Sexual transmitted infections.
What is a Sexually Transmitted
Infection or STI?
STI’s are infections that are spread from person to
person through intimate sexual contact.
STI’s are dangerous because they are easily spread
and it is hard to tell just by looking who has an STI.
1 in 4 sexually active teens has an STI
Genital Herpes (HSV-2)
Genital Warts (HPV)
Is caused by Neisseria gonorrhoeae, a Gram-negative
Signs and symptoms
The manifestations in males presents more early as
compared to female.
o A purulent discharge associated with dysuria is the first
sign of infection. The discharge, which is presumably
caused by chemotactic factors such as C5a released
when anti gonococcal antibody binds complement,
may become more profuse and blood tinged as the
o In female
Women often are asymptomatic. So it takes so
long for gonorrhea to be diagnosed in women.
The most common symptom is vaginal
discharge. including purulent or mucopurulent
Other cervical abnormalities., eg
erythema, friability, and edema of the zone of
Pelvic inflammatory disease (PID) is a serious
complication in 10% to 20% of women with acute
gonococcal infection and can lead to infertility and
Treatments; of uncomplicated gono..
Ceftriaxone, a third-generation cephalosporin, is given as a
single, small-volume IM injection (e.g., 125 mg diluted with
normal saline or 1% lidocaine solution). Ceftriaxone
eradicates anal and pharyngeal gonorrhea and is also safe
Other injectable cephalosporins (notably
ceftizoxime, cefoxitin, and cefotaxime) have been found to
be safe and highly effective, although efficacy in
pharyngeal infections is not as well-established.
Because a high percentage of patients with gonorrhea are
also coinfected with C. trachomatis, a single dose of
azithromycin or a 7-day course of doxycycline is
recommended to be taken concurrently for a presumed
Many strains exibit resistance to penicillin, tetracycline
All partners who have had sexual exposure to
patients with gonorrhea are advised, within 60
days should be treated.
This is especially true when the partner is
pregnant because gonorrhea during pregnancy is
associated with chorioamnionitis and
prematurity, as well as neonatal infection.
Pregnant women can be treated safely with
cephalosporins and azithromycin for gonorrhea
and Chlamydia. Doxycycline should be avoided
o Anorectal and Pharyngeal Gonorrhea
The most prevalent bacterial STI among the
homosexual male population is gonorrhea
pharyngeal and anorectal gonococcal infections are
often asymptomatic, a large reservoir of carriers in
the homosexual male population may exist.
Rectal gonorrhea produces the syndrome of
proctitis with anorectal pain, mucopurulent anorectal
discharge, constipation, tenesmus, and anorectal
The treatment of choice for patients with
anorectal and/or pharyngeal gonorrhea is
ceftriaxone 125 mg IM as a single dose.
Azithromycin or doxycycline should be given to
those with rectal gonorrhea to treat possible
coexisting rectal chlamydial infection.
Patients should be advised to avoid further
unprotected sexual activity and should be
counseled and tested for infection with HIV.
And an altenative drug like the cephalosporins
should be given if a patient do not torelate
Pelvic Inflammatory Disease
The term pelvic inflammatory disease (PID)
commonly refers to a variety of inflammatory
disorders of the upper female reproductive tract.
PID also has been used to connote an infection
that occurs acutely when either vaginal or cervical
micro-organisms traverse the sterile endometrium
and ascend to the fallopian tubes.
Acute salpingitis also may be used to describe
an acute infection of the fallopian tubes.
Therefore, the terms PID and salpingitis are used
interchangeably in this discussion to denote an
acute infection involving the fallopian tubes.
Most cases of PID are caused by C. trachomatis
and N. gonorrhoeae. Some micro-organisms that
comprise the vaginal flora are also associated
with PID, including Gardnerella vaginalis, H.
influenzae, and Streptococcus agalactiae.
Facultative enteric Gram-negative bacilli and a
variety of anaerobic bacteria have also been
isolated from the upper genital tract of up to 70%
of women with acute PID.
Women diagnosed with acute PID should be
tested for C. trachomatis and N. gonorrhoeae and
screened for HIV
abdominal pain often occurs soon after the
menstrual period, Vaginal
discharge, menorrhagia, dysuria, and
include cervical motion tenderness, uterine
tenderness, or adnexal tenderness white blood
cells (WBC) on saline microscopy of vaginal
secretions, elevated erythrocyte sedimentation
rate, or an elevated C-reactive protein
o Disseminated Gonococcal Infection(gonorrhoea
Signs and Symptoms
include fever, occasional chills, a mild tenosynovitis of
the small joints, and skin lesions
Patients with gonococcal arthritis and bacteremia
should be hospitalized for treatment with ceftriaxone 1
g IV daily until clinical improvement, such as
decreased fever and pain, is sustained for 24 to 48
hours, at which time therapy may be switched to an
appropriate oral agent. Symptoms and signs of
tenosynovitis should be improved markedly within 48
o Treatment of gonococcal endocarditis and
It is rare but life threatening, septic emboli, valve
damage of CHF.
Require high-dose IV therapy such as ceftriaxone
(1–2 g IV every 12 hours) for 10 days or more in the
case of meningitis and for 4 week
o Neonatal Disseminated Gonococcal Infection:
Acquired when fetus passes through infected birth
canal, leading to acute purulent, conjuctivitis 4
weeks after birth, it can lead to blindness
Neonatal DGI and meningitis can be treated with
either ceftriaxone or cefotaxime for 7 days;
however, if meningitis is documented, 10 to 14 days
of treatment is required. Ceftriaxone is given at 25 to
50 mg/kg (IV or IM) Q 24 hr and cefotaxime is given
A disease caused by chlamydia trachomatis, a
gram negative intracellular bacteria this is the
main cause of non gonococcal urethrites in
Has 15 serovars. Serovar d-k, are transmitted
sexually and are responsible for NGU.(urethritis,
epididymis, proctitis, cervicitis and salpingitis.)
Males; mucopurulent discharge, after 1-3 weeks
of intercourse, dysuria and pruritis.
Females; cervicitis, mild vaginal
discharge, salpingitis is a complication.
Tetracyclines are the drugs of
choice(tetracycline, minocyclines and
doxycyclines) 7-21 days., aternatively
erythromycin is used(in pregnancy or in allerge).
The cause of LGV is usually C. trachomatis serovars
L1, L2, or L3, which is different from those serovars
responsible for chlamydia urethritis.
Three stages of LGV infection are recognized in
During stage I, a small genital papule or vesicle
appears between 3 and 30 days after exposure. The
patient usually is asymptomatic; the ulcer heals
rapidly and leaves no scar
Stage II is characterized by acute, painful
lymphadenitis with bubo formation (the inguinal
syndrome) it often is accompanied by pain and fever,
Without treatment, the buboes may rupture, forming
numerous sinus tracts that drain chronically
Late or tertiary manifestations include perirectal
abscesses, rectovaginal fistulae (in women),
rectal strictures, and genital elephantiasis.
Appropriate treatment of stage II LGV usually
prevents these late complications.
An acute anorectal syndrome of LGV occurs in
homosexual men who acquire the infection
through rectal receptive intercourse. In these
cases, a primary anal ulcer may be noted with
associated inguinal adenopathy
include the use of doxycycline 100 mg PO BID or
erythromycin base 500 mg PO QID for 21
days.Surgical intervention may be needed for
later forms of the disease. Azithromycin 1 g
weekly for 3 weeks may be effective, but clinical
data on its use are lacking.
Def; is a chronic systemic infection due to
Treponema palidum. The microorganism
penetrate the epithelium and spread via the
Symptoms; after sexual intercourse a primary
chancre develops. This is a small macule
becoming a papule that breaks down into ulcer.
The ulcer is painless and does not bleed on
Stages of syphilis.;
Primary stage: it is the most infectious stage,
even the superficial lesions are infectious. The
chancre heals after 6-8 weeks, leaving no scar,
Secondary stage; this stage is manifest by a
widespread maculopapular skin rash that
involves the palms, soles, trunks and extremities
and the mucous membrane. In adition the patient
has fatigue, malaise,headache, fever, weight loss
and general lymphadenopath. Untreated lesions
heals in 4-12 weeks,, this is the latent stage of
syphilis, the early latent is infective, bt late latent
is non infective.
Tertiary stage, this is the late stage, it involves
every organ., the skeletal
system, cardiovascular, cns . Though it is a non
infective stage, it is a very destructive stage.
Penicillin G is the drug of choice for the treatment
for all stages of syphilis
Neurosyphilis can present at any stage of
neurosyphilis may be asymptomatic or
accompanied by a variety of manifestations; the
most common syndromes are meningovascular
syphilis, general paresis, tabes dorsalis
(locomotor ataxia), and optic atrophy
recommends treatment of neurosyphilis with
aqueous penicillin G, 3 to 4 MU IV every 4 hours,
or 18 to 24 MU/d continuous infusion, for 10 to 14
Acquired by transplacental infection of the fetus.
Occasionally a child is born with syphilitic
penphigus, bulbous eruption, often 2-3 weeks
after birth the skin lesion erupts. The child has
severe dehydration, malnutrition, long bone
destruction. 20 yrs later CNS may be
involved, leading to deafness, blindness, or
juvenile paresis and finally death.
Procaine penicillin G. 1.2 mu for 10
days, tetracycline 500mg, or you can
give, erythromycin, cephalothin, cephaloridine.., i
n pregnancy, inorder to cure fetal
spirochaetemia, ppf daily 0.6 mu for 7 days is the
Is a benign, self-limited complication of antitreponemal
antibiotic therapy that develops in a high proportion of
patients within a few hours after treatment of secondary
syphilis and less often after primary.
The cause of JHR is not well understood, but is
probably related to release of cytokines.
Clinical manifestations include fever, chills, myalgias,
headache, tachycardia, and hypotension
Usually self-limiting in non-pregnant patients, the
primary risk of this reaction in pregnant women is
miscarriage, premature labor, or fetal distress.
Pregnant women should seek medical attention if
contractions or a change in fetal movements are noted.
Antibiotic treatment should not be discontinued.
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