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DIAGNOSIS OF SEXUALLY TRANSMITTED INFECTIONS Bacterial Basics

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DIAGNOSIS OF SEXUALLY TRANSMITTED INFECTIONS Bacterial Basics

DIAGNOSIS OF SEXUALLY TRANSMITTED INFECTIONS Bacterial Basics

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  • 1. DIAGNOSIS OF SEXUALLY TRANSMITTED INFECTIONS Bacterial Basics Dr.T.V.Rao MD
  • 2. What are Sexually transmitted Infections, mean Today • More than 30 bacterial, viral, and parasitic pathogens are transmissible sexually and constitute a group of infections referred to as sexually transmitted infections (STIs). Although some of the pathogens can be acquired through routes other than sexual transmission, epidemiologically, sexual contact is more important for their transmission from one person to another
  • 3. Common STDs Estimated Annual Incidences • • • • • • • Human papilloma Virus: 5.5 million Trichomoniasis: 5 million Chlamydia: 3 million Genital herpes: 1 million Gonorrhea: 650,000 Hepatitis B: 120,000 Syphilis: 70,000
  • 4. Types of Sexually Transmitted Infections Bacterial Viral Parasitic • Chlamydia • Gonorrhea • Syphilis • HPV (Genital Warts) • HIV • Herpes • Hepatitis B • Pubic Lice (“crabs”) • Trichomoniasis
  • 5. Overview of Complications of Sexually Transmitted Diseases Fetal Wastage* Low Birth weight* Congenital Infection* Upper Tract Infection Infertility Ectopic Pregnancy* Chronic Pelvic Pain Systemic Infection STDs Cervical Cancer* HIV Infection* * Potentially Fatal
  • 6. Increased Transmission of HIV in the Presence of Other STDs • Transmission increased 3-5 times • Increased susceptibility – Mucosal breakdown due to genital ulcer may facilitate HIV entry – Recruitment of WBCs to site of active infection (inflammation) acts as an area of increased HIV receptors • Increased infectiousness – Increase in HIV viral load in semen, genital secretions and genital ulcers
  • 7. Genital Ulcer Diseases – Does It Hurt? • Painful – Chancroid – Genital herpes simplex • Painless – Syphilis – Lymphogranuloma venereum – Granuloma inguinale Dr.T.V.Rao MD 7
  • 8. Treponema pallidum – The Agent of Syphilis • Spirochete • Obligate human parasite • Transmission – Sexual – Trans-placental – Percutaneous following contact with infectious lesions – Blood Transfusion • No reported cases of transmission since 1964 Dr.T.V.Rao MD 5 8
  • 9. Syphilis – The “Great Imitator” • Infectious Dose: ~57 organisms1 • Incubation Period – 21 days (median) • 3 clinical stages of syphilis – Primary: • Painless sore (chancre) at inoculation site – Secondary: • Rash, Fever, Lymphadenopathy, Malaise – Tertiary/Latent: • CNS invasion, organ damage • “The physician that knows syphilis knows medicine.” – Sir William Osler Dr.T.V.Rao MD 6 9
  • 10. Primary Syphilis Dr.T.V.Rao MD 10
  • 11. Primary Syphilis Chancre Dr.T.V.Rao MD Source: Florida STD/HIV Prevention Training Center 11
  • 12. DIAGNOSIS OF SYPHILIS 1. History and clinical examination. 2. Dark-field microscopy: special technique use to demonstrate the spirochete as shiny motile spiral structures with a dark background. • The specimen includes oozing from the lesion or sometimes L.N. aspirate. It is usually positive in the primary and secondary stages and it is most useful in the primary stage when the serological tests are still negative. Dr.T.V.Rao MD 12
  • 13. Serologic Tests for Syphilis: Non-Treponemal Assays • Principle: – T. pallidum infection leads to the production of reagin • Reagin – Antibodies to substances released from cells damaged by T. pallidum – Reagin reacts with cardiolipin • Cardiolipin – a phospholipid component of certain eukaryotic and prokaryotic membranes • Examples of non-treponemal tests: – Rapid Plasma Reagin (RPR) – Venereal Disease Research Laboratory (VDRL) Dr.T.V.Rao MD 9 13
  • 14. Laboratory Testing • Direct examination of clinical specimen by dark-field microscopy or fluorescent antibody testing of sample. • Non-specific or non-treponemal serological test to detect reagin, utilized as screening test only. • Specific Treponemal antibody tests are used as a confirmatory test for a positive reagin test. Dr.T.V.Rao MD 14
  • 15. Diagnosis of Syphilis • Evaluation based on three factors: – Clinical findings. – Demonstration of spirochetes in clinical specimen. – Present of antibodies in blood or cerebrospinal fluid. • More than one test should be performed. • No serological test can distinguish between other Treponemal infections. Dr.T.V.Rao MD 15
  • 16. Provisional Diagnosis of Syphilis • A presumptive diagnosis is possible with sequential serologic tests (e.g. VDRL, RPR), using the same testing method each time. A fourfold change in titer (e.g. from 1:8 to 1:32) is usually considered to be clinically significant. Confirmatory tests should be performed Dr.T.V.Rao MD 16
  • 17. Laboratory Diagnosis of Syphilis The Common Methods • Serology –Mainstay for syphilis testing –Two classes of serologic tests • Non-treponemal • Treponemal Dr.T.V.Rao MD 8 17
  • 18. Laboratory Diagnosis of Syphilis The Uncommon Methods • Rabbit Infectivity Test (RIT) http://www.els.net – High Sensitivity and Specificity – Long turn-around-time – Limited to research settings • Dark Field Microscopy – Useful only during primary infection – Technician expertise required • Immunostaining – Direct fluorescent antibody or silver stain • Polymerase Chain Reaction (PCR) – Not commercial available textbookofbacteriology.net Dr.T.V.Rao MD 7 18
  • 19. Specific serological tests of Syphilis • A. Reiter protein complement fixation test. • B. Fluorescent Treponemal antibody/absorption test, FTA/ABS. the most specific and most sensitive . • C. Treponema pallidum haemagglutination test- TPHA- D. Treponema pallidum immobilization testTPI Dr.T.V.Rao MD 19
  • 20. VDRL • Each preparation of antigen suspension should first be examined by testing with known positive or negative serum controls. • The antigen particles appear as short rod forms at magnification of about 100x. Aggregation of these particles into large or small clumps is interpreted as degrees of positivity • Reactive on left, non-reactive on right Dr.T.V.Rao MD 20
  • 21. Rapid Plasma Reagin Test - RPR • General screening test, can be adapted to automation. • CANNOT be performed on CSF. • Antigen – VDRL cardiolipin antigen is modified with choline chloride to make it more stable – attached to charcoal particles to allow macroscopic reading – antigen comes prepared and is very stable. • Serum or plasma may be used for testing, serum is not heated. Dr.T.V.Rao MD 21
  • 22. RPR • Test Procedure: – Serum or plasma added to circle on card and spread. – One drop of antigen from a needle capable of delivering 60 drops/mL is added. – Rotate at 100 rpms/minute for 8 minutes. – Results are read macroscopically. • Daily quality control: – – – – 20 gauge needle checked for delivery of 60 drops/mL Rotator checked for 100 rpms/minute Room temperature must be 23-29 C. Three levels of control must be run and give appropriate results. • RPR appears to be more sensitive than the VDRL. Dr.T.V.Rao MD 22
  • 23. Serologic Tests for Syphilis: Non-Treponemal Assays • RPR and VDRL are agglutination assays Charcoal Cardiolipin Dr.T.V.Rao MD 10 23
  • 24. Serologic Tests for Syphilis: Non-Treponemal Assays • RPR and VDRL are agglutination assays Charcoal Cardiolipin Reagin Serum or CSF Dr.T.V.Rao MD 11 24
  • 25. Treponema pallidum haemagglutination (TPHA) • Adapted to micro techniques (MHA-TP) • Tanned sheep RBCs are coated with T. pallidum antigen from Nichol’s strain. • Agglutination of the RBCs is a positive result. Dr.T.V.Rao MD 25
  • 26. Non-Treponemal Tests: Advantages • Rapid turnaround time – Minutes • Inexpensive • No specialized instrumentation required • Usually revert to negative following therapy –Can be used to monitor response to therapy Dr.T.V.Rao MD 12 26
  • 27. Non-Treponemal Tests: Limitations • Results are subjective – Intra- and Inter-laboratory variability • Non-specific – False positive results can result from other infectious or non-infectious conditions • EBV, Lupus, etc. • Limited sensitivity in early/primary syphilis and in late/latent syphilis • Low throughput – Problematic for high volume laboratories Dr.T.V.Rao MD 13 27
  • 28. Non-Treponemal Tests: Limitations, continued • Possibility for prozone effect – High levels of antibody may inhibit the agglutination reaction – To identify prozone, labs must serially dilute samples Undilute 1:2 1:4 Dr.T.V.Rao MD 14 1:8 1:16 28
  • 29. Serologic Tests for Syphilis: Treponemal Assays • • • • • Microhemagglutination assay (MHA) Fluorescent treponemal antibody (FTA-ABS) Treponema pallidum particle agglutination (TP-PA) Enzyme Immunoassay (EIA) Multiplex Flow Immunoassay (MFI) FTA-ABS TP-PA Conventional EIA www.mastgrp.biz Yellow wells = positive Dr.T.V.Rao MD 16 29
  • 30. Fluorescent Treponemal Antibody Absorption Test (FTA-ABS) • Diluted, heat inactivated serum added to Reiter’s strain of T. pallidum to remove cross reactivity due to other Treponemes. • Slides are coated with Nichol’s strain of T. pallidum and add absorbed patient serum. Dr.T.V.Rao MD 30
  • 31. Fluorescent Treponemal Antibody Absorption Test (FTA-ABS) • Slides are washed, and incubated with antibody bound to a fluorescent tag. • After washing the slides are examined for fluorescence. • Requires experienced personnel to read. • Highly sensitive and specific, but time consuming to perform. Dr.T.V.Rao MD 31
  • 32. Every Pregnant women Needs Screening Dr.T.V.Rao MD 32
  • 33. Tests of the CSF (VDRL quantitative) should be performed in: • . • • all cases of congenital syphilis any syphilis patients with • neurologic or ophthalmic signs or symptoms, • evidence of active tertiary syphilis (e.g., aortitis, gumma, and iritis), • • treatment failure • • HIV infection with late latent or syphilis of unknown duration, or • • patient preference (in immunocompetent patient).
  • 34. Tests of the CSF (VDRL quantitative) should be performed in: • All infants born to mothers who have reactive Nontreponemal and treponemal test results should be evaluated with a • quantitative nontreponemal serologic test (RPR or VDRL) performed on infant serum, because umbilical cord blood can • become contaminated with maternal blood and could yield a false positive result. Refer to the Centres for Disease • Control and Prevention, Sexually Transmitted Diseases Treatment Guidelines 2002 for evaluation and treatment of • infants for congenital syphilis.
  • 35. Tests of the CSF (VDRL quantitative) should be performed in: • All seroreactive infants (or infants whose mothers were seroreactive at delivery) should receive careful follow-up • examinations and serologic testing (i.e., a nontreponemal test) every 2-3 months until the test becomes nonreactive or • the titer has decreased fourfold. Nontreponemal antibody titers should decline by 3 months of age and should be • nonreactive by 6 months of age if the infant was not infected (i.e., if the reactive test result was caused by passive • transfer of maternal IgG antibody) or was infected but adequately treated.
  • 36. “Drips” –Gonorrhea –Nongonococcal urethritis –Chlamydia –Mucopurulent cervicitis –Trichomonas vaginitis and urethritis –Candidiasis Dr.T.V.Rao MD 36
  • 37. Gonorrhea Clinical Manifestations • Urethritis - male – – – – Incubation: 1-14 d (usually 2-5 d) Sx: Dysuria and urethral discharge (5% asymptomatic) Dx: Gram stain urethral smear (+) > 98% culture Complications • Urogenital infection - female – – – – Endocervical canal primary site 70-90% also colonize urethra Incubation: unclear; sx usually in l0 d Sx: majority asymptomatic; may have vaginal discharge, dysuria, urination, labial pain/swelling, abd. pain – Dx: Gram stain smear (+) 50-70% culture – Complications Dr.T.V.Rao MD 37
  • 38. Gonorrhea Dr.T.V.Rao MD Source: Florida STD/HIV Prevention Training Center 38
  • 39. Gonorrhea Gram Stain Dr.T.V.Rao MD Source: Cincinnati STD/HIV Prevention Training Center 39
  • 40. Diagnosis not Easy • Three levels of diagnosis are defined on the basis of clinical findings or the results of laboratory diagnostic tests. A definitive diagnosis of gonorrhoea must be obtained for medico legal purposes. Dr.T.V.Rao MD 40
  • 41. Diagnosis of Gonorrhoea • Suggestive diagnosis is defined by the presence of: • A mucopurulent endocervical or urethral exudate on physical examination and sexual exposure to a person infected with N. gonorrhoea. Dr.T.V.Rao MD 41
  • 42. Presumptive diagnosis of gonorrhoea is made on the basis of one of the following three criteria: • Typical gram-negative intracellular diplococci on microscopic examination of a smear of urethral exudate from men or endocervical secretions from women*; • Growth of a gram-negative, oxidase-positive diplococcus, from the urethra (men) or endocervix (women), on a selective culture medium, and demonstration of typical colonial morphology, positive oxidase reaction, and typical gram- negative morphology; Dr.T.V.Rao MD 42
  • 43. Presumptive Diagnosis of Gonorrhoea • The observation of gram-negative, intracellular diplococci on microscopic examination of endocervical secretions from women must be supported by a positive result from a test from either 2 or 3 to make a laboratory diagnosis of “presumptive N. gonorrhoea.” Dr.T.V.Rao MD 43
  • 44. Definitive diagnosis of gonorrhoea requires: • Isolation of N. gonorrhoea from sites of exposure (e.g., urethra, endocervix, throat, rectum) by culture (usually a selective medium) and demonstrating typical colonial morphology, positive oxidase reaction, and typical gram-negative morphology
  • 45. Definitive diagnosis of gonorrhoea requires: • Confirmation of isolates by biochemical, enzymatic, serologic, or nucleic acid testing e.g., carbohydrate utilization, rapid enzyme substrate tests, serologic methods such as coagglutination or fluorescent antibody tests supplemented with additional tests that will ensure accurate identification of isolates, or a DNA probe culture confirmation technique. Dr.T.V.Rao MD 45
  • 46. Newer Methods in Diagnosis of Gonorrhoea • Detection of N. gonorrhoea by a nonculture laboratory test (Antigen detection test (e.g., Gonozyme [Abbott]), direct specimen nucleic acid probe test (e.g., Pace II [GenProbe]), nucleic acid amplification test (e.g., LCR [Abbott]). Dr.T.V.Rao MD 46
  • 47. Definitive diagnosis of gonorrhoea requires: • Confirmation of isolates by biochemical, enzymatic, serologic, or nucleic acid testing e.g., carbohydrate utilization, rapid enzyme substrate tests, serologic methods such as coagglutination or fluorescent antibody tests supplemented with additional tests that will ensure accurate identification of isolates, or a DNA probe culture confirmation technique. Dr.T.V.Rao MD 47
  • 48. Best Treatment continues to be… • CDC still recommends only one first-line treatment regimen: injectable ceftriaxone, in combination with one of two other oral antibiotics, either azithromycin or doxycycline. This regimen remains highly effective in treating gonorrhea and causes limited side effects
  • 49. Two New Promising Treatment Regimens for Gonorrhoea • Two new antibiotic regimens using existing drugs – injectable gentamicin in combination with oral azithromycin and oral Gemifloxacin in combination with oral azithromycin – successfully treated gonorrhea infections in a clinical trial. The trial was conducted by the Centres for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The study was conducted to identify new treatment options in the face of growing antibiotic resistance.
  • 50. Drips Nongonococcal Urethritis • Etiology: – 20-40% C. trachomatis – 20-30% genital mycoplasmas (Ureaplasma urealyticum, Mycoplasma genitalium) – Occasional Trichomonas vaginalis, HSV – Unknown in ~50% cases • Sx: Mild dysuria, mucoid discharge • Dx: Urethral smear 5 PMNs (usually 15)/OI field Urine microscopic 10 PMNs/HPF Leukocyte esterase (+) 50 Dr.T.V.Rao MD
  • 51. Chlamydia Dr.T.V.Rao MD 51
  • 52. Chlamydia • Chlamydia is an infection of the penis, vagina, throat, or tube that carries urine. • Chlamydia is caused by bacteria (a kind of germ). • You get it by having sex with someone who has Chlamydia. • Chlamydia can be spread by the vagina, penis, mouth, or anus. Dr.T.V.Rao MD 52
  • 53. Chlamydia • Too many people are continuing to have unsafe sex, put themselves at risk of STIs and the serious consequences associated with infection, including infertility. • "On-going investment in programmes to increase sexual health awareness, condom use and testing, particularly for groups at most risk, is vital. Dr.T.V.Rao MD 53
  • 54. Chlamydia trachomatis • More than three million new cases annually • Responsible for causing cervicitis, urethritis, Proctitis, lymphogranuloma venereum, and pelvic inflammatory disease • Direct and indirect cost of chlamydial infections run into billions of dollars • Potential to transmit to newborn during delivery – Conjunctivitis, pneumonia Dr.T.V.Rao MD 54
  • 55. Normal Cervix Dr.T.V.Rao MD Source: Claire E. Stevens, Seattle STD/HIV Prevention Training Center 55
  • 56. Chlamydia Cervicitis Dr.T.V.Rao MD Source: St. Louis STD/HIV Prevention Training Center 56
  • 57. Mucopurulent Cervicitis Dr.T.V.Rao MD Source: Seattle STD/HIV Prevention Training Center 57
  • 58. Drips Laboratory Tests for Chlamydia • Tissue culture has been the standard – Specificity approaching 100% – Sensitivity ranges from 60% to 90% • Non-amplified tests – Enzyme Immunoassay (EIA), e.g. Chlamydiazyme • sensitivity and specificity of 85% and 97% respectively • useful for high volume screening • false positives – Nucleic Acid Hybridization (NA Probe), e.g. Gen-Probe Pace2 • sensitivities ranging from 75% to 100%; specificities greater than 95% • detects chlamydial ribosomal RNA • able to detect gonorrhea and chlamydia from one swab • need for large amounts of sample DNA Dr.T.V.Rao MD 58
  • 59. Laboratory Tests for Chlamydia (continued) • DNA amplification assays – polymerase chain reaction (PCR) – ligase chain reaction (LCR) • Sensitivities with PCR and LCR 95% and 85-98% respectively; specificity approaches 100% • LCR ability to detect chlamydia in first void urine Dr.T.V.Rao MD 59
  • 60. Chlamydia Direct Fluorescent Antibody (DFA) Dr.T.V.Rao MD Source: Centers for Disease Control and Prevention 60
  • 61. Drips Pelvic Inflammatory Disease (PID) • l0%-20% women with GC develop PID • In Europe and North America, higher proportion of C. trachomatis than N. gonorrhoeae in women with symptoms of PID • CDC minimal criteria – uterine adnexal tenderness, cervical motion tenderness • Other symptoms include – endocervical discharge, fever, lower abd. pain • Complications: – Infertility: 15%-24% with 1 episode PID secondary to GC or chlamydia – 7X risk of ectopic pregnancy with 1 episode PID – chronic pelvic pain in 18% Dr.T.V.Rao MD 61
  • 62. Chancroid • The combination of a painful genital ulcer and tender Suppurative inguinal adenopathy suggests the diagnosis of Chancroid A probable diagnosis of Chancroid, for both clinical and surveillance purposes, can be made if all of the following criteria are met: 1) the patient has one or more painful genital ulcers; 2) the patient has no evidence of T. pallidum infection by dark field examination of ulcer exudate or by a serologic test for syphilis performed at least 7 days after onset of ulcers; Dr.T.V.Rao MD 62
  • 63. Chancroid • 3) the clinical presentation, appearance of genital ulcers and, if present, regional lymphadenopathy are typical for Chancroid; and 4) a test for HSV performed on the ulcer exudate is negative. Dr.T.V.Rao MD 63
  • 64. Chancroid • The combination of a painful genital ulcer and tender Suppurative inguinal adenopathy suggests the diagnosis of Chancroid A probable diagnosis of Chancroid, for both clinical and surveillance purposes, can be made if all of the following criteria are met: 1) the patient has one or more painful genital ulcers; 2) the patient has no evidence of T. pallidum infection by dark field examination of ulcer exudate or by a serologic test for syphilis performed at least 7 days after onset of ulcers; Dr.T.V.Rao MD 64
  • 65. Chancroid • 3) the clinical presentation, appearance of genital ulcers and, if present, regional lymphadenopathy are typical for Chancroid; and 4) a test for HSV performed on the ulcer exudate is negative. Dr.T.V.Rao MD 65
  • 66. Chancroid • A definitive diagnosis of Chancroid requires the identification of H. ducreyi on special culture media that is not widely available from commercial sources; even when these media are used, sensitivity is <80% (145). Dr.T.V.Rao MD 66
  • 67. Granuloma Inguinale (Donovanosis) • Granuloma inguinale is a genital ulcerative disease caused by the intracellular gramnegative bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). The disease occurs rarely in the United States, although it is endemic in some tropical and developing areas, including India; Papua, New Guinea; the Caribbean; central Australia; and southern Africa (192,193). Dr.T.V.Rao MD 67
  • 68. Granuloma Inguinale (Donovanosis) • Clinically, the disease is commonly characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudoboboes) might also occur. The lesions are highly vascular (i.e., beefy red appearance) and bleed easily on contact. Dr.T.V.Rao MD 68
  • 69. Granuloma Inguinale (Donovanosis) • The causative organism is difficult to culture, and diagnosis requires visualization of darkstaining Donovan bodies on tissue crush preparation or biopsy. No FDA-cleared molecular tests for the detection of K. granulomatis DNA exist, but such an assay might be useful when undertaken by laboratories that have conducted a CLIA verification study. Dr.T.V.Rao MD 69
  • 70. Lymph granuloma Venereum • Lymph granuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3 . The most common clinical manifestation of LGV among heterosexuals is tender inguinal and/or femoral lymphadenopathy that is typically unilateral. Dr.T.V.Rao MD 70
  • 71. Lymph granuloma Venereum • Diagnosis is based on clinical suspicion, epidemiologic information, and the exclusion of other Aetiologies for proctocolitis, inguinal lymphadenopathy, or genital or rectal ulcers. C. trachomatis testing also should be conducted, if available. Dr.T.V.Rao MD 71
  • 72. Lymph granuloma Venereum • Genital and lymph node specimens (i.e., lesion swab or bubo aspirate) can be tested for C. trachomatis by culture, direct immunofluorescence, or nucleic acid detection. NAATs for C. trachomatis are not FDA-cleared for testing rectal specimens, although some laboratories have performed the CLIA validation studies that are needed to provide results for clinical management. Additional molecular procedures (e.g., PCR-based genotyping) can be used to differentiate LGV from non-LGV C. trachomatis, but these are not widely available. Dr.T.V.Rao MD 72
  • 73. Lymph granuloma Venereum • chlamydia serology (complement fixation titers >1:64) can support the diagnosis of LGV in the appropriate clinical context. Comparative data between types of serologic tests are lacking, and the diagnostic utility of serologic methods other than complement fixation and some micro immunofluorescence procedures has not been established. Dr.T.V.Rao MD 73
  • 74. • • • • Trichomoniasis An estimated 5 million new cases occur each year in women and men. Occurs in vagina of women so may be sexually transmitted to men using infected washcloths and towels. It is transmitted to the baby during delivery. It also can occur in the urethra (carries urine to penis) in men, doesn’t have symptoms usually. SYMPTOMS: Appear within 5 to 28 days of exposure Women usually have a vaginal discharge that FEMALE SYMPTOMS: Itching and burning at the outside of the opening of the vagina and vulva. Painful and frequent urination Heavy, unpleasant smelling greenish, yellow discharge MALE SYMPTOMS: Usually nothing, or discomfort in urethra, inflamed head of the penis. Dr.T.V.Rao MD 74
  • 75. Bacterial Vaginitis • Controversy: STD - yes or no • Need for treatment – 1980: only if patient complains – 2002: increased risk of: • • • • • • • • Preterm birth / premature rupture of membranes Amniotic fluid infection Chorioamnionitis / Postpartum endometritis Pelvic inflammatory disease Postsurgical infection Cervical intraepithelial neoplasia Mucopurulent cervicitis Acquisition of HIV Dr.T.V.Rao MD infection 75
  • 76. Syndrome diagnosis • Syndromic diagnosis is a valuable element of STI control efforts, providing a rapid diagnostic assessment that can then be used to guide timely therapy for persons with signs and symptoms of infection. In settings where syndromic diagnosis represents an element of STI management efforts, periodic laboratory testing of patients diagnosed and treated using syndromic management algorithms for
  • 77. Syndrome based diagnosis • STIs should be performed to ensure that syndromic diagnosis is succeeding in identifying the infections targeted for intervention. In situations in which syndromic diagnosis is not resulting in treatment of its targeted STI, efforts to evaluate the reasons for failure are warranted
  • 78. Prevention is the Key • Abstinence, or not having oral, vaginal or anal sex, is the best way to protect yourself. • It is possible to get an STD even without having intercourse through skin-to-skin contact. • Use latex condoms correctly for any type of sex (vaginal, oral or anal) from start to finish.
  • 79. For More Articles of Current Interest Visit me on …………
  • 80. • Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World • Email • doctortvrao@gmail.com