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Std

  1. 1. STD
  2. 2. Gonorrhea (GC) <ul><li>Neisseria gonorrhoeae is a Gram-negative intracellular diplococcus. </li></ul><ul><li>Humans are the only host and the organism is spread by intimate physical contact. </li></ul>
  3. 4. Clinical features <ul><li>Incubation period is 2–14 days. </li></ul><ul><li>most symptoms occurr between days 2 and 5. </li></ul><ul><li>In men: </li></ul><ul><li>anterior urethritis-dysuria and urethral discharge. </li></ul><ul><li>Ascending infections-epididymitis,prostatits. </li></ul><ul><li>MSM-proctitis,discharge,itch. </li></ul>
  4. 5. <ul><li>In women: </li></ul><ul><li>primary site- endocervical canal . </li></ul><ul><li>vaginal discharge, pelvic pain, dysuria and intermenstrual bleeding. </li></ul><ul><li>Complications: </li></ul><ul><li>Bartholin’s abscesses </li></ul><ul><li>perihepatitis (Fitzhugh–Curtis syndrome)-rare. </li></ul><ul><li>GC is one of the most common causes of female infertility. </li></ul>
  5. 6. <ul><li>Disseminated GC leads to arthritis (usually monoarticular or pauciarticular ) </li></ul><ul><li>Characteristic papular or pustular rash with an erythematous base in association with fever and malaise. </li></ul><ul><li>More common in women . </li></ul>
  6. 7. Diagnosis <ul><li>By culture of infected areas.Sensitivity 95%. </li></ul><ul><li>Nucleic acid amplification tests ( NAATs ) using urine specimens are non-invasive and highly sensitive. May give false positive. </li></ul><ul><li>Microscopy of Gram-stained secretions. </li></ul><ul><li>Microscopy should not be used for pharyngeal specimens. </li></ul>
  7. 8. Treatment <ul><li>Single-dose ceftriaxone i.m . (250 mg) treats uncomplicated anogenital infection </li></ul><ul><li>Single-dose oral amoxicillin 3 g with probenecid 1 g, ciprofloxacin (500 mg) may be used in areas with low prevalence of antibiotic resistance. </li></ul>
  8. 9. Chlamydia Trachomatis (CT) <ul><li>Regularly found in association with other pathogens. </li></ul><ul><li>Often asymptomatic. </li></ul><ul><li>In men: anterior urethritis,proctitis,epididymitis. </li></ul><ul><li>In women: vaginal discharge, postcoital or intermenstrual bleeding and lower abdominal pain. </li></ul><ul><li>Reactive arthritis has been related to infection with C. trachomatis. </li></ul>
  9. 10. Diagnosis <ul><li>NAAT investigation of choice. 90–95% sensitivity. </li></ul><ul><li>Culture is the “gold standard”,100% specific, but expensive. </li></ul><ul><li>In men: First void urine tested/urethral swabs. </li></ul><ul><li>In women: Endocervical swabs. </li></ul>
  10. 11. Treatment <ul><li>Doxycyline 100mg po bd x 1 week OR </li></ul><ul><li>Azithromycin 1g po stat. </li></ul><ul><li>Tetracyclines are contraindicated in pregnancy . </li></ul><ul><li>Routine test of cure is not necessary after treatment with doxycycline or azithromycin. </li></ul><ul><li>NAATs may remain positive for up to 5 weeks after treatment-picks up nonviable organism. </li></ul>
  11. 12. Syphilis <ul><li>Acquired or congenital </li></ul><ul><li>Early and late stages </li></ul><ul><li>Caused by Treponema pallidum (TP). </li></ul>
  12. 14. <ul><li>Primary- between 10-90 days. </li></ul><ul><li>Secondary-between 4-10 weeks. </li></ul><ul><li>Individuals with either primary or secondary disease are highly infectious . </li></ul>
  13. 15. Congenital syphilis <ul><li>Apparent between 2 nd to 6 th weeks after birth. </li></ul><ul><li>Early signs being nasal discharge, skin and mucous membrane lesions, and failure to thrive. </li></ul>
  14. 16. Investigations <ul><li>Treponemal specific (highly specific) </li></ul><ul><li>EIA </li></ul><ul><li>TPHA </li></ul><ul><li>FTA abs </li></ul><ul><li>Does not differentiate between syphilis and other treponemal disease.ie: yaws. </li></ul><ul><li>Test remains positive for life . </li></ul>
  15. 17. <ul><li>Treponemal non-specific: </li></ul><ul><li>VDRL </li></ul><ul><li>RPR </li></ul><ul><li>Positive within 3-4 weeks of primary infection. </li></ul><ul><li>Used to monitor treatment efficacy and are helpful in assessing disease activity. </li></ul><ul><li>Become negative by 6 months after treatment in early syphilis. </li></ul>
  16. 18. Clinical use <ul><li>EIA screening test of choice . Detects IgM and IgG ab. </li></ul><ul><li>A positive test is then confirmed with the TPHA /TPPA and VDRL / RPR tests </li></ul><ul><li>All serological investigations may be negative in early primary syphilis. </li></ul><ul><li>EIA IgM and the FTA-abs being the earliest tests to be positive . </li></ul>
  17. 19. Treatment <ul><li>Early syphilis-procaine benzylpenicillin. </li></ul><ul><li>Late stage-course extended for a further week. </li></ul><ul><li>If penicillin sensitive, treat with doxycyline or erythromycin for 2-4 weeks. </li></ul><ul><li>If non-compliant-give single dose of benzathine penicillin G 2.4 g IM. </li></ul><ul><li>Azithromycin is not recommended. </li></ul>
  18. 20. The Jarisch–Herxheimer reaction. <ul><li>Due to release of TNF-α, IL-6 and IL-8. </li></ul><ul><li>Occurs about 8 hours after first injection and usually consists of mild fever, malaise and headache lasting several hours. </li></ul><ul><li>Prednisone given for 24 hours prior to therapy may ameliorate the reaction-little evidence. </li></ul><ul><li>Penicillin should not be withheld because of the Jarisch–Herxheimer reaction. </li></ul>

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