Sexually transmitted infections
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  • 1. Dr.T.V.Rao MD1/12/2013 Dr.T.V.Rao MD 1
  • 2. 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 ?.1/12/2013 Dr.T.V.Rao MD 2
  • 3. STDs• STDs are diseases and infections which are capable of being spread from person to person through: – sexual intercourse –oral-genital contact or in non-sexual ways. –IV drugs1/12/2013 Dr.T.V.Rao MD 3
  • 4. Four Classes of STD’s • Bacterial • Fungus • Parasites1/12/2013 • Viruses- NOT curable ? Dr.T.V.Rao MD 4
  • 5. Common STI’s• Chlamydia • HIV and• Gonorrhea• Genital Herpes AIDS (HSV-2) • Pubic Lice• Genital Warts (HPV) • Syphilis• Hepatitis B • Trichomoniasis1/12/2013 Dr.T.V.Rao MD 5
  • 6. What are some common Symptoms of STIs?• The symptoms vary among the different types of STIs. Some examples of common symptoms include: – Unusual discharge from the penis or vagina – Sores or warts on the genital area – Burning while urinating – Itching and redness in the genital area – Anal itching, soreness, or bleeding• If having any of these symptoms or think you might have an STI, talk to your health care provider.1/12/2013 Dr.T.V.Rao MD 6
  • 7. STIs in Women • Women are more vulnerable biologically, culturally, socioeconomically • Most are asymptomatic (no symptoms)in women1/12/2013 Dr.T.V.Rao MD 7
  • 8. STDs of Concern• Actually, all of them• “Sores” (ulcers) –Syphilis –Genital herpes (HSV-2, HSV-1) –Others uncommon in the U.S. • Lymph granuloma venereum • Chancroid1/12/2013 • Granuloma inguinale Dr.T.V.Rao MD 8
  • 9. STDs of Concern (continued)• “Drips” (discharges) – Gonorrhea – Chlamydia – Nongonococcal urethritis / mucopurulent cervicitis – Trichomonas vaginitis / urethritis – Candidiasis (vulvovaginal, less problems in men)• Other major concerns – Genital HPV (especially type 16, 18) and Cervical Cancer1/12/2013 Dr.T.V.Rao MD 9
  • 10. Scientifically known as the gonococcus, or Neisseria gonorrhea1/12/2013 Dr.T.V.Rao MD 10
  • 11. Signs & Symptoms• Most infected women have no symptoms• Include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods1/12/2013 Dr.T.V.Rao MD 11
  • 12. NEISSERIA GONORRHOEAE• 3rd most common STD i• It is a G-ve diplococci• Infects the endocervix  mucopurulent cervicitis• Majority of infections are asymptomatic• It is a leading cause of PID• Dx  endocervical culture• N gonorrhea & chlamydia coexist in 50% of patients• Rx  ceftriaxone 125 mg IM cefixime 400 mg PO• Followed by Rx for chlamydia• Husband should be treated• Can cause purulent conjunctivitis of the newborn1/12/2013 Dr.T.V.Rao MD 12
  • 13. 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 – Complications1/12/2013 Dr.T.V.Rao MD 13
  • 14. Gonorrhea 1/12/2013 Dr.T.V.Rao MD 14Source: Florida STD/HIV Prevention Training Center
  • 15. Gonorrhea1/12/2013 Dr.T.V.Rao MD 15
  • 16. Gonorrhea Gram Stain 1/12/2013 Dr.T.V.Rao MD 16Source: Cincinnati STD/HIV Prevention Training Center
  • 17. Effects on Pregnancy• Can also be spread from mother to child during birth• Can cause fertility problems, birth defects, skin problems, arthritis, blood poisoning, and heart and brain infections1/12/2013 Dr.T.V.Rao MD 17
  • 18. Nongonococcal Urethritis• Etiology: – 20-40% C. trachomatis – 20-30% genital mycoplasmas (Urea plasma 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 (+)1/12/2013 Dr.T.V.Rao MD 18
  • 19. Treatment• Several antibiotics can successfully cure gonorrhea• Because of drug-resistance the successful treatment o single shot of ceftriaxone 125 mg or a single dose of cefixime 400 mg taken by mouth are currently the recommended antibiotic treatment• Azithromycin (Zithromax) 2g in a single dose may be used for people who have severe allergic reactions to ceftriaxone, cefixime, or penicillin.f gonorrhea is becoming more difficult1/12/2013 Dr.T.V.Rao MD 19
  • 20. 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 infection1/12/2013 Dr.T.V.Rao MD 20
  • 21. SYPHILIS1/12/2013 Dr.T.V.Rao MD 21
  • 22. About Syphilis• Researchers tracing origins(CBC, 5:03)• Incidence  US: 13,997 in 2009 • Top 13 states = 75% of cases per CDC • Data by sex (males on the increase, females on the decrease)  King County: 289 early syphilis cases in 2010 • 285 - men, 4 - women  Over 90% among men (MSM) • Source: 2009 King County STD Epidemiology Report• Caused by bacteria, therefore curable• Transmission via vaginal, oral, anal sex1/12/2013 Dr.T.V.Rao MD 22
  • 23. Syphilis Symptoms• Syphilis is a multi-stage disorder:  Primary stage - painless, infectious chancre • Several days-few months after infection • Genitals, mouth, rectum, other areas • Sometimes there is no chancre • Ulcer heals; many may think there is no problem • Illustration: male (MayoClinic) • Photos: oral male, female, mix (CDC, Univ. of South Carolina Integrated Biomedical Sciences; University of Quebec; Cincinnati STD/HIV Prevention Training Center; istdpictures.com) 1/12/2013 Dr.T.V.Rao MD 23
  • 24. Sores Primary Syphilis - Clinical Manifestations• Incubation: 10-90 days (average 3 weeks)• Chancre – Early: macule/papule erodes – Late: clean based, painless, indurated ulcer with smooth firm borders – Unnoticed in 15-30% of patients – Resolves in 1-5 weeks – HIGHLY INFECTIOUS1/12/2013 Dr.T.V.Rao MD 24
  • 25. Primary Syphilis Chancre 1/12/2013 Dr.T.V.Rao MD 25Source: Florida STD/HIV Prevention Training Center
  • 26. Primary Syphilis 1/12/2013 Dr.T.V.Rao MD 26Source: Centers for Disease Control and Prevention
  • 27. Syphilis Symptoms  Secondary stage  Infectious rash • 3-6 weeks following infection • Hands, soles of feet; other areas • Fever and flu-like symptoms may also be apparent • Rash typically heals after several weeks  Condylomata Lata • Wart-like lesions (on female, male, CDC)1/12/2013 Dr.T.V.Rao MD 27
  • 28. Secondary Syphilis - Clinical Manifestations • Represents haematogenous dissemination of spirochetes • Usually 2-8 weeks after chancre appears • Findings: – rash - whole body (includes palms/soles) – mucous patches – Condylomata lata - HIGHLY INFECTIOUS – constitutional symptoms • Sn/Sx resolve in 2-10 weeks1/12/2013 Dr.T.V.Rao MD 28
  • 29. Secondary Syphilis Rash 1/12/2013 Dr.T.V.Rao MD 29Source: Florida STD/HIV Prevention Training Center
  • 30. Secondary Syphilis: Generalized Body Rash 1/12/2013 Dr.T.V.Rao MD 30Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
  • 31. Secondary Syphilis Rash 1/12/2013 Dr.T.V.Rao MD 31Source: Cincinnati STD/HIV Prevention Training Center
  • 32. Syphilis1/12/2013 Dr.T.V.Rao MD 32
  • 33. Syphilis Symptoms• Latent Stage  Infection hides in body, often central nervous system  Infected person can remain in this stage for years  There may be no symptoms for a long time  Disease begins to attack organs  Latent further divided into early, late, or unknown stages based on when infection occurred• Late/Tertiary Stage  Severe symptoms develop: paralysis/numbness; blindness; heart disease; dementia1/12/2013 Dr.T.V.Rao MD 33
  • 34. Secondary Syphilis 1/12/2013 Dr.T.V.Rao MD 34Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas
  • 35. Syphilis Treatment• Penicillin or other antibiotics• Communicate with all sex partners regarding syphilis• Refrain from sexual activity until infection is gone• Condoms may help prevent syphilis transmission1/12/2013 Dr.T.V.Rao MD 35
  • 36. Chancroid• A sexually transmitted disease caused by a bacterium. More commonly seen in men than women, particularly uncircumcisedmales• Chancroid is spread by having unprotected anal, vaginal or oral sex.• Some symptoms include: – sores or raised bumps on the genitals which eventually if untreated, becomes filled with pus and eventually ruptures leaving a painful sore/ulcer. – The bacterial may also infect the lymph glands in the groin. These glands may become enlarged, hard and painful. – In Women, ulcers appear on the genitals, painful urination and painful intercourse• Chancroids are contagious as long as the person as open sores. The open sores contain bacteria and any contact with these sores can result in infection.• Chancroids may be treated with certain antibiotics. The ulcers generally heal within 2 to 3 weeks.1/12/2013 Dr.T.V.Rao MD 36
  • 37. Chancroid ulcers1/12/2013 Dr.T.V.Rao MD CDC / Center for Disease Control and Prevention/ Division of STD Prevention 37
  • 38. Regional adenopathy CDC / Center for Disease Control and Prevention/ Division of STD Prevention1/12/2013 Dr.T.V.Rao MD 38
  • 39. Chlamydia• Bacterial Infection• Spread During unprotected anal, vaginal, or oral sex.• Symptoms: Occur within 7-21 days of infection.• Men: Clear thick discharge from Penis, burning during urination• Women: Painful Urination, itching, burning or bleeding from vagina. 1/12/2013 Dr.T.V.Rao MD 39
  • 40. 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, pneumonia1/12/2013 Dr.T.V.Rao MD 40
  • 41. Chlamydia• Chlamydia is one of the most common STIs, infecting an estimated 1 in 6 teens.• An infected person with no symptoms can still pass the disease to others, or have serious complications.• Symptoms in a male may include: a slight discharge (drip) from the penis, and a tingling sensation or pain with urination.• A female may experience irregular bleeding, pain during intercourse, a vaginal discharge, belly pain, or pain with urination.• Untreated chlamydia can lead to fertility problems. This disease can also be passed to babies during birth.• Chlamydia is treated with antibiotics• To prevent chlamydia use latex or plastic condoms each time you have sex.1/12/2013 Dr.T.V.Rao MD 41
  • 42. Chlamydia• Four million new cases occur each year• SYMPTOMS: fever, weight loss for no reason, swollen glands, fatigue, diarrhea, white spots on the mouth. FEMALE SYMPTOMS: Vaginal discharge (white or grey) or burning with urination Lower abdominal pain Bleeding between menstrual periods. Low-grade fever (later symptom) MALE SYMPTOMS: Discharge from the penis and/or burning when urinating Burning and itching around the opening of the penis Pain and swelling in the testicles Low –grade fever (associated with epididymitis – inflammation of the testicles)1/12/2013 Dr.T.V.Rao MD 42
  • 43. Chlamydia1/12/2013 Dr.T.V.Rao MD 43
  • 44. Chlamydia Cervicitis1/12/2013 Dr.T.V.Rao MD 44 Source: St. Louis STD/HIV Prevention Training Center
  • 45. Chlamydia Complications• Conjunctivitis in newborn (eye drops given)• Reiter’s Disease (sensitive photos)• Pelvic Inflammatory Disease (“PID” Illustration) – Infection – Disease-causing organisms migrate to uterus, fallopian tubes, ovaries – Untreated, PID leads to scarring, pelvic pain, tubal pregnancy, infertility – Treatment includes antibiotics – Approximately 1 million women affected each year – Approximately 100,000 women become infertile each year –)1/12/2013 Dr.T.V.Rao MD 45
  • 46. Chlamydia Complications• Epididymitis  600,000 cases a year  Inflammation of epididymis • Tube located in back of testicle • Holds maturing sperm  Disease-causing microbe enters urethra, travels  Symptoms include fever, pain, discharge, swelling  Treatment includes antibiotics, STD treatment if applicable  Chronic epididymitis does not threaten fertility1/12/2013 Dr.T.V.Rao MD 46
  • 47. Lymphogranuloma venereum• From different chlamydia bacteria• More prevalent in Asia, Africa, South America, but increasing in North America; now required to be reported in WA• Per DOH, six cases in 2008- 2009• Painless pimple or lesion on genitals• Infection spreads to lymph1/12/2013 Dr.T.V.Rao MD 47 tissue
  • 48. Lymphogranuloma Venerum (LGV) Complication of Chlamydia1/12/2013 Dr.T.V.Rao MD 48 CDC / Center for Disease Control and Prevention/ Division of STD Prevention
  • 49.  Herpes Simplex Virus (HSV-2), which is related to the viruses that belongs to the same family of viruses that cause chicken pox and shingles1/12/2013 Dr.T.V.Rao MD 49
  • 50. About Herpes• Transmission via vaginal, oral, anal sex• Transmission of virus can also occur through fingers (touching a sore, then touching a membrane)• Transmission of virus possible when no sores present• Transmission to fetus possible, but not typically if herpes was contracted before pregnancy  If pregnant woman contracts herpes toward end of pregnancy, transmission to fetus more likely  If pregnant woman has active herpes, Cesarean performed• Transmission may occur outside body contact, but no proof1/12/2013 Dr.T.V.Rao MD 50
  • 51. HERPES GENITALIS• It is a recurrent sexually transmitted disease• Caused by Herpes simplex virus HSV-1  10% of genital lesions HSV-2  90% of genital lesions• HSV-1 & 2 also infect the orofacial skin in reversed %• The virus causes prolonged lifelong infection of the nerve cells of the affected area1-PRIMARY (FIRST) INFECTION  multiple vesicles which will ulcerate forming shallow superficial ulcers over the external genitalia• There is often simultaneous involvement of the vagina & cx1/12/2013 Dr.T.V.Rao MD 51
  • 52. Herpes Symptoms• Most common symptom is blisters  First (primary) outbreak occurs within a few weeks of contact  May continue for a couple weeks, longer for those with compromised immune system  May feel painful, itchy, tingle/burn1/12/2013 Dr.T.V.Rao MD 52
  • 53. HERPES GENITALIS• It causes severe pain, itching, vaginal discharge & painful urination  urine retention that may require catheterization• Associated with fever, general malaise & headache• It takes 2-4 weeks to heal2-SECONDARY (RECURRENT ) HERPES• The viruses that are already present in the nerve cells will be reactivated by various stresses such as generalized illness, menses, emotional stress or trauma• It is less painful, circumscribed, not associated with generalized symptoms & lasts an average of 7 days1/12/2013 Dr.T.V.Rao MD 53
  • 54. Herpes1/12/2013 Dr.T.V.Rao MD 54
  • 55. Oral Herpes Source: CDC/NCHSTP/Division of STD, STD Clinical Slides1/12/2013 Dr.T.V.Rao MD 55
  • 56. 1/12/2013 Oral Herpes Dr.T.V.Rao MD 56
  • 57. Herpes Simplex Oralis1/12/2013 Dr.T.V.Rao MD 57 patient age: 15 years, patient sex: male
  • 58. Herpes Simplex 1 & 2• 45 million people in the United States ages 12 and older have herpes• 1 out of 5 of the total adolescent and adult population, are infected with Herpes Simplex1/12/2013 Dr.T.V.Rao MD 58
  • 59. Primary Herpes, vulva CDC / Center for Disease Control and Prevention/ Division of STD Prevention1/12/2013 Dr.T.V.Rao MD 59
  • 60. Genital Herpes Simplex - Clinical Manifestations • Direct contact – may be with asymptomatic shedding • Primary infection commonly asymptomatic; symptomatic cases sometimes severe, prolonged, systemic manifestations • Vesicles painful ulcerations crusting • Recurrence a potential • Diagnosis: – Culture – Serology (Western blot) – PCR1/12/2013 Dr.T.V.Rao MD 60
  • 61. HERPES GENITALIS• There may be an association between the Herpes virus & precancerous & cancerous conditions of the genital tract . The virus has been detected in in squamous cell carcinoma of the cx vagina & vulva• It was not proven to a causative factor for these cancer• Transmission of AIDS virus is increased in the presence of genital ulcers caused by infections such as Herpes or Syphilis1/12/2013 Dr.T.V.Rao MD 61
  • 62. Herpes Type 2 (HSV-2)• Cause lesions around and on the genital areas• Bumps form on the lips and sometimes in the mouth, tongue, and throat• Blisters crust over and heal within 10-16 days1/12/2013 Dr.T.V.Rao MD 62
  • 63. SoresEpidemiology of Genital Herpes• One of the 3 most common STDs, increased 30% from late 70s to early 90s• 25% of US population by age 35• HSV-2: 80-90%, HSV-1: 10-20% (majority of infections in some regions)• Most cases subclinical• Transmission primarily from subclinical infection• Complications: neonatal transmission, enhanced HIV transmission, psychosocial issues1/12/2013 Dr.T.V.Rao MD 63
  • 64. Genital Herpes Simplex 1/12/2013 Dr.T.V.Rao MD 64Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas
  • 65. Genital Herpes Simplex 1/12/2013 Dr.T.V.Rao MD 65Source: CDC/NCHSTP/Division of STD, STD Clinical Slides
  • 66. Genital Herpes Simplex 1/12/2013 Dr.T.V.Rao MD 66Source: Florida STD/HIV Prevention Training Center
  • 67. Effects on Pregnancy • Type 2 Viral shedding from cervix, vagina, vulva plays the primary role in transmitting the disease from mother to infant • About 60% of newborns infected and not treated will die or be severely damaged1/12/2013 Dr.T.V.Rao MD 67
  • 68. HERPES GENITALIS• Dx Viral culture of a suspicious lesion Blood test for detection of antibodies  helpful to Dx asymptomatic individuals or to confirm a past infection• Rx Acyclovir 200mg orally 5 times /day for 10 days   duration of ulcerative lesions Improve the symptoms Used for 1ry infection -2ry infection  no Rx -Supportive care  keeping the area clean & dry xylocaine jelly Applying compresses Tylenol1/12/2013 Dr.T.V.Rao MD 68
  • 69. HERPES GENITALIS• Patients with recurrence ≥ 6 years  prophylactic Acyclovir 400 mg twice a day• To reduce sexual transmission  couples should avoid direct sexual contact (by abstinence or using condom) when the infected individual has a lesion or experiencing a prodrome “tingling, itching, or pain felt before the recurrent lesion appear”• 1ry infection in pregnancy close to delivery  risk of transmission to the newborn  50%• If the mother have active lesions  elective CS should be performed• Infection to the newborn is devastating  disseminated infection with CNS involvement & 50% mortality1/12/2013 Dr.T.V.Rao MD 69
  • 70. LYMPHGRANULOMA VENEREUM “A disease of Tropical Countries”• Caused by Chlamydia trachomatis, serotype L1,2,3• A chronic infection of the lymphatic tissue• ♂:♀ 5:1• Incubation period 4-21 days• Involves : Vulva  most frequent site Cx, urethra, rectum• 3 phases of the disease -Primary phase Shallow , painless ulcer of the vestibule, labia or perirectal Heals without Rx -Secondary phase 1-4 wk after 1ryPainful lymphadenopathy in the inguinal or perirectal areas1/12/2013 Dr.T.V.Rao MD 70
  • 71. LYMPHGRANULOMA VENEREUM 2/3 unilateral adenopathy ½ Systemic symptoms “malaise & fever• Tertiary phase -The nodes enlarged, tender , matted together & adherent to the overlaying skin “bubos” -7-15 days the bubo  rupture spontaneously  multiple draining sinuses & fistulas -Extensive tissue destruction of the genitalia & anorectal region  elephantiasis, multiple fistulas & stricture• Treatment -Doxycycline 100 mg bd for 21 days1/12/2013 Dr.T.V.Rao MD 71
  • 72. GRANULOMA INGUINALE (DONOVANOSIS) “A disease of Tropical Countries”• Caused by G-ve , nonmotile , encapsulated rod  Calymmatobacterium granulomatous• Transmitted sexually & by close nonsexual contact• Incubation period 1-12 wk• Dx Donovan bodies in specimen taken from the ulcers  dark staining bacteria with safety pin appearance in the cytoplasm of mononuclear cells• Painless red ulcer with fresh granulation tissue• Multiple ulcers of the vulva  destroy normal vulvar architecture  scarring & lymphatic obstruction  marked enlargement of the vulva• Rx  Tatracycline 500 mg qid for 3 wk1/12/2013 Dr.T.V.Rao MD 72
  • 73. Known as “Human Papillomavirus”1/12/2013 Dr.T.V.Rao MD 73
  • 74. Human Papillomavirus (HPV)• 20 million people are currently infected with HPV• Very common amongst sexually active college students1/12/2013 Dr.T.V.Rao MD 74
  • 75. Human Papilloma Virus• Known as Genital Warts. • NOT Curable!!!• It causes growths of tiny, skin- colored, cauliflower-like warts to appear on the penis, vulva, vagina, and the cervix, in or around the anus or the throat.• Spread by sexual or skin to skin contact with someone who has HPV.• Symptoms: Irritation or itching in both men and women. HPV is extremely dangerous for women because it can lead to cervical cancer.• Warts caused by HPV are treated with an ointment, laser surgery, burning it with acid or freezing it with liquid nitrogen! 1/12/2013 Dr.T.V.Rao MD 75
  • 76. Signs & Symptoms• Most common manifestation of HPV is warts• Includes warts on skin such as plantar warts or in the genital area, known as genital warts1/12/2013 Dr.T.V.Rao MD 76
  • 77. HPV Penile Warts1/12/2013 Dr.T.V.Rao MD 77 Source: Cincinnati STD/HIV Prevention Training Center
  • 78. 1/12/2013 Condylomata acuminata, anal Dr.T.V.Rao MD 78
  • 79. Signs & Symptoms• May be associated with discomfort such as itching, burning, or tenderness in the genital area• Most women with HPV do not have any symptoms at all1/12/2013 Dr.T.V.Rao MD 79
  • 80. Signs & Symptoms• Include fever, general muscle aches, swollen lymph nodes in the neck, flu-like symptoms• Increased salivation and sometimes bleeding in the mouth1/12/2013 Dr.T.V.Rao MD 80
  • 81. Treatment• No effective treatment• Warts may be treated with agents designed to reduce or remove the warts, including creams, oral medications, or surgery• The infection usually goes away without treatment, but for high risk HPV1/12/2013 Dr.T.V.Rao MD 81
  • 82. HPV and Cervical Cancer1/12/2013 Dr.T.V.Rao MD 82
  • 83. HPV and Cervical Cancer HPV and Cervical Cancer • Infection is generally indicated by the detection of HPV DNA • HPV infection is causally associated with cervical cancer and probably other anogenital squamous cell cancers (e.g. anal, penile, vulvar, vaginal) • Over 99% of cervical cancers have HPV DNA detected within the tumor • Routine Pap smear screening ensures early detection (and treatment) of pre-cancerous lesions1/12/2013 Dr.T.V.Rao MD 83
  • 84.  HIV-Human Immunodeficiency Virus  AIDS-Acquired Immune Deficiency1/12/2013 Syndrome Dr.T.V.Rao MD 84
  • 85. HIV/AIDS• HIV is the virus that causes AIDS• The definition of AIDS relates to CD4+ T-cells Count• Healthy adults usually have CD4+ T-cell counts of 1,000 or more• Aids and some HIV sufferers have less than 200 CD4+ T-cells1/12/2013 Dr.T.V.Rao MD 85
  • 86. Modes of Transmission• blood• blood products• sexual fluids• People can be infected and NOT look sick or even have AIDS but can still transmit HIV1/12/2013 Dr.T.V.Rao MD 86
  • 87. Signs & Symptoms• rapid weight loss• dry cough• recurring fever or profuse night sweats• profound and unexplained fatigue• swollen lymph glands diarrhea• white spots or unusual blemishes on the tongue, in the mouth, or in the throat1/12/2013 Dr.T.V.Rao MD 87
  • 88. Effects of Pregnancy• 70% transmission occurs at the time of delivery 30% amount occurs antenatally (before delivery)• A significant contributor to transmission is breastfeeding1/12/2013 Dr.T.V.Rao MD 88
  • 89. TREATMENT IN PREGNANCY• Zidovudine monotherapy  vertical transmission 25% 8%• Standard triple therapy should be offered• Zidovudine should be included in the Rx to prevent perinatal transmission• Zidovudine IV intrapartum to the neonate for the first 6 wk of life• Elective CS recommended if -Women did not receive antiretroviral therapy -Monotherapy -Detectable viral load > 500 RNA copies /ml -Viral load determination not done -No prenatal care1/12/2013 Dr.T.V.Rao MD 89
  • 90. AIDS-related Opportunistic Infections • Kaposi’s Sarcoma Yeast Infections1/12/2013 Dr.T.V.Rao MD 90
  • 91. Treatment• Antiviral drugs drug’s that boost the immune system have allowed many people with HIV to resist infections, stay healthy, and prolong their lives, but these medications are not a cure1/12/2013 Dr.T.V.Rao MD 91
  • 92. STD/HIV Inter-RelationshipsSTD increases HIV susceptibility• STD causes infection and desquamation of squamous or columnar cells producing an inflammatory response• Results in increased number of HIV target cells (lymphocytes) on mucous membrane surfaces and a portal of entry for HIV1/12/2013 Dr.T.V.Rao MD 92
  • 93. STD increases HIV transmissionFor a person with HIV, having an STD:• Brings inflammatory cells loaded with HIV to the genital tract• Increases HIV viral shedding from mucous membranes1/12/2013 Dr.T.V.Rao MD 93
  • 94. HEPATITIS• Hepatitis A, B, and C all can be transmitted sexually• Hepatitis B is the most common & its sexual transmission is the most efficient• Hepatitis A & B  can be prevented by vaccination• Sexual transmission accounts for 45% of new cases• Hepatitis B immunoglobulins  post exposure prophylaxis within 14 days• Pregnant mothers with Hepatitis B  transmit the infection to their infants during or after birth Newborn infant should receive Immunoglobulins + Vaccination within 12 hrs of birth1/12/2013 Dr.T.V.Rao MD 94
  • 95. • Parasitic Infection of the vagina in women and urethra in men.• Mostly passed through sexual contact. It is also spread through damp towels, bathing suits or wash clothes shared with an infected person.• There are frequently no symptoms. – Men: discharge from penis, mild discomfort in penis and swelling in genitalia. – Women: green to yellow discharge with bad odor, vaginal itching, painful urination, inflammation in genitals. Sometimes in lower abdomen.• Trichomoniasis can usually be cured with the prescription drug, metronidazole, given by mouth in a single dose 1/12/2013 Dr.T.V.Rao MD 95
  • 96. TRICHOMONIASIS• Caused by a protozoan Trichomonas vaginalis• Symptoms  diffuse malodorous yellowish green discharge vulvar irritation• Dx  microscopy of vaginal secretion sensitivity 60-70% culture  more sensitive• Rx  Metronidazole 2 gm orally single dose• Husband  should be treated & they should avoid intercourse until they are cured• Vaginal Trichomoniasis has been associated with adverse pregnancy outcome  PROM, preterm delivery & low BWt.• Metronidazole is safe in pregnancy1/12/2013 Dr.T.V.Rao MD 96
  • 97. PID(Pelvic Inflammatory Disease)• Caused by a complication of bacterial vaginosis and/or gonorrhea/chlamydia.• Sexually active women aged 15- 25 are at highest risk for developing PID.• A woman’s genital tract becomes inflamed and infected causing swelling, scarring, fever and pain.• PID is a major cause for infertility.• Symptoms: Abdominal and pelvic pain, vaginal bleeding, discharge and pain during sex.1/12/2013 Dr.T.V.Rao MD 97
  • 98. Candidiasis •The 2nd most common cause of vaginal irritation or vaginitis and can also occur on male genitals. It can also appear in the mouth and throat as white sores. • Contrary to popular belief, Candidiasis is rarely transmitted by sexual contact. It is generally passes by • Everyone has this fungus on and inside their bodies. Most of the time it is harmless and keeps the bacterial levels in your body in check, but if there is an overgrowth of this fungus it can lead to a variety of problems • Some symptoms include: •In Women: A thick white discharge that looks like cottage cheese, itching and burning as well as a rash on the outer lips of the vagina. •In Men: Soreness, itching and redness of the head of the penis, scrotum and foreskin. (Uncircumcised men are more likely to develop yeast because it thrives in moist areas) •1/12/2013 Dr.T.V.Rao MD 98 An
  • 99. Infections with Trichomoniasis and Candia1/12/2013 Dr.T.V.Rao MD 99
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  • 102. SCABIES• Scabies is a fairly common infectious disease of the skin caused by a mite. Scabies mites burrow into the skin producing pimple-like irritations or burrows.• Scabies mites are transferred by direct skin-to-skin contact. Indirect transfer from undergarments or bedclothes can occur only if these have been contaminated by infected people immediately beforehand. Scabies can also be transmitted during sexual contact.• The most prominent symptom of scabies is intense itching particularly at night. The areas of the skin most affected by scabies include the webs and sides of the fingers, around the wrists, elbows and armpits, waist, thighs, genitalia, nipples, breasts and lower buttocks.• Skin lotions are available through a physicians prescription for the treatment of scabies.1/12/2013 Dr.T.V.Rao MD 102
  • 103. ECTOPARASITIC INFESTATION PEDICULOSIS PUBIS• Humans are the only reservoir for pubic lice• Can be transmitted by sexual & close nonsexual contact• Pruritus is the most common symptom• Rx  Washing the area with pediculicide formulations Washing the clothes & linens with very hot water1/12/2013 Dr.T.V.Rao MD 103
  • 104. Scabies (under the skin crabs)1/12/2013 Dr.T.V.Rao MD 104
  • 105. 1/12/2013 Scabies (under the skin crabs) Dr.T.V.Rao MD 105
  • 106. What STD screening tests would you order?1. Urine for GC and CT and syphilis serology 39% 39%2. Urine for GC and CT and syphilis and HSV-2 serology3. Urine and rectal GC and CT tests, pharyngeal GC, and syphilis serology 17%4. Urine, rectal and pharyngeal GC and CT, and syphilis and HSV-2 6% serology 1 2 3 4
  • 107. STI Prevention• Abstain from sexual intercourse— vaginal, oral, or anal• Be in a monogamous relationship with an uninfected partner1/12/2013 Dr.T.V.Rao MD 107
  • 108. • Reduce Number of Partners• Get to know the Person• Get tested together• Try celibacy• Learn about HIV/STDs together• Talk to your partner about what you know• How many can you think of…?1/12/2013 Dr.T.V.Rao MD 108
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  • 110. • Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World from Various WEB RESSOURCES • Email • doctortvrao@gmail.com1/12/2013 Dr.T.V.Rao MD 110