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Sexually transmitted diseases

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Oral Diagnosis I …

Oral Diagnosis I
Third Year

Published in: Health & Medicine
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  • 1. By Dr . Wael Mohamed Swelam 1 Sunday, November 25, 2007 Sexually Transmitted Diseases
  • 2. 2 َ‫ال‬َ‫و‬ َ‫ر‬َ‫خ‬‫ءا‬ ‫ا‬َ‫ه‬ٰ‫ـ‬َ‫ل‬ِ‫إ‬ ِ‫ه‬َّ‫ل‬‫ٱل‬ َ‫ع‬َ‫م‬ َ‫ن‬‫و‬ُ‫ع‬ْ‫د‬َ‫ي‬ َ‫ال‬ َ‫ن‬‫ي‬ِ‫ذ‬َّ‫ل‬‫ٱ‬َ‫و‬ ّ‫ق‬َ‫ح‬ْ‫ل‬‫ٱ‬ِ‫ب‬ َّ‫ال‬ِ‫إ‬ ُ‫ه‬َّ‫ل‬‫ٱل‬ َ‫م‬َّ‫ر‬َ‫ح‬ ‫ى‬ِ‫ت‬َّ‫ل‬‫ٱ‬ َ‫س‬ْ‫ف‬َّ‫ن‬‫ٱل‬ َ‫ن‬‫و‬ُ‫ل‬ُ‫ت‬ْ‫ق‬َ‫ي‬ ً‫ا‬‫ام‬َ‫ث‬َ‫أ‬ َ‫ق‬ْ‫ل‬َ‫ي‬ َ‫ك‬ِ‫ل‬ٰ‫ذ‬ ْ‫ل‬َ‫ع‬ْ‫ف‬َ‫ي‬ ‫ن‬َ‫م‬َ‫و‬ َ‫ن‬‫و‬ُ‫ن‬ْ‫ز‬َ‫ي‬ َ‫ال‬َ‫و‬ ْ‫د‬ُ‫ل‬ْ‫خ‬َ‫ي‬َ‫و‬ ِ‫ة‬َ‫ٰم‬‫ـ‬‫ي‬ِ‫ق‬ْ‫ل‬‫ٱ‬ َ‫م‬ْ‫و‬َ‫ي‬ ُ‫اب‬َ‫ذ‬َ‫ع‬ْ‫ل‬‫ٱ‬ ُ‫ه‬َ‫ل‬ ْ‫ف‬َ‫ع‬ٰ‫ـ‬ َ‫ض‬ُ‫ي‬ ً‫ال‬َ‫م‬َ‫ع‬ َ‫ل‬ِ‫م‬َ‫ع‬َ‫و‬ َ‫ن‬َ‫م‬‫ءا‬َ‫و‬ َ‫اب‬َ‫ت‬ ‫ن‬َ‫م‬ َّ‫ال‬ِ‫إ‬ ً‫ا‬‫ان‬َ‫ه‬ُ‫م‬ ِ‫يه‬ِ‫ف‬ ْ‫م‬ِ‫ه‬ِ‫ت‬‫ا‬َ‫ئ‬ّ‫ي‬ َ‫س‬ ُ‫ه‬َّ‫ل‬‫ٱل‬ ُ‫ل‬ّ‫د‬َ‫ب‬ُ‫ي‬ َ‫ك‬ِ‫ـئ‬َ‫ل‬ْ‫و‬ُ‫أ‬َ‫ف‬ ً‫ا‬‫ح‬ِ‫ٰل‬‫ـ‬ َ‫ص‬ ‫ن‬َ‫م‬َ‫و‬ ً‫ا‬‫يم‬ِ‫ح‬َّ‫ر‬ ً‫ا‬‫ور‬ُ‫ف‬َ‫غ‬ ُ‫ه‬َّ‫ل‬‫ٱل‬ َ‫ن‬‫ا‬َ‫ك‬َ‫و‬ ٍ‫ٰت‬‫ـ‬َ‫ن‬ َ‫س‬َ‫ح‬ ِ‫ه‬َّ‫ل‬‫ٱل‬ ‫ى‬َ‫ل‬ِ‫إ‬ ُ‫وب‬ُ‫ت‬َ‫ي‬ ُ‫ه‬َّ‫ن‬ِ‫إ‬َ‫ف‬ ً‫ا‬‫ح‬ِ‫ٰل‬‫ـ‬ َ‫ص‬ َ‫ل‬ِ‫م‬َ‫ع‬َ‫و‬ َ‫اب‬َ‫ت‬
  • 3. 3 Syphilis An infectious systemic disease that may be either congenital or acquired through sexual contact or contaminated needles. High-risk groups 1. Sexually active teenagers 2. People infected with another sexually transmitted disease (STD), including AIDS 3. Sexually abused children 4. Women of childbearing age 5. Prostitutes of either sex and their customers 6. Prisoners 7. Persons who abuse drugs or alcohol Motzart
  • 4. TREPONEMA PALLIDUM 4 Gram stainSilver stain Electron Microscope
  • 5. CHANCROID ULCERS 5 1. This first stage of syphilis is called primary syphilis characterized by (Chancre) a) contains a clear fluid that is full of Treponema pallidum b) patient highly contagious c) chancre will heal even without treatment within a few weeks Chancre
  • 6. SECONDARY SYPHILIS 1. Characterized by flu-like illness 2. The patient will be highly infectious 3. If the immune system does not destroy the microbes, a generalized skin rash develops 4. Mucous patches 5. Moist, warty patches may develop on the genitalia or skin folds 6
  • 7. TERTIARY SYPHILIS “GUMMAS” AFTER 3-15 YEARS LATENCY 1. Microorganism spread to other parts of the body, in particular: a) Mucous membranes, b) Liver, Central nervous system (CNS) c) Eyes, Joints, bones, muscles, 2. 50% proceed to Gumma stage, the symptoms depend on what organs have active pathogen replication; a) Although they may be very destructive, they respond rapidly to treatment b) Start as a superficial nodule or as a deeper lesion that breaks down to form punchedout ulcers c) Significant central nervous system involvement resulting in paralysis and death 7
  • 8. CONGENITAL SYPHILIS - MUCOUS PATCHES 8
  • 9. CONDYLOMA ACCUMINATUM Causative organism: HPV-6, HPV-11, HPV-16, and HPV-18 ! Develops at a site of sexual contact or trauma ! Age: Teenagers and young ! Shape: •Broad-based, •Pink mass, •Short, blunted projections
  • 10. GONORRHEA Gram stain of Neisseria gonorrhoeae from urethral discharge Nisseria G. can grow and multiply easily in the warm, moist areas of the reproductive tract Modes of transmission 1.The lining of the urethra (the opening at the tip of the penis); 2.The lining of the vagina or cervix; 3.The lining of the anus; or 4.Directly into the body through small cuts or open sores.
  • 11. GONOCOCCAL INFECTIONS 11 Ophthalmia Disseminated G skin lesion Gonorrhea infections of the mouth and throat are usually without symptoms. If present, symptoms include soreness and redness in the mouth or throat
  • 12. 12
  • 13. ORAL LESIONS ASSOCIATED WITH HIV INFECTION ✓ RECOGNIZE ORAL LESIONS SEEN WITH IMMUNOSUPPRESSION ! ✓ EFFECTS OF HAART ON PREVALENCE OF THESE LESIONS
  • 14. ▪ IMMUNOSUPPRESION n. The inhibition of the normal immune response because of disease. ▪ OPPORTUNISTIC INFECTION adj. A microorganism causing disease only under certain conditions, as when a person’s immune system is impaired. WHAT DO WE SEE IN HIV/AIDS?
  • 15. WHAT ARE SOME OF THE FACTS ▪ Approximately 70 to 80 percent of people with HIV/AIDS will experience an oral manifestation ▪ Treating routine problems as soon as possible can prevent more serious infections ! ▪ Almost all of the infections we see, appear in people who are not infected with HIV/AIDS, but they appear more frequently and with more severity in people who are infected
  • 16. RECOMMENDATIONS FOR AN ORAL EXAMINATION •LIPS AND GUMS ! •CHEEKS ! •TONGUE ! •FLOOR OF THE MOUTH ! •ROOF OF THE MOUTH ! •LYMPH NODES ! ! ! !
  • 17. ! ▪ Recognition of the lesion ▪ History of the condition ▪ Observation ▪ Palpation ! ! DIFFERENTIAL DIAGNOSIS The process
  • 18. CAUSES OF ORAL LESIONS ✓ FUNGAL ✓ VIRAL ✓ BACTERIAL ✓ ULCERATIVE ✓ NEOPLASTIC
  • 19. FUNGAL ANGULAR CHELITIS
  • 20. ✓ Inflammation/irritation ✓ Cracking and fissuring ✓ Pain upon opening the mouth ✓ Susceptible to infection ANGULAR CHELITIS TREATMENT • Antifungal medication • Correct vertical dimension FUNGAL
  • 21. FUNGAL PSEUDOMEMBRANOUS CANDIDIASIS
  • 22. PSEUDOMEMBRANOUS CANDIDIASIS ✓ Multiple white to yellow soft plaques ✓ Plaques easily removed by gauze ✓ Areas may bleed and burn ✓ Taste alterations ✓ Xerostomia TREATMENT • Antifungal medication FUNGAL
  • 23. FUNGAL ATROPHIC OR ERYTHEMATOUS CANDIDIASIS
  • 24. ATROPIC CANDIDIASIS ✓ Spotty appearance ✓ May look like pizza burn ✓ Mistaken for trauma, infections, radiation, xerostomia ✓ Pain is less severe than pseudomembranous candidiasis TREATMENT • Antifungal medications FUNGAL
  • 25. VIRAL ORAL HAIRY LEUKOPLAKIA
  • 26. ORAL HAIRY LEUKOPLAKIA ✓ Asymptomatic ✓ Predictive of disease progression ✓ Affects the lateral border and ventral tongue, and buccal vestibule ✓ Can result from epithelial hyperplasia, secondary to a reactivation of latent EBV TREATMENT • usually none • occasionally antivirals ! VIRAL
  • 27. VIRAL HERPES SIMPLEX VIRUS
  • 28. HERPES SIMPLEX VIRUS ✓ Vesicles that coalesce into bullae and break ✓ Some report a tingling sensation ✓ Occur on fixed and keratinized tissue ✓ Painful ✓ May have systemic manifestations TREATMENT • Antivirals • Palliative support VIRAL
  • 29. VIRAL HUMAN PAPILLOMA VIRUS
  • 30. HUMAN PAPILLOMA VIRUS (HPV) ✓ Some begin as a smooth-surface papule ✓ Rough fingerlike projections ✓ Occur mainly on keratinized mucosa ✓ Tend to reoccur ✓ May interfere with eating and swallowing and may bleed ✓ Not painful ✓ Transmissible VIRAL TREATMENT • Excision
  • 31. PERIODONTAL DISEASE BACTERIAL
  • 32. ✓ Most common oral bacterial infection among HIV infected persons ✓ Contributing factors include poor diet, poor oral hygiene, and lack of saliva ✓ Mainly due to overgrowth of normal flora PERIODONTAL DISEASE BACTERIAL TREATMENT • Deep scaling and root planning •Good home care •Antimicrobial rinses
  • 33. BACTERIAL LINEAR GINGIVAL ERYTHEMA
  • 34. LINEAR GINGIVAL ERYTHEMA (LGE) ✓ Inflammation ✓ Spontaneous bleeding ✓ Not always painful ✓ May occur without the presence of plaque ✓ Microbiologic profile of gingival fluids is same as for Periodontal Disease ✓ Early manifestation of HIV TREATMENT • Periodontal scaling • Peridex BACTERIAL
  • 35. ULCERATIVE APTHOUS ULCER
  • 36. APTHOUS ULCER ✓ Crater type sore on mucous membrane ✓ Pus formation ✓ Painful ✓ Interference with speech and swallowing ✓ Stress, Acidic Foods, Trauma, and Medication ✓ CMV (Cytomegalovirus) are clinically identical TREATMENT • Topical steroids mixed with Orabase ULCERATIVE
  • 37. BACTERIAL NECROTIZING ULCERATIVE PERIODONTITIS (NUP)
  • 38. NEOPLASM KAPOSI’S SARCOMA (KS)
  • 39. KAPOSI’S SARCOMA (KS) NEOPLASM ✓ Lesions begin flat and painless and can progress to painful papules and nodules ✓ It is mainly seen in men with AIDS ✓ Recent studies indicate that it may be caused by a sexually transmitted herpes virus-HHV 8 TREATMENT •Radiation therapy •Chemotherapy •Immuno-modulator drugs
  • 40. NEOPLASM NON-HODGKIN’S LYMPHOMA
  • 41. NON-HOGKIN’S LYMPHOMA NEOPLASM ✓ Second most common malignancy in AIDS ✓ Tumors present intraorally as soft tissue masses ✓ Grows faster and spreads outside the lymph system in those with AIDS 
 TREATMENT •Radiation therapy •Chemotherapy •Immuno-modulator drugs
  • 42. 42 ‫سبح‬ ‫انك‬ ‫اللهم‬ ‫وبح‬ ‫مدك‬

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