Sexually Transmitted           Infections   By: Maria Carmela L. Domocmat, RN, MSN                            Nurse Instru...
Diseases Characterized by         Diseases Characterized by Ulcerations                       Vaginal Discharge   Chancroi...
› Chancroid› Genital HSV Infections› Granuloma Inguinale (Donovanosis),› Lymphogranuloma Venereum› Syphilis        Maria C...
CHANCROID
http://www.webmd.com/sexual-conditions/slideshow-std-pictures-and-http://www.webmd.com/sexual-conditions/slideshow-std-pic...
Chancroid is caused by Haemophilusducreyi a, a small, gram-negative,facultative anaerobic bacillus.It produces a cytocidal...
usually from 3 to 5                   days                   may extend up to 2                   weeksIncubation period  ...
transmitted sexually by direct contactwith purulent lesionsby autoinoculation to nonsexual sites suchas the eye and skin.c...
Initially papules or pustules   Multiple painful, irregular, deep genital ulcers Inguinal lymphadenopathy or buboes (swell...
Culture of H. ducreyi            The differential            diagnosis proved to be            chancroid, caused by       ...
Chancroid of the Penis    Chancroid of the Labia                         Maria Carmela L.Domocmat, RN, MSN
IM, single dose   Oral azithromycin   Ceftriaxone Oral   Ciprofloxacin   Erythromycin Sexual partners within 10 days befor...
Drain fluctuant lymph nodes by eitherneedle aspiration or incision.                    Maria Carmela L.Domocmat, RN, MSN
Syphilis, herpes simplex virus (HSV), andHIV testing and counseling are essentialto diagnose those patients who arecoinfec...
Rupture of buboes, with subsequent scarring and/or chronic sinus tract drainage Phimosis (the foreskin cannot be fully ret...
Maria Carmela L.Domocmat, RN, MSN
GENITAL HERPES
At least 50 million persons in the UnitedStates have genital HSV infectionestimated that 1.6 million new casesoccur each y...
Maria Carmela L.Domocmat, RN, MSN
Two types of a viral infection characterized by periodic outbreaks of painful sores. Stress, sunburn, and certain foods ar...
Both herpes simplex virus-1 and virus-2may be transmitted through sex, or bykissing or touching any affected area.Possible...
Fetal demise due to HSV              Maria Carmela L.Domocmat, RN, MSN
Genital Herpes Organism: Herpes simplex II (90% of cases) & Herpes simplex I, viruses             Maria Carmela L.Domocmat...
from five to twenty daysIncubation Period                     Maria Carmela L.Domocmat, RN, MSN
Herpes simplex virus-1 usually shows up as cold sores or blisters. Herpes simplex virus-2  some are asymptomatic  Early sy...
Maria Carmela L.Domocmat, RN, MSN
A short while later, small red bumps may appear around the genitals or on the mouth; later these bumps become painful blis...
Herpes genitalis                   Maria Carmela L.Domocmat, RN, MSN
Genital HerpesMaculopapular herpetic rash on the penile shaft and corona of the                                  Maria Car...
Herpes simplex keratitis   is a serious viral infection.   It may cause repeated attacks that are  triggered by stress, es...
Infectivity: Washing with soap            people can infect and water readily            others when they inactivates HSV;...
Visual – lesions Viral culture  Confirm the dx  Most accurate if specimens are obtained within  48 hrs of 1st outbreak of ...
Decrease discomfort Promote healing without secondary infection Decrease viral shedding Prevent infection transmissionGoal...
TreatmentNo cureDrugs help decrease severity ofsymptoms, promote healing, anddecrease recurrent outbreaks                 ...
Genital Herpes:  Acyclovir 200-400mg TID x 10 days  Famciclovir (Famvir)  Valacyclovir (Valtex) Herpes prophylaxis: Acyclo...
Oral analgesics Local anesthetic sprays Ice packs or warm compress to lesions Sitz bath – 3-4x/day Increase fluid intake F...
When vesicles rupture release highly contagious exudate Wash hands thoroughly after contact with lesion Genital hygiene Ke...
Emphasize risk of fetal infection to both male and female clients A condom can prevent herpes transmission during vaginal ...
While herpes is not life-threatening, and not all people who have it suffer from outbreaks  disseminated infections Mening...
HSV Vesicles               Maria Carmela L.Domocmat, RN, MSN
Maria Carmela L.Domocmat, RN, MSN
GRANULOMA INGUINALE
Aka: donovanosis           Incubation period initially described           1 to 12 weeks by Donovan over a century agoGran...
bacterium was classified in 1913as Calymmatobacterium granulomatis.the molecular structure of the causativeorganism was si...
About half of infected men and women       have sores in the anal area.       Small, beefy-red bumps appear on the       g...
Maria Carmela L.Domocmat, RN, MSN
The disease slowly spreads and destroys genital       tissue.       Tissue damage may spread to the area where       the l...
causative organism - difficult to culture, diagnosis requires visualization of dark- staining Donovan bodies on tissue cru...
sexual contact; however, it ishypothesized to have low infectiouscapabilities because repeated exposure isnecessary for cl...
Donovanosisor granuloma inguinale               Maria Carmela L.Domocmat, RN, MSN
Antibiotics are used to treat donovanosis. To cure the condition requires long-term treatment. Most treatment courses run ...
Doxycycline 100 mg orally BID for at least 3 weeks and until all lesions have completely healedRecommended Regimen        ...
Azithromycin 1 g orally once per week for at least 3 weeks and  until all lesions have completely healedOR  Ciprofloxacin ...
Genital damage and scarring Loss of skin color in genital area Permanent genital swelling due to scarringComplications    ...
Treat partners within 60 days before dx.Health educ                     Maria Carmela L.Domocmat, RN, MSN
LYMPHOGRANULOMAVENERUEM (LGV)
AKA: lymphopahia venerea tropical bubo, climatic bubo, strumous bubo, poradenitis inguinales, Durand-Nicolas- Favre diseas...
is a chronic (long-term) infection of the lymphatic system caused by three different types of the bacterium Chlamydia trac...
3 to 30 daysIncubation period                Maria Carmela L.Domocmat, RN, MSN
Tender, enlarged, inflamed inguinal and/or femoral lymphadenopathy -typically unilateral.   Both sides – “groove sign”   C...
Maria Carmela L.Domocmat, RN, MSN
Rectal exposure in women or MSM can result in proctocolitis,  including mucoid and/or hemorrhagic rectal  discharge,  anal...
Diagnosis is based on  clinical suspicion,  epidemiologic information,  and the exclusion of other etiologies for proctoco...
Treatment cures infection and prevents ongoing tissue damage, although tissue reaction to the infection can result in scar...
Recommended Regimen  Doxycycline 100 mg orally twice a day for 21 days Alternative Regimen   Erythromycin , 500 mg orally ...
Management of Sex Partners  Persons who have had sexual contact with a  patient who has LGV within the 60 days before  ons...
Pregnancy   Pregnant and lactating women should be  treated with erythromycin.   Azithromycin might prove useful for treat...
HIV Infection  Persons with both LGV and HIV infection  should receive the same regimens as those  who are HIV negative. P...
Abnormal connections between the rectum and vagina Brain inflammation (very rare) Infections in the joints, eyes, heart, o...
LGV is an invasive, systemic infection If not treated early LGV proctocolitis can lead to chronic, colorectal fistulas and...
Maria Carmela L.Domocmat, RN, MSN
SYPHILIS
Treponema pallidum bacterium.Secondary syphilis is the most contagious of allthe stages, and is characterized by a systemi...
Stages         Maria Carmela L.Domocmat, RN, MSN
Genital chancre Chancre – an oval ulcer with a raised firm border that does not bleed readily and is painless unless infec...
Syphilitic Ulcer                   Maria Carmela L.Domocmat, RN, MSN
Lymphadenopathy near the chancre  Nodes – painless, firm, discrete                       Maria Carmela L.Domocmat, RN, MSN
Develops when primary is untreated  6 to 8 wks after infection Generalized rash – maculopapular and nonpruritic rash  Usua...
Secondary Syphilis: includes multiplelesions located on the penis and scrotum.                                         The...
syphilis can causepainless ulcers(know as chancres)to appear on thepenis, or at theplace where thesyphilis bacteriaentered...
can cause painless ulcers (known as chancres) to appear on the vagina, or at the place where the syphilis bacteria entered...
Condylomata lata   Broad-based flat papules   Develop in warm, moist body areas (i.e.,  labia, anus corners of mouth)   Hi...
Condylomata lata              Maria Carmela L.Domocmat, RN, MSN
Maria Carmela L.Domocmat, RN, MSN
Maria Carmela L.Domocmat, RN, MSN
Maria Carmela L.Domocmat, RN, MSN
secondary stage syphilis caninclude flat, warty-lookinggrowths on the vulva andaround the anus.(Credit: CDC)              ...
Maria Carmela L.Domocmat, RN, MSN
Client is seroreactive but shows no evidence of disease non infectious except transplacental spread or BT Not sexually tra...
Occurs 1 to 35 yrs after primary infection Devastating, irreversible complications   Chronic bone and joint inflammation  ...
Tertiary neurosyphilis presents with symptoms of meningitis or with focal deficits consistent with stroke. The mnemonic de...
gummas observed in tertiarysyphilis                Maria Carmela L.Domocmat, RN, MSN
oral, anal, or vaginal sex, or via intimatetouching or kissing.Mothers can pass it to their babies bytouching syphilis sor...
One week to three monthsIncubation Period                   Maria Carmela L.Domocmat, RN, MSN
Dark-filed microscopy (DFA)  Lesions scraped and causative organism identified Serologic tests    Indirect test that detec...
Dark-filed microscopy (DFA)   Lesions scraped  and causative  organism  identifiedDiagnostic tests                     Mar...
T. pallidum cannot be        Advantages of viewed by normal             darkfield microscopy: light microscopy.           ...
An experienced microscopist and specialized equipment (often not available outside of a specialized clinic) are required. ...
Serologic tests   Indirect test that detect antibodies   Note: antibodies are not present in serum until   4 wks after the...
Venereal disease research laboratory (VDRL) Rapid plasma reagin (RPR)   Uses antigen to detect the antibody  relatively sp...
Fluorescent treponemal antibody absorptions (FTA-ABS) test Treponema pallidum particle agglutination (TP-PA)Diagnostic tes...
Direct fluorescent antibody - T. pallidum (DFA-TP)   identifies T.  pallidum on direct  lesion smear by  immunofluorescenc...
Maria Carmela L.Domocmat, RN, MSN
Primary, secondary,         Primary, secondary tertiary syphilis           syphilis    Benzathine                  Abstain...
Latent syphilis  Three weekly penicillin injections  Neurosyphilis – IV aqueous crystalline  penicillin GTreatment:       ...
AdultsPrimary, secondary, and early latentsyphilis without neurologic involvement:Benzathine penicillin G, IM, 2.4 million...
AdultsLate latent or latent syphilis of unknownduration without neurologic involvement:•Benzathine penicillin G 7.2 millio...
AdultsTertiary (late) syphilis without neurologicinvolvement:Benzathine penicillin G 7.2 million units total,administered ...
Alternative regimen (if compliance can be ensured):     Procaine penicillin 2.4 million units IM once daily               ...
is a self-limited reaction to anti- treponemal therapy. characterized by fever, malaise, nausea, and vomiting. may be asso...
Patients should be warned that it is not an allergic reaction to penicillin and that it can be treated with symptomatic su...
serious damage to         A fetus is at the brain and the         particular risk if the nervous system;           mother ...
Irreversible blindness Mental illness Paralysis Heart disease deathComplications                      Maria Carmela L.Domo...
caused by transplacental transmission of spirochetes; the transmission rate approaches 100%. Perinatal death may result fr...
Among survivors, manifestations have traditionally been divided into early and late stages. Manifestations are defined as ...
Syphilis in pregnancy can lead to spontaneous abortion, stillbirth, premature delivery, or perinatal death. It can also ca...
Hutchinsons teeth notched,narrow-edged permanent incisors,sometimes but not always a sign ofcongenital syphilis.          ...
Early manifestations of congenital infection vary and involve multiple organ systems. The most striking lesions affect the...
Nasal fluid is highly infectious. Snuffles are followed quickly by a diffuse maculopapular desquamative rash that involves...
syphilisScarring from the early systemic disease causes late manifestations of congenital syphilis. Manifestations include...
http://www.nzma.org.nz/journal/120-1250/2448/content01.jpgCongenital syphilis                                             ...
HIV infected persons with early stage syphilis should receive a single IM dose of 2.4mu of benzathine penicillin Some spec...
All patients who have syphilis should be tested for HIV infection. Persons with primary or secondary syphilis who live in ...
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Sexually transmitted infections. Part II

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Includes Sexually transmitted infections that is characterized by ulcers: chancroid, herpes, donovanosis, lymphogranuloma venereum, syphilis

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  • I just want everyone to know never to give up believing there is someone out there for you even though you have std! We are very happy with each other and that www.Hmeet.net made it possible for us to find each other. Don't pass a good thing, you never know what it may evolve into.Good luck on your search and wish you the best:)
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Sexually transmitted infections. Part II

  1. 1. Sexually Transmitted Infections By: Maria Carmela L. Domocmat, RN, MSN Nurse Instructor Northern Luzon Adventist College
  2. 2. Diseases Characterized by Diseases Characterized by Ulcerations Vaginal Discharge Chancroid Bacterial Vaginosis Trichomoniasis Genital HSV Infections Vulvovaginal Candidiasis Granuloma Inguinale (Donovanosis) Human Papillomavirus (HPV) Infection Lymphogranuloma Venereum Genital Warts Syphilis Hepatitis A, B, C Diseases Characterized by Sexually transmitted enteric Urethritis or Cervicitis infections Chlamydial Infections Proctitis, Proctocolitis, and Gonococcal Infections Enteritis Ectoparasitic Infections Scabies Pediculosis PubisOverview Maria Carmela L.Domocmat, RN, MSN
  3. 3. › Chancroid› Genital HSV Infections› Granuloma Inguinale (Donovanosis),› Lymphogranuloma Venereum› Syphilis Maria Carmela L.Domocmat, RN, MSN
  4. 4. CHANCROID
  5. 5. http://www.webmd.com/sexual-conditions/slideshow-std-pictures-and-http://www.webmd.com/sexual-conditions/slideshow-std-pictures-and-facts Maria Carmela L.Domocmat, RN, MSN
  6. 6. Chancroid is caused by Haemophilusducreyi a, a small, gram-negative,facultative anaerobic bacillus.It produces a cytocidal distending toxinthat appears to be responsible for its toxiceffects.Cofactor of HIV transmission, syphilis andHSV Maria Carmela L.Domocmat, RN, MSN
  7. 7. usually from 3 to 5 days may extend up to 2 weeksIncubation period Maria Carmela L.Domocmat, RN, MSN
  8. 8. transmitted sexually by direct contactwith purulent lesionsby autoinoculation to nonsexual sites suchas the eye and skin.can be transmitted as long as the originalsore or oozing lymph node remainsinfected with the bacteria.MOT Maria Carmela L.Domocmat, RN, MSN
  9. 9. Initially papules or pustules Multiple painful, irregular, deep genital ulcers Inguinal lymphadenopathy or buboes (swelling of the lymph nodes)s/s Maria Carmela L.Domocmat, RN, MSN
  10. 10. Culture of H. ducreyi The differential diagnosis proved to be chancroid, caused by Haemophilus ducreyi, and not syphilis.. Dx Maria Carmela L.Domocmat, RN, MSN
  11. 11. Chancroid of the Penis Chancroid of the Labia Maria Carmela L.Domocmat, RN, MSN
  12. 12. IM, single dose Oral azithromycin Ceftriaxone Oral Ciprofloxacin Erythromycin Sexual partners within 10 days before onset of s/s should also be treated Chancroid ulcers typically improve within 3 to 7 days after institution of therapy and healing is usually complete in 2 weeks. http://www.ncbi.nlm.nih.gov/books/NBK25605/Treatment Maria Carmela L.Domocmat, RN, MSN
  13. 13. Drain fluctuant lymph nodes by eitherneedle aspiration or incision. Maria Carmela L.Domocmat, RN, MSN
  14. 14. Syphilis, herpes simplex virus (HSV), andHIV testing and counseling are essentialto diagnose those patients who arecoinfected with this disease. Maria Carmela L.Domocmat, RN, MSN
  15. 15. Rupture of buboes, with subsequent scarring and/or chronic sinus tract drainage Phimosis (the foreskin cannot be fully retracted over the glans penis) and balanoposthitis (or balanitis is an inflammation of the foreskin and head of the penis)Complications Maria Carmela L.Domocmat, RN, MSN
  16. 16. Maria Carmela L.Domocmat, RN, MSN
  17. 17. GENITAL HERPES
  18. 18. At least 50 million persons in the UnitedStates have genital HSV infectionestimated that 1.6 million new casesoccur each year.Most persons infected with HSV-2 havenot been diagnosed. Maria Carmela L.Domocmat, RN, MSN
  19. 19. Maria Carmela L.Domocmat, RN, MSN
  20. 20. Two types of a viral infection characterized by periodic outbreaks of painful sores. Stress, sunburn, and certain foods are the primary causes of a herpes outbreak.Herpes simplex Maria Carmela L.Domocmat, RN, MSN
  21. 21. Both herpes simplex virus-1 and virus-2may be transmitted through sex, or bykissing or touching any affected area.Possible by fomites (e.g., towels)Newborn vaginal deliveryMOT Maria Carmela L.Domocmat, RN, MSN
  22. 22. Fetal demise due to HSV Maria Carmela L.Domocmat, RN, MSN
  23. 23. Genital Herpes Organism: Herpes simplex II (90% of cases) & Herpes simplex I, viruses Maria Carmela L.Domocmat, RN, MSN
  24. 24. from five to twenty daysIncubation Period Maria Carmela L.Domocmat, RN, MSN
  25. 25. Herpes simplex virus-1 usually shows up as cold sores or blisters. Herpes simplex virus-2 some are asymptomatic Early symptoms can include burning sensation in the genitals, low back pain, dysuria, and flu-like symptoms.Symptoms: Maria Carmela L.Domocmat, RN, MSN
  26. 26. Maria Carmela L.Domocmat, RN, MSN
  27. 27. A short while later, small red bumps may appear around the genitals or on the mouth; later these bumps become painful blisters which then crust over, form a scab, and heal. symptoms go away but reappear since the virus stays in the bodySymptoms: Maria Carmela L.Domocmat, RN, MSN
  28. 28. Herpes genitalis Maria Carmela L.Domocmat, RN, MSN
  29. 29. Genital HerpesMaculopapular herpetic rash on the penile shaft and corona of the Maria Carmela L.Domocmat, RN, MSNglans penis.
  30. 30. Herpes simplex keratitis is a serious viral infection. It may cause repeated attacks that are triggered by stress, esposure to sunlight, or any condition that impairs the immune system.Herpes simplex keratitis Maria Carmela L.Domocmat, RN, MSN
  31. 31. Infectivity: Washing with soap people can infect and water readily others when they inactivates HSV; have symptoms & therefore fomite some times when transmission is they do not unlikely. Maria Carmela L.Domocmat, RN, MSN
  32. 32. Visual – lesions Viral culture Confirm the dx Most accurate if specimens are obtained within 48 hrs of 1st outbreak of blisters Direct immunofluorescence staining Antigen detection testing of vesicualar exudate Pap smearDx Maria Carmela L.Domocmat, RN, MSN
  33. 33. Decrease discomfort Promote healing without secondary infection Decrease viral shedding Prevent infection transmissionGoals of treatment Maria Carmela L.Domocmat, RN, MSN
  34. 34. TreatmentNo cureDrugs help decrease severity ofsymptoms, promote healing, anddecrease recurrent outbreaks Maria Carmela L.Domocmat, RN, MSN
  35. 35. Genital Herpes: Acyclovir 200-400mg TID x 10 days Famciclovir (Famvir) Valacyclovir (Valtex) Herpes prophylaxis: Acyclovir 200-400mg BID Herpes zoster (shingles): Acyclovir 800mg 5 times a day for 10 days use Betadine on lesions to dry & prevent secondary infectionsTreatment Maria Carmela L.Domocmat, RN, MSN
  36. 36. Oral analgesics Local anesthetic sprays Ice packs or warm compress to lesions Sitz bath – 3-4x/day Increase fluid intake Frequent urination Pour water over genitalia while voiding, or encourage voiding while sitting in tub of water or standing in shower Catheterize as necessary Wear loose-fitting nonsynthetic undergarmentsReduce pain Maria Carmela L.Domocmat, RN, MSN
  37. 37. When vesicles rupture release highly contagious exudate Wash hands thoroughly after contact with lesion Genital hygiene Keep skin clean and dry Wear gloves when applying ointment Avoid touching eyes Avoid sex when (+) with lesion Use latex or polyurethane condoms Launder towels that have direct contact with lesion; separate towels and other personal items of clientPrevent reinfection Maria Carmela L.Domocmat, RN, MSN
  38. 38. Emphasize risk of fetal infection to both male and female clients A condom can prevent herpes transmission during vaginal or anal sex, but oral contact with genitals or open sores anywhere can spread the disease.Health educ Maria Carmela L.Domocmat, RN, MSN
  39. 39. While herpes is not life-threatening, and not all people who have it suffer from outbreaks disseminated infections Meningitis Transverse myelitis Risk for spontaneous abortion Predispose carcinoma of cervixComplications Maria Carmela L.Domocmat, RN, MSN
  40. 40. HSV Vesicles Maria Carmela L.Domocmat, RN, MSN
  41. 41. Maria Carmela L.Domocmat, RN, MSN
  42. 42. GRANULOMA INGUINALE
  43. 43. Aka: donovanosis Incubation period initially described 1 to 12 weeks by Donovan over a century agoGranuloma Inguinale Maria Carmela L.Domocmat, RN, MSN
  44. 44. bacterium was classified in 1913as Calymmatobacterium granulomatis.the molecular structure of the causativeorganism was similar to Klebsiella speciesand reclassified the gram-negativepleomorphic bacillus as Klebsiellagranulomatis. Maria Carmela L.Domocmat, RN, MSN
  45. 45. About half of infected men and women have sores in the anal area. Small, beefy-red bumps appear on the genitals or around the anus. The skin gradually wears away, and the bumps turn into raised, beefy-red, velvety nodules called granulation tissue. usually painless, but they bleed easily if injured. without lymphadenopathy S/Shttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001660/ Maria Carmela L.Domocmat, RN, MSN
  46. 46. Maria Carmela L.Domocmat, RN, MSN
  47. 47. The disease slowly spreads and destroys genital tissue. Tissue damage may spread to the area where the legs meet the torso. This area is called the inguinal folds. The genitals and the skin around them lose skin color. In its early stages, it may be hard to tell the difference between donovanosis and chancroid In the later stages, donovanosis may look like advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amebiasis S/Shttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001660/ Maria Carmela L.Domocmat, RN, MSN
  48. 48. causative organism - difficult to culture, diagnosis requires visualization of dark- staining Donovan bodies on tissue crush preparation or biopsy Culture of tissue sample (hard to do and not routinely available) Scrapings or punch biopsy of lesion Microscopic identification of Donovan’s bodies from edge scraping of lesionsDx Maria Carmela L.Domocmat, RN, MSN
  49. 49. sexual contact; however, it ishypothesized to have low infectiouscapabilities because repeated exposure isnecessary for clinical infection to occur.may also be obtained through the fecalrouteor by passage through an infected birthcanal.MOT Maria Carmela L.Domocmat, RN, MSN
  50. 50. Donovanosisor granuloma inguinale Maria Carmela L.Domocmat, RN, MSN
  51. 51. Antibiotics are used to treat donovanosis. To cure the condition requires long-term treatment. Most treatment courses run 3 weeks or until the sores have completely healed. A follow-up examination is important because the disease can reappear after it seems to be cured.Treatment Maria Carmela L.Domocmat, RN, MSN
  52. 52. Doxycycline 100 mg orally BID for at least 3 weeks and until all lesions have completely healedRecommended Regimen Maria Carmela L.Domocmat, RN, MSN
  53. 53. Azithromycin 1 g orally once per week for at least 3 weeks and until all lesions have completely healedOR Ciprofloxacin 750 mg orally BID for at least 3 weeks and until all lesions have completely healedOR Erythromycin base 500 mg orally four times a day for at least 3 weeks and until all lesions have completely healedOR Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally twice a day for at least 3 weeks and until all lesions have completely healed The addition of an aminoglycoside (e.g., gentamicin 1 mg/kg IV every 8 hours) to these regimens can be considered if improvement is not evident within the first few days of therapy.Alternative Regimens Maria Carmela L.Domocmat, RN, MSN
  54. 54. Genital damage and scarring Loss of skin color in genital area Permanent genital swelling due to scarringComplications Maria Carmela L.Domocmat, RN, MSN
  55. 55. Treat partners within 60 days before dx.Health educ Maria Carmela L.Domocmat, RN, MSN
  56. 56. LYMPHOGRANULOMAVENERUEM (LGV)
  57. 57. AKA: lymphopahia venerea tropical bubo, climatic bubo, strumous bubo, poradenitis inguinales, Durand-Nicolas- Favre disease, lymphogranuloma inguinaleLymphogranuloma venereum Maria Carmela L.Domocmat, RN, MSN
  58. 58. is a chronic (long-term) infection of the lymphatic system caused by three different types of the bacterium Chlamydia trachomatis. serovars L1, L2, or L3 not caused by the same bacteria that cause genital chlamydia more common in men than women. The main risk factor is being HIV-positive.Causes, incidence, and risk factors Maria Carmela L.Domocmat, RN, MSN
  59. 59. 3 to 30 daysIncubation period Maria Carmela L.Domocmat, RN, MSN
  60. 60. Tender, enlarged, inflamed inguinal and/or femoral lymphadenopathy -typically unilateral. Both sides – “groove sign” Can drain, ulcerate and scar Or recede self-limited genital ulcer or papule sometimes occurs at the site of inoculation. However, by the time patients seek care, the lesions have often disappeared. Marked external genital deformitySymptoms Maria Carmela L.Domocmat, RN, MSN
  61. 61. Maria Carmela L.Domocmat, RN, MSN
  62. 62. Rectal exposure in women or MSM can result in proctocolitis, including mucoid and/or hemorrhagic rectal discharge, anal pain, constipation, fever, and/or tenesmus (painful bowel movements)Symptoms Maria Carmela L.Domocmat, RN, MSN
  63. 63. Diagnosis is based on clinical suspicion, epidemiologic information, and the exclusion of other etiologies for proctocolitis, inguinal lymphadenopathy, or genital or rectal ulcers. C. trachomatis testing also should be conducted, if available. 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. Chlamydia serologyDx tests Maria Carmela L.Domocmat, RN, MSN
  64. 64. Treatment cures infection and prevents ongoing tissue damage, although tissue reaction to the infection can result in scarring. Buboes aspiration through intact skin or incision and drainage to prevent the formation of inguinal/femoral ulcerations. Doxycycline is the preferred treatmentTreatment Maria Carmela L.Domocmat, RN, MSN
  65. 65. Recommended Regimen Doxycycline 100 mg orally twice a day for 21 days Alternative Regimen Erythromycin , 500 mg orally 4x/day for 21 days Although clinical data are lacking, Azithromycin 1 g orally once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.Treatment Maria Carmela L.Domocmat, RN, MSN
  66. 66. Management of Sex Partners Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined, tested for urethral or cervical chlamydial infection, and treated with a chlamydia regimen (azithromycin 1 gm orally single dose or doxycycline 100 mg orally twice a day for 7 days).Treatment Maria Carmela L.Domocmat, RN, MSN
  67. 67. Pregnancy Pregnant and lactating women should be treated with erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.Special Considerations Maria Carmela L.Domocmat, RN, MSN
  68. 68. HIV Infection Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.Special Considerations Maria Carmela L.Domocmat, RN, MSN
  69. 69. Abnormal connections between the rectum and vagina Brain inflammation (very rare) Infections in the joints, eyes, heart, or liver Long-term inflammation and swelling of the genitals Scarring and narrowing of the rectum Complications can occur many years after you are first infected.Complications Maria Carmela L.Domocmat, RN, MSN
  70. 70. LGV is an invasive, systemic infection If not treated early LGV proctocolitis can lead to chronic, colorectal fistulas and strictures. Genital and colorectal LGV lesions can also develop secondary bacterial infection or can be coinfected with other sexually and nonsexually transmitted pathogens.Complications Maria Carmela L.Domocmat, RN, MSN
  71. 71. Maria Carmela L.Domocmat, RN, MSN
  72. 72. SYPHILIS
  73. 73. Treponema pallidum bacterium.Secondary syphilis is the most contagious of allthe stages, and is characterized by a systemicspread of the Maria Carmela L.Domocmat, RN, MSN
  74. 74. Stages Maria Carmela L.Domocmat, RN, MSN
  75. 75. Genital chancre Chancre – an oval ulcer with a raised firm border that does not bleed readily and is painless unless infected Develop at site of inoculation (i.e., genitalia, anus, mouth) Occurs abt 4 wks after initial infection If untreated – heals spontaneously in 4 to 6 wks Leave thin, atrophic scarPrimary syphilis Maria Carmela L.Domocmat, RN, MSN
  76. 76. Syphilitic Ulcer Maria Carmela L.Domocmat, RN, MSN
  77. 77. Lymphadenopathy near the chancre Nodes – painless, firm, discrete Maria Carmela L.Domocmat, RN, MSN
  78. 78. Develops when primary is untreated 6 to 8 wks after infection Generalized rash – maculopapular and nonpruritic rash Usually on palm, sole Infectious Generalized nontender, discrete Lymphadenopathy Mucous patches Gray, superficial patches on mucous membranes in mouthSecondary syphilis Maria Carmela L.Domocmat, RN, MSN
  79. 79. Secondary Syphilis: includes multiplelesions located on the penis and scrotum. The secondary maculopapular rash usually causes no itching, and can appear as the chancre, or chancres found during the primary stage of syphilis are healing, or several weeks after the chancres have Maria Carmela L.Domocmat, RN, MSN healed.
  80. 80. syphilis can causepainless ulcers(know as chancres)to appear on thepenis, or at theplace where thesyphilis bacteriaentered thebody.(Credit: MRein/CDC)Syphilis chancre Maria Carmela L.Domocmat, RN, MSN
  81. 81. can cause painless ulcers (known as chancres) to appear on the vagina, or at the place where the syphilis bacteria entered the body.(Credit: CDC)Syphilis Maria Carmela L.Domocmat, RN, MSN
  82. 82. Condylomata lata Broad-based flat papules Develop in warm, moist body areas (i.e., labia, anus corners of mouth) Highly contagious General flu-like manifestations Patchy hair loss from eyebrows and scalp (alopecia) Usually disappear after 2 to 6 wksSecondary syphilis Maria Carmela L.Domocmat, RN, MSN
  83. 83. Condylomata lata Maria Carmela L.Domocmat, RN, MSN
  84. 84. Maria Carmela L.Domocmat, RN, MSN
  85. 85. Maria Carmela L.Domocmat, RN, MSN
  86. 86. Maria Carmela L.Domocmat, RN, MSN
  87. 87. secondary stage syphilis caninclude flat, warty-lookinggrowths on the vulva andaround the anus.(Credit: CDC) Maria Carmela L.Domocmat, RN, MSN
  88. 88. Maria Carmela L.Domocmat, RN, MSN
  89. 89. Client is seroreactive but shows no evidence of disease non infectious except transplacental spread or BT Not sexually transmitted this time Occurs 1 to 2 yrs after primary lesion, can last as long as 50 yrs More than half remain at this stageLatent syphilis Maria Carmela L.Domocmat, RN, MSN
  90. 90. Occurs 1 to 35 yrs after primary infection Devastating, irreversible complications Chronic bone and joint inflammation Cardiovascular problems (e.g., aneurysms, valvular involvement) Granulomatous lesions (gummas) on any part of the body Ophthalmic, auditory, CNS problems Noninfectious Terminal if untreatedTertiary Maria Carmela L.Domocmat, RN, MSN
  91. 91. Tertiary neurosyphilis presents with symptoms of meningitis or with focal deficits consistent with stroke. The mnemonic device "PARESIS" is an aid to recall the following types of symptoms: Personality Affect Reflexes (e.g., hyperactive) Eye (e.g., Argyll Robertson pupils) Sensorium (e.g., illusions, delusions, hallucinations) Intellect (e.g., decreased recent memory, orientation, judgment, insight) Speech abnormalitiesTertiary Maria Carmela L.Domocmat, RN, MSN
  92. 92. gummas observed in tertiarysyphilis Maria Carmela L.Domocmat, RN, MSN
  93. 93. oral, anal, or vaginal sex, or via intimatetouching or kissing.Mothers can pass it to their babies bytouching syphilis sores (chancres) andthen touching the baby.MOT Maria Carmela L.Domocmat, RN, MSN
  94. 94. One week to three monthsIncubation Period Maria Carmela L.Domocmat, RN, MSN
  95. 95. Dark-filed microscopy (DFA) Lesions scraped and causative organism identified Serologic tests Indirect test that detect antibodies Venereal disease research laboratory (VDRL) Rapid plasma reagin (RPR) Fluorescent treponemal antibody absorptions (FTA-ABS) test Treponema pallidum particle agglutination (TP- PA)Dx tests Maria Carmela L.Domocmat, RN, MSN
  96. 96. Dark-filed microscopy (DFA) Lesions scraped and causative organism identifiedDiagnostic tests Maria Carmela L.Domocmat, RN, MSN
  97. 97. T. pallidum cannot be Advantages of viewed by normal darkfield microscopy: light microscopy. Definitive immediate Darkfield microscopy diagnosis (useful in primary and secondary can identify T. disease). pallidum with its Rapid results. spiral shape, 10-14 coils, corkscrew motion, and a total length of 6-20 micrometers.Darkfield microscopy Maria Carmela L.Domocmat, RN, MSN
  98. 98. An experienced microscopist and specialized equipment (often not available outside of a specialized clinic) are required. Confusion with other pathogenic or nonpathogenic spirochetes may occur. Generally not recommended on oral lesions because of specificity problem with nonpathogenic spirochetes in the oral cavity. It must be performed immediately because motility is important to identification. The sensitivity of darkfield microscopy decreases as the lesion heals. Possibility of false-negatives increases with use of topical substances such as soap and water, antibiotic ointments, etc.Disadvantages of darkfieldmicroscopy: Maria Carmela L.Domocmat, RN, MSN
  99. 99. Serologic tests Indirect test that detect antibodies Note: antibodies are not present in serum until 4 wks after the appearance of chancreDiagnostic tests Maria Carmela L.Domocmat, RN, MSN
  100. 100. Venereal disease research laboratory (VDRL) Rapid plasma reagin (RPR) Uses antigen to detect the antibody relatively specific for Treponema pallidumDiagnostic tests: Serologic tests Maria Carmela L.Domocmat, RN, MSN
  101. 101. Fluorescent treponemal antibody absorptions (FTA-ABS) test Treponema pallidum particle agglutination (TP-PA)Diagnostic tests: Serologic tests Maria Carmela L.Domocmat, RN, MSN
  102. 102. Direct fluorescent antibody - T. pallidum (DFA-TP) identifies T. pallidum on direct lesion smear by immunofluorescence using polyclonal antiserum or monoclonal antibody.Direct fluorescent antibody Maria Carmela L.Domocmat, RN, MSN
  103. 103. Maria Carmela L.Domocmat, RN, MSN
  104. 104. Primary, secondary, Primary, secondary tertiary syphilis syphilis Benzathine Abstain from penicillin G 2.4 sexual contact at mU, IM, one dose least 1 month Doxycycline or after treatment tetracycline 100 mg, PO, 2-3 times a day for 14 days.Treatment Maria Carmela L.Domocmat, RN, MSN
  105. 105. Latent syphilis Three weekly penicillin injections Neurosyphilis – IV aqueous crystalline penicillin GTreatment: Maria Carmela L.Domocmat, RN, MSN
  106. 106. AdultsPrimary, secondary, and early latentsyphilis without neurologic involvement:Benzathine penicillin G, IM, 2.4 millionunits in a single dose If penicillin allergic (one of thefollowing): Doxycycline 100 mg orally twicedaily for 2 weeks Tetracycline 500 mg orally 4 timesdaily for 2 weeks Maria Carmela L.Domocmat, RN, MSN
  107. 107. AdultsLate latent or latent syphilis of unknownduration without neurologic involvement:•Benzathine penicillin G 7.2 million unitstotal, administered as 3 doses of 2.4million units IM each at 1-week intervalsIf penicillin allergic (one of the following): Doxycycline 100 mg orally twicedaily for 28 days Tetracycline 500 mg orally 4 timesdaily for 28 days Maria Carmela L.Domocmat, RN, MSN
  108. 108. AdultsTertiary (late) syphilis without neurologicinvolvement:Benzathine penicillin G 7.2 million units total,administered as three doses of 2.4 million units IMeach at 1-week intervals If penicillin allergic: Treat according to treatment for late latentsyphilis.Neurosyphilis:Aqueous crystalline penicillin G 18-24 million unitsper day, administered as 3-4 million units IV every 4hours or continuous infusion for 10-14 days IV Maria Carmela L.Domocmat, RN, MSN
  109. 109. Alternative regimen (if compliance can be ensured): Procaine penicillin 2.4 million units IM once daily PLUSProbenecid 500 mg orally 4 times a day, both for 10-14 days Maria Carmela L.Domocmat, RN, MSN
  110. 110. is a self-limited reaction to anti- treponemal therapy. characterized by fever, malaise, nausea, and vomiting. may be associated with chills and exacerbation of secondary rash. This reaction occurs within 24 hours after therapy and usually resolves within 24 hours.Jarisch-Jarisch-Herxheimer Reaction Maria Carmela L.Domocmat, RN, MSN
  111. 111. Patients should be warned that it is not an allergic reaction to penicillin and that it can be treated with symptomatic support. It occurs more frequently after treatment with penicillin and treatment of early syphilis, especially at the secondary stage. Pregnant women should be informed that treatment for syphilis may precipitate early labor and that they should notify an obstetrician if problems develop.Jarisch-Jarisch-Herxheimer Reaction Maria Carmela L.Domocmat, RN, MSN
  112. 112. serious damage to A fetus is at the brain and the particular risk if the nervous system; mother doesnt mental seek treatment; deterioration; the chances for a loss of balance, stillbirth and serious vision, and birth defects, sensation; including blindness, leg pain; and are very high. heart disease.Complications: Untreated syphiliscan lead to Maria Carmela L.Domocmat, RN, MSN
  113. 113. Irreversible blindness Mental illness Paralysis Heart disease deathComplications Maria Carmela L.Domocmat, RN, MSN
  114. 114. caused by transplacental transmission of spirochetes; the transmission rate approaches 100%. Perinatal death may result from congenital infection in more than 40% of affected, untreated pregnancies.Congenital syphilis Maria Carmela L.Domocmat, RN, MSN
  115. 115. Among survivors, manifestations have traditionally been divided into early and late stages. Manifestations are defined as early if they appear in the first 2 years of life and late if they develop after age 2 years.Congenital syphilis Maria Carmela L.Domocmat, RN, MSN
  116. 116. Syphilis in pregnancy can lead to spontaneous abortion, stillbirth, premature delivery, or perinatal death. It can also cause significant morbidity during infancy, childhood, and adolescence. A very strict follow-up of pregnant women before delivery and an active approach to identify and treat exposed neonates born to infected mothers are strongly recommended. A study in Nigeria has demonstrated the usefulness of syphilis screening during pregnancy and recommended that syphilis screening should be continued as part of routine antenatal testingSyphilis in pregnancy Maria Carmela L.Domocmat, RN, MSN
  117. 117. Hutchinsons teeth notched,narrow-edged permanent incisors,sometimes but not always a sign ofcongenital syphilis. Maria Carmela L.Domocmat, RN, MSN
  118. 118. Early manifestations of congenital infection vary and involve multiple organ systems. The most striking lesions affect the mucocutaneous tissues and bones. Mucous patches, rhinitis, and condylomatous lesions are highly characteristic features of mucous membrane involvement in congenital syphilis.Early onset congenital syphilis Maria Carmela L.Domocmat, RN, MSN
  119. 119. Nasal fluid is highly infectious. Snuffles are followed quickly by a diffuse maculopapular desquamative rash that involves extensive sloughing of the epithelium, particularly on the palms and soles and around the mouth and anus. In contrast to acquired syphilis, a vesicular rash and bullae may develop. These lesions are highly infectious. Hepatomegaly is reported in almost 100% of cases, and biochemical evidence of liver dysfunction is usually observed.Early onset congenital syphilis Maria Carmela L.Domocmat, RN, MSN
  120. 120. syphilisScarring from the early systemic disease causes late manifestations of congenital syphilis. Manifestations include neurosyphilis and involvement of the teeth, bones, eyes, and the eighth cranial nerve.Late-Late-onset congenital Maria Carmela L.Domocmat, RN, MSN
  121. 121. http://www.nzma.org.nz/journal/120-1250/2448/content01.jpgCongenital syphilis Maria Carmela L.Domocmat, RN, MSN
  122. 122. HIV infected persons with early stage syphilis should receive a single IM dose of 2.4mu of benzathine penicillin Some specialists suggest that HIV-infected persons with primary or secondary syphilis receive additional treatments (e.g., benzathine penicillin G administered at 1- week intervals for 3 weeks, as recommended for late syphilis). However, the benefit of this approach remain unprovenSyphilis and HIV/Other STDs Maria Carmela L.Domocmat, RN, MSN
  123. 123. All patients who have syphilis should be tested for HIV infection. Persons with primary or secondary syphilis who live in areas with a high prevalence of HIV should be retested for HIV after 3 months if the first HIV test result was negative. Consider screening persons with syphilis for other STDs.Syphilis and HIV/Other STDs Maria Carmela L.Domocmat, RN, MSN
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