10 pregnancy with sexual transmitted disease

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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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  • Many sexually transmitted diseases can be acquired by transplacental spread, by passage through the birth canal, and via lactation during the neonatal period. The organisms involved are peculiarly adapted to growth in the genital tract, and are present in body secrections or blood.
  • 通过 性接触 而直接传染给对方; 通过 间接传染 而侵入人体; 有些性传播病还可以在 妊娠和分娩过程 中传染给胎儿或新生儿。 The route of transmission includes 3 mains modes, Sexual contact: as we mentioned just now 2) Indirect contact: touch the secrections, blood or clothes of patients or carriers. 3) STD be acquired by mother-infant route-----by transplacental spread during pregnancy, by passage through the birth canal during delivery, and via lactation during the neonatal period.
  • Physicians have a critical role in preventing as well as treating STDs. The clinician’s role is fourfold. 1) To understand the microbiology of STDs in order to appropriately diagnose and treat patients. 2) To alleviate the symptoms and prevent future sequelae 3) To prevent the transmission to others including health care profesionals. 4) To do all of the above combined with patient education and conselling. Prevention through lifestyle and behavioral modification is the primary weapon against the spread of sexually transmitted diseases. Many studies have shown the effective protection of condoms. Preexposure vaccinations appears to be the trend is future therapy.
  • The rates of syphilis in women are the highest since 1940s. Syphilis is caused by Treponema Pallidum, transmitted by direct contact with an infectious moist lesion. Treponema pass through intact mucous membranes or abraded skin.
  • The transmission of syphilis is mainly by sexual contact . The untreated patients have the strongest infectivity in the 1st year of infection. Usually after 4 years of infection, the patients are no longer infectious. Direct contact the patients, such as touch the skin or mucosa, kissing, shaking hand, or indirect contact the clothes, knife and fork, are also infectious. Contact the blood of patients, or transfusion of contaminated blood, lead to hematogenous spread . 性接触传染 - 约 90% 以上梅毒患者是由性接触而传染。 - 未经治疗的患者在感染后 一年内 最具传染性。 - 感染后 4 年 通过性接触,一般己无传染性。 非性接触传染 - 直接接触 梅毒患者皮肤粘膜而受到传染。 - 如普通的接吻、握手、妇科检查、哺乳等。 间接接触传染 - 接触带有梅毒螺旋体的内衣、被褥、毛巾、剃刀、餐具、烟嘴、医疗器械等而 间接被传染 。 输血感染 - 由于输入有传染性的梅毒病人血液而受到感染。
  • STD be acquired by mother-infant route-----by transplacental spread during pregnancy, by passage through the birth canal during delivery, and via lactation during the neonatal period. The fetus is often infected after 4 month gestation. usually in mothers of early syphilis. The baby can also be infected during delivery when he or she pass through the birth canal. But this is not belong to congenital syphilis. 通过胎盘传染(胎传梅毒) - 感染一般发生在 妊娠 4 个月以后。 - 主要在孕妇早期梅毒时发生,晚期较少。 - 第三代梅毒 :胎传梅毒患者,妊娠时未经过充分 治疗,也可传染给其子女。 - 胎儿分娩时经产道而传染上的梅毒不属胎传梅毒。
  • Depending on the transmission route, syphilis is divided to two categories. 1)Acquired syphilis and 2) congenital syphilis . Depending on the duration of disease, syphilis can be divided to 1)early syphilis , the duration less than 2 years, and 2) late syphilis , also called tertiary syphilis, the duration more than 2 years. Latent syphilis : With resolution of the lesions of primary and secondary infection or the finding of a reactive serologic test without a history of therapy, a patient passes into latency.( 定义: 感染梅毒后经一定的活动期,由于治疗影响或机体抵抗力增强,临床症状暂时消失,但未完全治愈,梅毒血清反应仍为阳性并排除假阳性反应者称为潜伏梅毒 , )With the increase of resistance, or the effect of therapy, the lesions of primary and secondary infection may disappear, but the patient does not completely heal. The serologic test continue to be positive, we called this condition Latent syphilis. 分期: 后天 (获得性)梅毒 1. 早期梅毒 病期在 2 年以内 一期梅毒 硬下疳 二期梅毒 二期早发 二期复发 早期潜伏梅毒 2. 晚期梅毒 (三期梅毒)病期在 2 年以上 晚期良性梅毒(皮肤、粘膜、骨、眼等) 心血管梅毒 神经梅毒 晚期潜伏梅毒
  • 10-90 days after the traponemes enter, a primary lesion may develop.Primary lesions may occur on any mucous membrane or skin area of body. Chancre in external genital organs is the typical clinical finding. The chancre persists for 1-5 weeks, and then heals spontaneously, but may persisti with signs of secondary disease. Although patients of primary syphilis is asymptomatic, they had highest infectivity. 2. Groin lymph nodes may be enlarged, firm and painless 3. Darkfield examination is required for all suspect lesions. 4.Serologic tests for syphilis are usually nonreactive when the chancre first appears, but become reactive 1-4 weeks later. Serologic tests should be done every week for 6 week or until positive. 一期梅毒 ——硬下疳 梅毒螺旋体侵入人体后首先出现的症状是硬下疳,潜伏期为 3w 硬下疳如不治疗, 3w ~ 6w 后可自然消退。硬下疳 3w 左右,梅毒血清反应开始呈阳性。 一期梅毒传染性很强。
  • The chancre is an indurated, firm, painless papule or ulcer with raised borders. 2 weeks to 6 months (6 weeks average)after the primary lesions appears, the generalized cutaneous eruption of secondary syphilis may appear.
  • 10-90 days after the traponemes enter, a primary lesion may develop.Primary lesions may occur on any mucous membrane or skin area of body. Chancre in external genital organs is the typical clinical finding. The chancre persists for 1-5 weeks, and then heals spontaneously, but may persisti with signs of secondary disease. Although patients of primary syphilis is asymptomatic, they had highest infectivity. 2. Groin lymph nodes may be enlarged, firm and painless 3. Darkfield examination is required for all suspect lesions. 4.Serologic tests for syphilis are usually nonreactive when the chancre first appears, but become reactive 1-4 weeks later. Serologic tests should be done every week for 6 week or until positive. 一期梅毒 ——硬下疳 梅毒螺旋体侵入人体后首先出现的症状是硬下疳,潜伏期为 3w 硬下疳如不治疗, 3w ~ 6w 后可自然消退。硬下疳 3w 左右,梅毒血清反应开始呈阳性。 一期梅毒传染性很强。
  • 2 weeks to 6 months (6 weeks average ) after the primary lesions appears, the generalized cutaneous eruption of secondary syphilis may appear. Signs of diffuse systemic infection become evident as the spirochetes spread hematogenously. 1.The characteristic dermatitis appears as diffuse, bilateral, symmetric, papulosquamous lesions that often involve the palms and soles. Lesions may also cover the trunk and be macular, maculopapular, papular, or pustular. The skin lesions heal spontaneously in 2-6 weeks. 2. Moist papules can be seen in the perineal area (condyloma lata). Mucous patches may also been seen. They are darkfield-positive, infectious lesions. 3. Serologic tests are almost always positive during the secondary phase. 4. A “viral syndrome” presentation, often with diffuse lymphadenopathy, is not uncommon. 二期梅毒 感染后 7w ~ 10w 或一期梅毒出现后 6w ~ 8w 皮肤粘膜损害 :梅毒疹 在硬下疳消退后 3~ 4周发生,发疹前常发生低热、头痛、骨痛、神经痛、四肢痠痛等前驱症状 , 约持续 3~5 天 , 待皮疹出现后 , 即行好转
  • 1.The characteristic dermatitis appears as diffuse, bilateral, symmetric, papulosquamous lesions that often involve the palms and soles. Lesions may also cover the trunk and be macular, maculopapular, papular, or pustular.
  • We can the lesions are bilateral, involving the palms and soles.
  • 2 weeks to 6 months (6 weeks average ) after the primary lesions appears, the generalized cutaneous eruption of secondary syphilis may appear. Signs of diffuse systemic infection become evident as the spirochetes spread hematogenously. 1.The characteristic dermatitis appears as diffuse, bilateral, symmetric, papulosquamous lesions that often involve the palms and soles. Lesions may also cover the trunk and be macular, maculopapular, papular, or pustular. The skin lesions heal spontaneously in 2-6 weeks. 2. Moist papules can be seen in the perineal area (condyloma lata). Mucous patches may also been seen. They are darkfield-positive, infectious lesions. 3. Serologic tests are almost always positive during the secondary phase. 4. A “viral syndrome” presentation, often with diffuse lymphadenopathy, is not uncommon. 二期梅毒 感染后 7w ~ 10w 或一期梅毒出现后 6w ~ 8w 皮肤粘膜损害 :梅毒疹 在硬下疳消退后 3~ 4周发生,发疹前常发生低热、头痛、骨痛、神经痛、四肢痠痛等前驱症状 , 约持续 3~5 天 , 待皮疹出现后 , 即行好转
  • In one-third of untreated cases, the destructive lesions of late (tertiary) syphilis may develop. These involve skin or bone (gumma), the cardiovascular system (aortic aneurysm or insuffiency), and the nervous system (meningitis, tabes dorsalis, paresis) The complications of tertiary syphilis are fatal in almost one-fourth of cases, but one-fourth never show any ill effects.
  • skin or bone (gumma), 三期梅毒疹——梅毒性树胶肿 为破坏性最大的一种损害。 部位: 以小腿多见,常单发。 形态: - 初为皮下深在性结节,后破溃并流出粘稠树胶状脓汁,并形成溃疡。 - 溃疡境界清楚,扩大后可形成肾形或马 蹄形。 疤痕: 有。 自觉: 症状轻微。
  • In one-third of untreated cases, the destructive lesions of late (tertiary) syphilis may develop. These involve skin or bone (gumma), the cardiovascular system (aortic aneurysm or insuffiency), and the nervous system (meningitis, tabes dorsalis, paresis) The complications of tertiary syphilis are fatal in almost one-fourth of cases, but one-fourth never show any ill effects.
  • the cardiovascular system (aortic aneurysm or insuffiency), 任何内脏皆可受累。 心血管梅毒 最常见而重要:基本损害为主 A 炎, -> 主 A 瓣闭锁不全、主 A 瘤等。 肝树胶肿 次之, 胃肠、呼吸 系统及 泌尿生殖 系统损害 少见 。
  • In one-third of untreated cases, the destructive lesions of late (tertiary) syphilis may develop. These involve skin or bone (gumma), the cardiovascular system (aortic aneurysm or insuffiency), and the nervous system (meningitis, tabes dorsalis, paresis) The complications of tertiary syphilis are fatal in almost one-fourth of cases, but one-fourth never show any ill effects.
  • The effect of syphilis on pregnancy outcome can be profound. The risk of fetal infection depends on the degree of maternal sprochetemia (greater in the secondary stage than in the primary or latent stages) 2.The gestational age of the fetus. Treponemes may cross the placenta at all stages of pregnancy, but fetal involvement is rare before 18 weeks because of fetal immunoincompetence. After 18 weeks, the fetus is able to mount an immunologic response, and tissue damage may result. The earlier in pregnancy the fetus is exposed, the more severe the fetal infection and the greater the risk of premature delivery or stillbirth. 患一、二期的孕妇传染性最强,梅毒螺旋体可通过胎盘感染胎儿,引起流产、早产、死胎、死产,娩出先天梅毒儿 未经治疗的一、二期梅毒,胎儿感染率几乎 100 % 早期潜伏梅毒胎儿的感染率 80 % 未经治疗的晚期梅毒,胎儿的感染率 30 % 晚期潜伏梅毒胎儿的感染率 10 %
  • 1.Most infants with congenital syphilis are born to women of low socioeconomic status with inadequate or no prenatal care. The neonates may be affected at birth from intrauterine infection , or symptoms may develop weeks or months later. The clinical spectrum of congenital infection in similar to adult secondary disease, since the disease is systemic from onset due to transplacental hematogenous inoculation. 2. Since the antibodies from the mothers are of the IgG class, they freely cross the placenta, giving most neonates a reactive serologic test if the mother’s test was reactive. 3. The newborn may have lymphadenitis and an enlarged liver and spleen. The bones usually reveal signs of osteochondritis and an irregular epiphyseal juncture (Guaaerin’s line) on x-ray. The eyes, central nervous system structures, and other organs may reveal malities at birth, or defects may develop later in untreated cases. Any infant with the stigmata of syphilis should be placed in isolation until a definite diagnosis can be made and treatment administered. 先天(胎传)梅毒 母体内梅毒螺旋体经胎盘使胎儿受到感染 特点 胎传 , 不出现硬下疳 , 自出生后即已进入二期感染阶段 早期病变较后天者重 , 晚期病变较后天轻 心血管系统受侵犯者多见 , 而眼、耳、鼻等感官系统被累及者多见 影响身体发育者多 , 骨骼损害也较多见
  • 临床特点 年龄在 2 岁以下, 往往早产、营养不良、消瘦、烦躁; 皮肤干皱脱水,呈老人面貌; 哭声低弱嘶哑; 严重者可有贫血及发热。
  • The newborn may have lymphadenitis and an enlarged liver and spleen.
  • The clinical spectrum of congenital infection in similar to adult secondary disease, since the disease is systemic from onset due to transplacental hematogenous inoculation
  • 症状与后天者相似,发病率较低; 皮肤损害: 树胶肿多见。结节性梅毒疹少见。 间质性角膜炎: 导致角膜混浊和失明 骨梅毒: 导致军刀状胫、骨树胶肿和 Clutton 关节形成。 神经梅毒: 导致肢体麻痹、神经性耳聋、视神经萎缩、癫痫发作、脊髓痨和麻痹性痴呆。 标记性损害 哈钦森三联征: 哈钦森牙、实质性角膜炎、 神经性耳聋;
  • The bones usually reveal signs of osteochondritis and an irregular epiphyseal juncture (Guaaerin’s line) on x-ray.
  • 1.Most infants with congenital syphilis are born to women of low socioeconomic status with inadequate or no prenatal care. The neonates may be affected at birth from intrauterine infection , or symptoms may develop weeks or months later. The clinical spectrum of congenital infection in similar to adult secondary disease, since the disease is systemic from onset due to transplacental hematogenous inoculation. 2. Since the antibodies from the mothers are of the IgG class, they freely cross the placenta, giving most neonates a reactive serologic test if the mother’s test was reactive. 3. The newborn may have lymphadenitis and an enlarged liver and spleen. The bones usually reveal signs of osteochondritis and an irregular epiphyseal juncture (Guaaerin’s line) on x-ray. The eyes, central nervous system structures, and other organs may reveal malities at birth, or defects may develop later in untreated cases. Any infant with the stigmata of syphilis should be placed in isolation until a definite diagnosis can be made and treatment administered. 先天(胎传)梅毒 母体内梅毒螺旋体经胎盘使胎儿受到感染 特点 胎传 , 不出现硬下疳 , 自出生后即已进入二期感染阶段 早期病变较后天者重 , 晚期病变较后天轻 心血管系统受侵犯者多见 , 而眼、耳、鼻等感官系统被累及者多见 影响身体发育者多 , 骨骼损害也较多见
  • 暗视野检查: 可观察到螺旋体的形态及运动特征。 直接荧光抗体法: 检查皮损疮面血清中的螺旋体。 镀银染色法: 检查皮肤组织中的梅毒螺旋体。
  • 血清学检查 非梅毒螺旋体抗原血清反应( RPR) 梅毒螺旋体抗原血清反应 (TPPA) 诊断程序 一般先用 USR 或 RPR 作筛选试验; 只有在怀疑梅毒时才作进一步确证试验。 若筛选试验结果与病史及体检不符合者,也应进一步作确证试验。
  • 早期梅毒:一期、二期和早期潜伏梅毒 青霉素疗法: 普青 80 万 U / 日, qd ,肌注,连续 10-15 天 苄青 240 万 U ,分两侧臀部肌注, qw ,共 3 次。 青霉素过敏者 四环素(多西环素?): 0.5qid × 15 天 ( 孕妇及肝肾功能不良者禁用 ) , 红霉素: 0.5qid × 15 天(孕妇适用)。
  • 晚期梅毒: 三期梅毒,晚期潜伏梅毒,二期复发梅毒。 青霉素疗法: 普青 80 万 U / 日, qd ,肌注,连续 10-15 天 苄青 240 万 U ,分两侧臀部肌注, qw ,共 3 次。 青霉素过敏者 四环素(多西环素?): 0.5qid × 15 天 ( 孕妇及肝肾功能不良者禁用 ) , 红霉素: 0.5qid × 15 天(孕妇适用)。
  • 先天梅毒: 所有确诊新生儿均需治疗 青霉素疗法: 普青 5 万 U /kg 日, qd ,肌注,连续 10-15 天 苄青 5 万 U /kg ,肌注, 1 次。 青霉素过敏者 红霉素: 7.5-12.5mg/kg 日,分 4 次口服 × 30 天
  • Now, I’d like to use a few minutes to summarize syphilis. Syphilis is a chronic sexually transmitted disease. It is caused by Treponema. It is mainly transmitted by sexual contact. Intrauterine infection is another important transmission route, called vertical transmission. It can be divided to acquired syphilis and congenital syphilis according to the different transmission route. It can be divided to early and late syphilis according to the duration of disease. In the early stage, it usually shows skin and mucosa lesion. But in the late stage, it can involve many organs, and lead to serious complication. In-time diagnosis and treatment is very important. Penicillin is the first-choice.
  • Neisseria gonorrheae is a gram-negative diplococcus. The columnar and transitional epithelium of the genitourinary tract is the principal site of invasion 为淋球菌,又称奈瑟淋球菌: 属革兰氏阴性双球菌; 呈卵圆形或肾形,成对排列; 常存在于多形核白细胞的胞浆内。 对理化因子的抵抗力弱: 但在和脓汁中能保持传染性 10 余小时至数天。 对一般消毒剂很敏感。 淋球菌表面的 菌毛 含有粘附因子,有粘附作用。 淋球菌 内毒素 及淋菌表面外膜产生的 脂多糖 与补体结合能产生一种化学毒素,能引起局部急性炎症,出现充血、水肿、化脓和疼痛
  • Most women with gonorrhea are asymptomatic. When symptoms occur, they are localized to the lower genitourinary tract and include vaginal discharge, urinary frequency or dysuria, and rectal discomfort. The vulva, vagina, cervix and urethra may be inflamed, and may itch or burn. May progress to pelvic infection or disseminated infection
  • The vulva, vagina, cervix and urethra may be inflamed, and may itch or burn. With purulent vaginal discharge
  • Most women with gonorrhea are asymptomatic. When symptoms occur, they are localized to the lower genitourinary tract and include vaginal discharge, urinary frequency or dysuria, and rectal discomfort. The vulva, vagina, cervix and urethra may be inflamed, and may itch or burn. May progress to pelvic infection or disseminated infection
  • Most women with gonorrhea are asymptomatic. When symptoms occur, they are localized to the lower genitourinary tract and include vaginal discharge, urinary frequency or dysuria, and rectal discomfort. The vulva, vagina, cervix and urethra may be inflamed, and may itch or burn. May progress to pelvic infection or disseminated infection
  • 对妊娠影响 妊娠早期淋菌性宫颈炎可导致感染性流产及人流后感染; 妊娠晚期胎膜早破、早产、绒毛膜羊膜炎 产褥感染发生率高,产妇抵抗力低易发生淋病播散 对胎儿的影响 早产和宫内感染,胎儿生长受限,胎儿窘迫,死胎,死产 对婴幼儿影响 新生儿淋菌结膜炎,幼女淋菌性外阴阴道炎
  • 首选药物 头孢曲松钠, 250mg ,单次肌注 头孢噻肟钠, 1g ,单次肌注 不能耐受头孢菌素或喹诺酮类者 大观霉素, 4g ,单次肌注 同时加用 阿奇霉素, 1g ,单次口服 多西环素, 100mg bid×7 天
  • 淋菌盆腔炎,播散性淋病 头孢曲松钠, 1g qd ,肌注,连续 10 天 大观霉素, 2g bid ,肌注,连续 10 天 同时加用 甲硝唑, 400mg bid 口服 ×10 天 多西环素, 100mg bid 口服 ×10 天
  • 妊娠期淋病 头孢曲松钠, 1g ,单次肌注 同时加用红霉素: 0.5qid 口服,连续 7-1 0 天 新生儿处理 娩出后用 1% 硝酸银液滴眼 头孢曲松钠, 25-50mg/kg (≮ 125mg) 肌注或静脉注射,单次给药
  • 定义: 是由人乳头瘤病毒引起的皮肤粘膜良性新生物,又称生殖器疣或性病疣。
  • HPV is repsonsible for condyloma acuminata of the vagina, cervix, vulva, perineum, and perianal areas, as well as cervical cancer. Type 6 and 11 are associated with genital condyloma.
  • HPV is repsonsible for condyloma acuminata of the vagina, cervix, vulva, perineum, and perianal areas, as well as cervical cancer. Type 6 and 11 are associated with genital condyloma.
  • The lesion is usually located in vulva,vagina, or perianal region The typical signs are Exophytic or papillomatous condyloma 好发于外阴及肛门附近的皮肤粘膜 , 呈乳头样或菜花样突起 部位: 男性:龟头、冠状沟、包皮内侧、包皮系带等; 女性:大小阴唇、肛周、宫颈、阴道口等; 同性恋者:肛周及直肠部。 形态: 开始为小而柔软的淡红色疣状丘疹,湿润; 以后增大呈菜花状或鸡冠状, 可融合成大团块; 温度较低而干燥部位的疣常较小,呈扁平疣状。 好发部位为外阴、大小阴唇、阴道、尿道口、宫颈、肛门周围 临床症状常不明显,可有瘙痒、烧灼痛见疣状突起,粉红、暗红或污灰色,表面湿润 妊娠后病灶生长迅速,可以阻塞产道;分娩后缩小或自然消退
  • States of immunosuppression, such as pregnancy,HIV infection, are associated with massive proliferation of condyloma, and are often difficulte to treat . 妊娠合并尖锐湿疣 妊娠期病灶生长迅速,巨大尖锐湿疣可阻塞产道, 病灶组织脆弱,阴道分娩时易大出血 妊娠期有垂直传播风险,宫内感染罕见 幼儿期发生喉乳头瘤可能,由产道感染引起
  • 诊断 临床典型症状 病理学检查见到特征性的挖空细胞 PCR 技术检测到 HPV DNA
  • 妊娠 36 周前孕妇患尖锐湿疣 病灶小且少者可局部用药 病灶大者行物理或手术治疗 同时治疗配偶或性伴侣 妊娠近足月或足月孕妇患尖锐湿疣 病灶局限在外阴,可冷冻手术治疗,仍可经阴道分娩 病灶广泛存在于外阴、阴道和宫颈时,应择期剖宫产结束分娩 分娩后迅速缩小或自然消退
  • 定义: 是获得性免疫缺陷综合征 ( acquired immunodificiency syndrome) 的简称,是由人类免疫缺陷病毒 (HIV) 所引起的一种性传播病。其特点为患者细胞免疫功能特别是 T 辅助细胞 (T H ) 免疫功能缺陷,引起一系列条件性感染或肿瘤,造成患者死亡,死亡率极高。
  • HIV exists in the secretions and blood of infected persons. Both patients and carriers are infectious. It would cause immunodeficiency of T lymphocyte, lead to opportunistic infections and rare carcinoma. HIV 存在于感染者体液中 精液、血液、阴道分泌物,唾液、尿液、泪液、脑脊液、乳汁 艾滋病患者及 HIV 携带者均有传染性 造成 T 淋巴细胞免疫功能缺陷 引起多器官条件性感染或罕见恶性肿瘤 HIV 病毒: 是一种逆转录的 RNA 病毒,它通过逆转录酶,将其 RNA 转录为 DNA 。 对热敏感。 在 56 ℃ 时 30 分钟可被杀死。 对各种消毒剂敏感。 乙醇、漂白粉、 0.2% ~ 0.5% 次氯酸钠、甲醛溶液等有良好的灭活作用
  • Up to now, there is no treatment that can cure AIDS, So prevention is essential to lower the incidencs of AIDS
  • 10 pregnancy with sexual transmitted disease

    1. 1. Pregnancy with Sexually Transmitted Diseases Li Lin Sun Yat-sen Memorial Hospital
    2. 2. Sexually Transmitted Diseases (STDs)
    3. 3. General Considerations <ul><li>A group of transmitted diseases mainly transmitted by sexual behaviors </li></ul><ul><ul><li>sexual intercourse </li></ul></ul><ul><ul><li>close body contact, kissing, </li></ul></ul><ul><ul><li>mouth-breast contact, anal intercourse </li></ul></ul><ul><ul><li>cunnilingus, anilingus, fellatio </li></ul></ul><ul><ul><li>transplacental spread, passage through the birth canal, lactation </li></ul></ul>
    4. 4. Pathogen <ul><li>Bacteria </li></ul><ul><li>Virus </li></ul><ul><li>Spirochete </li></ul><ul><li>Mycoplasma </li></ul><ul><li>Chlamydia </li></ul><ul><li>Fungus </li></ul><ul><li>Protozoon </li></ul><ul><li>Parasite </li></ul>
    5. 5. Route of Transmission <ul><li>Sexual contact </li></ul><ul><li>Direct or Indirect contact </li></ul><ul><li>Hematogenous spread </li></ul><ul><li>Mother-infant transmission </li></ul><ul><ul><li>Vertical transmission </li></ul></ul><ul><ul><li>Intrapartum </li></ul></ul><ul><ul><li>Postpartum </li></ul></ul>
    6. 6. <ul><li>Syphilis </li></ul><ul><li>Gonorrhea </li></ul><ul><li>Condylomata Acuminata </li></ul><ul><li>Acquired Immunodeficiency Syndrome (AIDS) </li></ul>
    7. 7. Syphilis ( 梅 毒 )
    8. 8. Etiology <ul><li>Treponema Pallidum </li></ul>
    9. 9. Route of Transmission (1) <ul><li>Sexual contact (95%) </li></ul><ul><ul><li>strongest infectivity in 1st year for untreated patients </li></ul></ul><ul><ul><li>little infectivity after 4-yr infection </li></ul></ul><ul><li>Direct or indirect contact </li></ul><ul><li>Hematogenous spread </li></ul>
    10. 10. Route of Transmission (2) <ul><li>Vertical transmission </li></ul><ul><ul><li>Congenital syphilis </li></ul></ul><ul><ul><li>30% of fetal death </li></ul></ul><ul><ul><li>Usually after 4-month gestation in early syphilis </li></ul></ul><ul><li>Transmission of birth canal </li></ul>
    11. 11. Type & Stage of syphilis <ul><ul><ul><li>Acquired syphilis </li></ul></ul></ul><ul><ul><ul><ul><li>Early syphilis <2 yr </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Primary syphilis </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Secondary syphilis </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Late (tertiary) syphilis >2 yr </li></ul></ul></ul></ul><ul><ul><ul><li>Congenital syphilis </li></ul></ul></ul><ul><ul><ul><li>Latent syphilis </li></ul></ul></ul>
    12. 12. Clinical Manifestations (1) <ul><li>Primary syphilis </li></ul><ul><ul><li>Painless genital sore ( Chancre ) on labia, vulva, vagina, cervix, anus, lips, nipples </li></ul></ul><ul><ul><li>Painless, rubbery, regional lymphadenopathy followed by generalized lymphadnopathy in 3-6 weeks </li></ul></ul><ul><ul><li>Darkfield microscopic findings </li></ul></ul><ul><ul><li>Positive serologic test in 70% of cases </li></ul></ul>
    13. 13. Chancre
    14. 14. Clinical Manifestations (1) <ul><li>Primary syphilis </li></ul><ul><ul><li>Chancre: painless genital sore on labia, vulva, vagina, cervix, anus, lips, nipples </li></ul></ul><ul><ul><li>Painless, rubbery, regional lymphadenopathy followed by generalized lymphadnopathy in 3-6 weeks </li></ul></ul><ul><ul><li>Darkfield microscopic findings </li></ul></ul><ul><ul><li>Positive serologic test in 70% of cases </li></ul></ul>
    15. 15. Clinical Manifestations (2) <ul><li>Secondary syphilis </li></ul><ul><ul><li>Syphilid: bilateral symmetric extragenital papulosquamous eruption </li></ul></ul><ul><ul><li>Condyloma latum, mucous patches </li></ul></ul><ul><ul><li>Darkfield findings positive in moist lesions </li></ul></ul><ul><ul><li>Positive serologic test for syphilis </li></ul></ul>
    16. 16. Syphilid
    17. 17. Syphilid
    18. 18. Syphilid
    19. 19. Clinical Manifestations (2) <ul><li>Secondary syphilis </li></ul><ul><ul><li>Syphilid: bilateral symmetric extragenital papulosquamous eruption </li></ul></ul><ul><ul><li>Condyloma latum, mucous patches </li></ul></ul><ul><ul><li>Darkfield findings positive in moist lesions </li></ul></ul><ul><ul><li>Positive serologic test for syphilis </li></ul></ul>
    20. 20. Clinical Manifestations (3) <ul><li>Tertiary syphilis (Late syphilis) </li></ul><ul><ul><li>Skin, bone lesion ( gumma ) </li></ul></ul><ul><ul><li>Cardiovascular syphilis ( aortic aneurysm or insuffciency) </li></ul></ul><ul><ul><li>Neurosyphilis (meningitis, tabes dorsalis, paresis) </li></ul></ul><ul><ul><li>Ophthalmic, auditory lesions </li></ul></ul>
    21. 21. Gumma
    22. 22. Clinical Manifestations (3) <ul><li>Tertiary syphilis (Late syphilis) </li></ul><ul><ul><li>Skin, bone lesion ( gumma ) </li></ul></ul><ul><ul><li>Cardiovascular syphilis ( aortic aneurysm or insuffciency) </li></ul></ul><ul><ul><li>Neurosyphilis (meningitis, tabes dorsalis, paresis) </li></ul></ul><ul><ul><li>Ophthalmic, auditory lesions </li></ul></ul>
    23. 23. 主动脉瘤 Aortic aneurysm
    24. 24. Clinical Manifestations (3) <ul><li>Tertiary syphilis (Late syphilis) </li></ul><ul><ul><li>Skin or bone lesion ( gumma ) </li></ul></ul><ul><ul><li>Cardiovascular syphilis ( aortic aneurysm or insuffciency) </li></ul></ul><ul><ul><li>Neurosyphilis (meningitis, tabes dorsalis, paresis) </li></ul></ul><ul><ul><li>Ophthalmic, auditory lesions </li></ul></ul>
    25. 25. Clinical Manifestations (4) <ul><li>Syphilis during pregnancy </li></ul><ul><ul><li>Highest infectivity in secondary syphilis </li></ul></ul><ul><ul><li>Vertical transmission </li></ul></ul><ul><ul><li>Congenital syphilis </li></ul></ul><ul><ul><li>Abortion, premature delivery, fetal death, stillbirth </li></ul></ul>
    26. 26. Clinical Manifestations (5) <ul><li>Congenital syphilis </li></ul><ul><ul><li>History of maternal syphilis </li></ul></ul><ul><ul><li>Stigmata of congenital syphilis </li></ul></ul><ul><ul><ul><li>x-ray changes of bone, hepatosplenomegaly, jaundice, anemia </li></ul></ul></ul><ul><ul><li>Often stillborn or premature </li></ul></ul><ul><ul><li>Positive serologic test </li></ul></ul>
    27. 27. <ul><li>Features </li></ul><ul><ul><li>premature </li></ul></ul><ul><ul><li>dehydrated </li></ul></ul><ul><ul><li>dystrophy </li></ul></ul><ul><ul><li>anemia </li></ul></ul>
    28. 28. Hepatosplenomegaly
    29. 29. Skin lesions
    30. 30. Late congenital syphilis <ul><li>Active damages </li></ul><ul><ul><li>Gumma in the skin and mucosa </li></ul></ul><ul><ul><li>Acute interstitial keratitis </li></ul></ul><ul><ul><li>Periostitis, osteochondritis </li></ul></ul><ul><li>Marker damages </li></ul><ul><ul><li>Hutchinson triad signs </li></ul></ul><ul><ul><li>Saber-shin </li></ul></ul>
    31. 31. Hutchinson triad signs <ul><li>Hutchinson tooth </li></ul><ul><li>Interstitial keratitis </li></ul><ul><li>Nerve deafness </li></ul>
    32. 32. X-ray changes of bone
    33. 33. Clinical Manifestations (5) <ul><li>Congenital syphilis </li></ul><ul><ul><li>History of maternal syphilis </li></ul></ul><ul><ul><li>Stigmata of congenital syphilis </li></ul></ul><ul><ul><ul><li>x-ray changes of bone, hepatosplenomegaly, jaundice, anemia </li></ul></ul></ul><ul><ul><li>Often stillborn or premature </li></ul></ul><ul><ul><li>Positive serologic test </li></ul></ul>
    34. 34. Laboratory Examinations (1) <ul><li>Identification of the pathogen </li></ul><ul><ul><li>Darkfield examination </li></ul></ul><ul><ul><li>Silver staining </li></ul></ul>梅毒螺旋体镀银染色
    35. 35. Laboratory Examinations (2) <ul><li>Serologic tests </li></ul><ul><ul><li>Nontreponemal tests </li></ul></ul><ul><ul><ul><li>Highly sensitive, nonspecific </li></ul></ul></ul><ul><ul><ul><li>Screening, follow-up </li></ul></ul></ul><ul><ul><li>Treponemal antibody tests </li></ul></ul><ul><ul><ul><li>More sensitive and specific </li></ul></ul></ul><ul><ul><ul><li>Remain positive after therapy </li></ul></ul></ul>
    36. 36. Treatment (1) <ul><li>Primary, secondary, early latent syphilis </li></ul><ul><ul><li>Procaine penicillin 0.8 million U/d im, qd× 10-15 d </li></ul></ul><ul><ul><li>Benzathine penicillin 2.4 million U im, qw× 3 </li></ul></ul><ul><ul><li>Doxycycline 0.5 qid× 15 d, orally </li></ul></ul><ul><ul><ul><li>nonpregnant penicillin-allergic patients </li></ul></ul></ul><ul><ul><li>Erythromycin 0.5 qid× 15 d, orally </li></ul></ul><ul><ul><ul><li>pregnant patients </li></ul></ul></ul>Jarish-Herxhermer Reaction
    37. 37. Treatment (2) <ul><li>Late syphilis </li></ul><ul><ul><li>Procaine penicillin 0.8 million U/d im, qd× 20 d </li></ul></ul><ul><ul><li>Benzathine penicillin 2.4 million U im, qw× 3 </li></ul></ul><ul><ul><li>Doxycycline 0.5 g qid× 30 d, orally </li></ul></ul><ul><ul><ul><li>nonpregnant penicillin-allergic patients </li></ul></ul></ul><ul><ul><li>Erythromycin 0.5 g qid× 30 d, orally </li></ul></ul><ul><ul><ul><li>pregnant patients </li></ul></ul></ul>
    38. 38. Treatment (3) <ul><li>Congenital syphilis </li></ul><ul><ul><li>Procaine penicillin 50 hundred U/kg·d im, qd× 10-15 d </li></ul></ul><ul><ul><li>Benzathine penicillin 50 hundred U/kg·d, im × 1 </li></ul></ul><ul><ul><li>Erythromycin 7.5-12.5 mg/kg·d qid× 30 d, orally </li></ul></ul><ul><ul><ul><li>penicillin-allergic patients </li></ul></ul></ul>
    39. 39. Summarization <ul><li>Chronic STD caused by Treponema </li></ul><ul><li>Sexual contact, vertical transmission </li></ul><ul><li>Acquired and Congenital syphiils </li></ul><ul><li>Early and Late syphilis </li></ul><ul><li>Involvement of multiple systems </li></ul><ul><li>Treatment of Penicillin </li></ul>
    40. 40. Gonorrhea ( 淋病 )
    41. 41. Etiology <ul><li>Neisseria gonorrheae </li></ul><ul><ul><li>Epithelium of the genitourinary tract </li></ul></ul>
    42. 42. Clinical Manefestations (1) <ul><li>Adult patients </li></ul><ul><ul><li>Most affected women are asymtomatic carriers </li></ul></ul><ul><ul><li>Purulent vaginal discharge, urinary frequency, dysuria </li></ul></ul><ul><ul><li>complicated gonococcal infections </li></ul></ul><ul><ul><li>disseminated gonococcal infection </li></ul></ul>
    43. 43. Purulent discharge
    44. 44. Clinical Manefestations (1) <ul><li>Adult patients </li></ul><ul><ul><li>Most affected women are asymtomatic carriers </li></ul></ul><ul><ul><li>Purulent vaginal discharge, urinary frequency, dysuria </li></ul></ul><ul><ul><li>complicated gonococcal infections </li></ul></ul><ul><ul><li>disseminated gonococcal infection </li></ul></ul>
    45. 45. Clinical Manifestations (2) <ul><li>Neonates or children </li></ul><ul><ul><li>Gonorrheal conjunctivitis </li></ul></ul><ul><ul><ul><li>Delivery through an infected birth canal </li></ul></ul></ul><ul><ul><li>Vulvovaginitis </li></ul></ul><ul><ul><ul><li>Purulent vaginal discharge, dysuria, urinary frequecy </li></ul></ul></ul>
    46. 46. Gonorrheal conjunctivitis in neonates Vulvovaginitis in Children
    47. 47. Clinical Manifestations (3) <ul><li>Gonorrhea during pregnancy </li></ul><ul><ul><li>Pregnant patients </li></ul></ul><ul><ul><ul><li>Abortion, intrauterine infection, premature delivery, premature rupture of membrane </li></ul></ul></ul><ul><ul><li>fetus </li></ul></ul><ul><ul><ul><li>intrauterine infection, fetal growth restriction, fetal death, stillbirth </li></ul></ul></ul><ul><ul><li>Neonates and children </li></ul></ul><ul><ul><ul><li>Gonorrheal conjunctivitis </li></ul></ul></ul><ul><ul><ul><li>Vulvovaginitis </li></ul></ul></ul>
    48. 48. Laboratory Examinations <ul><li>Stained smear </li></ul><ul><ul><li>cervical or urethral discharge </li></ul></ul><ul><ul><li>Gram-negative diplococci </li></ul></ul><ul><ul><li>Screening, low detection rate in subacute stage </li></ul></ul><ul><li>Gonococcus culture </li></ul><ul><ul><li>Gold standard </li></ul></ul>
    49. 49. Treatment (1) <ul><li>Uncomplicated infection </li></ul><ul><ul><li>Ceftriaxone ( 头孢曲松钠 ) 250mg , im×1 </li></ul></ul><ul><ul><li>Cefotaxime sodium ( 头孢噻肟钠 ) 1g , im×1 </li></ul></ul><ul><ul><li>Spectinomycin ( 大观霉素 ) 4g ,单次肌注 </li></ul></ul><ul><ul><ul><li>Patients cannot take cephalosporins or quinolones </li></ul></ul></ul><ul><li>Plus </li></ul><ul><ul><li>Azithromycin( 阿奇霉素 ) 1g×1 , orally </li></ul></ul><ul><ul><li>Doxycycline( 多西环素 ) 100mg bid×7 , orally </li></ul></ul>
    50. 50. Treatment (2) <ul><li>Pelvic or disseminated infection </li></ul><ul><ul><li>Ceftriaxone ( 头孢曲松钠 ) 1g/d, im×10d </li></ul></ul><ul><ul><li>Spectinomycin ( 大观霉素 ) 2g/d, im×10d </li></ul></ul><ul><ul><ul><li>Patients cannot take cephalosporins or quinolones </li></ul></ul></ul><ul><li>Plus </li></ul><ul><ul><li>Metronidazole ( 甲硝唑 ) 400mg bid×10, orally </li></ul></ul><ul><ul><li>Doxycycline ( 多西环素 ) 100mg bid×10, orally </li></ul></ul>
    51. 51. Treatment (3) <ul><li>Gonorrhea during pregnancy </li></ul><ul><ul><li>Ceftriaxone ( 头孢曲松钠 ) 1g, im×1 </li></ul></ul><ul><ul><li>Plus Erythromycin ( 红霉素 ) 0.5 qid×7-10d, orally </li></ul></ul><ul><li>Neonates and Children </li></ul><ul><ul><li>Ceftriaxone 25-50mg/kg (≮ 125mg), im×1 </li></ul></ul><ul><ul><li>1% Silver Nitrate ( 硝酸银液 ) eye drop </li></ul></ul>
    52. 52. Condyloma acuminatum ( 尖锐湿疣 )
    53. 53. Etiology <ul><li>Human papilloma virus (HPV) </li></ul><ul><ul><li>Type 6, 11 </li></ul></ul>
    54. 54. 哈拉尔德 · 楚尔 · 豪森( Harald zur Hausen ) 弗朗索瓦丝 · 巴尔-西诺西( Françoise Barré-Sinoussi ) 吕克 · 蒙塔尼 ( Luc Montagnier )
    55. 55. Harald zur Hausen 哈拉尔德 · 楚尔 · 豪森 Germany
    56. 56. Human papillomavirus (HPV) <ul><li>Low-risk subtypes </li></ul><ul><ul><li>HPV 6, 11, 40, 42-44, 61 </li></ul></ul><ul><ul><li>Genital tract infection </li></ul></ul><ul><li>High-risk subtypes </li></ul><ul><ul><li>HPV 16, 18, 31, 33, 35, 39, 45, 56, 58 </li></ul></ul><ul><ul><li>Cervical cancer </li></ul></ul>
    57. 57. Etiology <ul><li>Human papilloma virus (HPV) </li></ul><ul><ul><li>Type 6, 11 </li></ul></ul>
    58. 58. Clinical Manifestations <ul><li>Vulva and vagina, perianal region </li></ul><ul><li>Exophytic or papillomatous condyloma </li></ul>
    59. 59. Condyloma during pregnancy <ul><li>Mothers </li></ul><ul><ul><li>Massive proliferation, often difficult to treat </li></ul></ul><ul><ul><li>Obstruction of birth canal </li></ul></ul><ul><li>Infants </li></ul><ul><ul><li>Rare intrauterine infection </li></ul></ul><ul><ul><li>Laryngeal papilloma </li></ul></ul>
    60. 60. Laboratory Examinations <ul><li>Pathology </li></ul><ul><ul><li>Vacuolated cells </li></ul></ul><ul><li>PCR detection </li></ul><ul><ul><li>HPV DNA </li></ul></ul>
    61. 61. Treatment <ul><li>Before 36 –week gestation </li></ul><ul><ul><li>Local application </li></ul></ul><ul><ul><li>Physical therapy, operation </li></ul></ul><ul><ul><li>Treatments of sexual partners </li></ul></ul><ul><li>Perinatal period </li></ul><ul><ul><li>Vaginal delivery (localized foci) </li></ul></ul><ul><ul><li>Cesarean section (diffuse foci) </li></ul></ul>
    62. 62. Acquired immunodificiency syndrome (AIDS)
    63. 63. Etiology <ul><li>Human immunodeficiency virus (HIV) </li></ul>opportunistic
    64. 64. 哈拉尔德 · 楚尔 · 豪森( Harald zur Hausen ) 弗朗索瓦丝 · 巴尔-西诺西( Françoise Barré-Sinoussi ) 吕克 · 蒙塔尼 ( Luc Montagnier )
    65. 65. Human immunodeficiency virus (HIV)
    66. 66. Transmission Routes <ul><li>Sexual contact </li></ul><ul><li>Blood contact </li></ul><ul><li>Mother-infant contact </li></ul><ul><ul><li>Intrauterine infection </li></ul></ul><ul><ul><li>Delivery </li></ul></ul><ul><ul><li>Lactation </li></ul></ul>
    67. 67. Prevention Treatment
    68. 68. Summarization <ul><li>Syphilis </li></ul><ul><li>Gonorrhea </li></ul><ul><li>Condyloma acuminate </li></ul><ul><li>AIDS </li></ul><ul><ul><li>Pathogen, transmission route </li></ul></ul><ul><ul><li>Influence on fetus, neonate, chilidren </li></ul></ul><ul><ul><li>Diagnosis, treatment, prevention </li></ul></ul>
    69. 69. Thank you !

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