondary phase: With painful inguinal and peri rectal lymphadenopathy. If untreated the nodes adhere together and to the overlying skin to form (Buboes). Tertiary phase: Rupture of buboes leading to the formation of multiple sinuses and fistulas discharging pus.  Lymphogranuloma Venereum Diagnosis By polymerase chain reaction (PCR) for C. Trachomatis. Treatment: Oral Tetracyclines or Erythromycin for 2 to 3 weeks. Aspiration of Buboes.  Genital warts = Condylomata Accuminata "Human Papilloma Virus" The most common viral STD. Causative organism It is highly contagious DNA, HPV. Types no. 16 & 18 cause flat warts with the risk of CIN. Types no. 6 & 11 cause exophytic warts with no malignant potential. Vulva, vagina, perineum, anus and the cervix are common sites. Genital warts  Genital warts Diagnosis On Pap smear there are Koilocytes, which are cells with peri nuclear halos that are often associated with atypia and dysplasia Colposcopic examination is mandatory after its detection.  Genital warts Treatment Small Warts: Topical application of: Large Warts: Podophyllin. Cryotherapy. Trichloroacetic acid. Electrocautery. 5-fluorouracil. Laser therapy.  Genital Herpes Simplex Virus (HSV) It is caused by DNA virus which is highly contagious (HSV). HSV type 2 is more common than type 1 as a cause of genital herpes. The skin is infected then the virus travels to the lumbosacral dorsal root ganglia. These ganglia becomes affected by persistent but subclinical infection.  Genital Herpes Simplex Virus (HSV) Periodically, the virus becomes activated & travels via the peripheral nerves to cause the characteristic recurrent skin lesions. HSV type 1 causes orolabial herpes (fever blisters).  Genital Herpes Simplex Virus (HSV) Incubation Period: 2 to 7 days Symptoms of Primary Infection The duration of primary infection is about 10 days It may be accompanied by general symptoms like malaise and fever. The primary lesions are multiple vesicles which may coalesce together to form superficial ulcers. The ulcers simultaneously involve the vagina and the cervix. Genital Herpes Simplex Virus (HSV) The lesions are associated with extreme pain and tenderness with inguinal lymphadenopathy. Urine retention may occur secondary to vulval pain. In 50% of infected peoples the condition is subclinical and the patients are unaware that they harbor the virus.  Genital Herpes Simplex Virus (HSV) Diagnosis By cytologic smear (multinucleated giant cells) and viral culture. It may be recurrent which is usually less severe and shorter in duration. Treatment ▪ General: By keeping the lesions dry and giving analgesics. ▪ Specific: Anti-viral (Acyclovir): Orally: can reduce viral shedding and shorten the clinical course. 5% topical ointment. ▪ Follow-up with Pap smears. Acquired Immunodeficiency Syndrome (AIDS) It is caused by the human immunodeficiency virus (HIV), which is a subgroup of retroviruses (reverse transcryptase enzyme). HIV attacks CD4+ T-lymphocytes. Opportunistic infections occur when CD4+ cells count drops below 200. CD4 is a specific antigen on the T lymphocytes. Infection of the T lymphocytes by HIV impairs ability of the host to fight invading micro-organisms. Acquired Immunodeficiency Syndrome (AIDS) Clinical Picture Asymptomatic carrier for years (till CD4+ cells count drops to 200). Persistent lymphadenopathy. Thrombocytopenia. Aids related complex: Lymphadenopathy. Oral candidiasis. Pneumonias. Viral infections like HSV. Cytomegalovirus. T.B. Toxoplasmosis. Acquired Immunodeficiency Syndrome (AIDS) Diagnosis History: STD, homosexuality, blood transfusion, addicts. Persistent lymphadenopathy, fungal, bacterial and viral infections. Investigations ELISA Test for antibodies of HIV: high rates of false positive results. Western Blot Test for antibodies to HIV-specific protein Viral Culture. Acquired Immunodeficiency Syndrome (AIDS) Treatment: It is mainly prophylactic to avoid acquiring infection: Health education. Safe sexual practice. Test for Aids before blood transfusion. Fight addiction & drugs abuse. Thank you