Sexualy transmitted

1. Prepared by Abdireshid (RN, BSC, MPH)
Sexually Transmitted Infections

2. Brainstorming (10 Minutes)
What is the STI?
How can STI be transmited ?
What is the clinical presentation of STI?
Complications of STI
Prevention and treatment of STI

3. STI
 The name of this group of diseases was changed from “venereal
diseases” to “sexually transmitted diseases” or “STDs”
 And now “sexually transmitted infections or “STIs.”
 STI – Infections acquired through sexual intercourse (may be
symptomatic or asymptomatic)
 STD – Symptomatic disease acquired through sexual intercourse
 STI is most commonly used because it applies to both symptomatic
and asymptomatic infections

4. Definition
 Sexually transmitted infection is Acquired through sexual
contact with an infected person
 Infection of the genitals and reproductive organs (as well as
body tissues)

5. STIs are a Significant Problem
5
The consequences of untreated STIs
 Ectopic pregnancy (7-10 times increased risk
in women with history of PID)
 Increased risk of cervical cancer
 Chronic abdominal pain (18% of females
with a history of PID)

6. STIs are a Significant Problem cont...
6
 Infertility:
 20-40% of males with untreated Chlamydia and
gonorrhea
 55-85% of females with untreated PID
 (8-20% of females with untreated gonorrhea develop
PID)
Increased risk of HBV and HIV/AIDS
transmission

7. STIs are a Significant Problem cont...
7
Infants can:
Be infected at birth with blinding , eye
infections and pneumonia (chlamydia, genital
herpes and gonorrhea)
 Suffer central nervous system damage or die
(syphilis or genital herpes) as a result of STIs

8. STIs - classification
BACTERIAL
VIRAL
PROTOZOAL
FUNGAL
ECTOPARASITES

9. Bacterial STIs
Chlamydia
gonorrhea
 Syphilis
 Chlamydia
• Bacteria - Chlamydia trachomatis
 Transmission: mainly through penile vaginal intercourse. It
is also possible for a pregnant mother to transmit it to her
baby during vaginal delivery.

10.  Most common STI
 Females outnumber males 6 to 1
 Cervix is site of infection
 Most women are asymptomatic until the pain and
fever from PID occur
 If symptomatic - discharge, painful urination, lower
abdominal pain, bleeding, fever and nausea
 Complications include; cervicitis, infertility, chronic
pain, salpingitis, ectopic pregnancies, stillbirths,
reactive arthritis.

11. Effect of Chlamydia
1. On Pregnancy :
PID-
 Postpartum or post
abortion endometritis
and salpingitis
 Preterm delivery
 PROM
 Stillbirth
 Ectopic pregnancy
 Infertility and pain
2. On Neonatal :
 Acquires infection from
mother
 Infections to the
mucous membranes of
the eye, oropharynx,
 urogenital tract and
rectum
 LBW
Ophthalmia neonatorum
Pneumonia
Conjunctivitis

12. Chlamydia
Diagnostic Methods
1. Direct fluorescent antibody
2. Enzyme immunoassay
3. Nucleic acid hybridization (DNA probe)
4. Cell culture
5. DNA amplification

13. Recommended Treatment
 Doxycycline 100 mg orally 2 times a day for 7 days or
 Azithromycin (Zithromax) 1 g orally
 Azithromycin and doxycycline are equally effective
 abstain from sexual intercourse for 7 days
 sex partners must be evaluated and treated

14. Gonorrhea
 Etiologic agent: Neisseria gonorrhea
 Mucus membranes affected include: cervix, anus,
throat, eyes
 Bacteria neisseria gonorrhea organism attacks cervix
as first site of infection
S/Sx:
 mucopurulent vaginal discharge
 burning urination, and
 severe menstrual or abdominal cramps
 10 to 40 percent women develop PID

15. Effects of gonorrhoea
1.Pregnancy
 Chorioamnionitis
 Intrauterine growth
restriction (IUGR)
 Pelvic abscess or
Bartholin’s abscess
 PID
 Postpartum sepsis
 Preterm delivery
 PROM
 Spontaneous septic
abortion
2. Neonate
 Acquires infection from
mother
 Ophthalmia
neonatorum-blindness
 bacterial sepsis
 nasopharyngeal,
vaginal, anal, ear
throat and mouth
infection; may enter
the bloodstream &
invade joints, heart,
liver, CNS

16. Consequences:
 Female :- PID with infertility; ectopic pregnancy,
severe pelvic pain; infant conjunctivitis.
 Male:- prostate abscesses with fever, difficult
urination; gonococcal epididymitis with ? sterility
Diagnosis:
 Gram stain
 Gram negative intracellular diplococci
 Tissue Culture
 DNA probe

17. Treatment
 Ceftriaxone (Rocephin) 125 mg IM or
Cefixime 400 mg orally or
 Ciprofloxacin (Cipro) 500 mg orally or
Ofloxacin (Floxin) 400 mg orally
Plus: (for chlamydia)
 Doxycycline 100 mg 2 times a day for 7 days or
azithromycin 1 g orally

18. Treatment
In newborns:
Eye ointment:
Erythromycin
Silver Nitrate
Infants of untreated mother:
Ceftriaxone

19. SYPHILIS
 Caused by bacteria treponema pallidum
 Spreads throughout the body within hours of infection
 Transmitted primarily through sexual intercourse, but also
from infected mother to fetus
 Appearance of red or brown painless sore on mouth, fingers,
reproductive organs in primary syphilis (CHANCERS)
 Appearance of rash on palms, soles, looks like eczema,
psoriasis, measles or sunburn and flu like symptoms in
secondary syphilis

20. Primary syphilis Vs secondary syphilis
 Home taking reading assignment

21. Latent Syphilis
In this stage, you can still infect a sexual partner.
begins when secondary syphilis symptoms end.
This stage can start from 2 years to over 30 years
after the primary infection.
In early latent syphilis, you may not have syphilis
symptoms, but the infection remains in your body.

22. Tertiary Syphilis
In this stage of syphilis, the bacteria can damage
almost any part of the body, but most commonly
affects the:-
Heart ,Eyes ,Brain ,Nervous system , Bone,
Liver ,Joints
This damage can happen years or even decades
after the primary stage of syphilis.

23. Congenital syphils
 Ultrasound
findings
Hepatomegaly
Polyhydramnios
Placentomegaly
Ascites

24. Pregnancy
complications:
 Preterm labor
 Spontaneous abortion
 Stillbirth
any stage of maternal
syphilis may result in
fetal infection
Neonatal
complications:
 Acquires infection from
mother
 Blindness
 Bone and tooth
abnormalities
 Brain damage
 Hearing loss
 Death

25. Syphilis
Diagnostic Methods
 Clinical appearance
 Dark-field microscopy
 Rapid plasma regain
 VDRL
 Treponemal test

26. Recommended Treatment
Primary and secondary syphilis and early latent syphilis (<1 year
duration):
benzathine penicillin G 2.4 million units IM in a single dose.
Late latent syphilis or latent syphilis of unknown duration and late
syphilis
Benzathine penicillin G 7.2 million units total, as 3 doses of 2.4
million units IM, at 1-week intervals.
Neurosyphilis:
Aqueous penicillin G, 18-24 million units a day, as 3-4 million
units IV q4h for 10-14 days.

27. Viral STIs
 Herpes simplex
 Genital Warts (HPV)
 Hepatitis B virus
 HIV ( AIDS virus)

28. HERPES
Etiologic agent:-Herpes Simplex Virus
Contagious viral infection that spreads from direct
skin to skin contact particularly in the oral and
genital areas.
HSV1:Nongenital herpetic infection
 In form of cold sores, fever blisters, primarily
around the mouth and it affects around 80 % of all
adults
HSV2: Genital herpetic infection
Recurrent, incurable viral disease

29. HERPES cont...
 Primary infection is indicated by no prior
antibodies to HSV-1 or HSV-2
incubationperiod:3-6 days followed by a papular
eruption with itching or tingling which becomes
painful and vesicular, with multiple vulvar and
perineallesions .

30.  Nonprimary: first episode defines newly acquired
HSV-2 infection with preexisting HSV-1 cross-
reacting antibodies
fewer lesions, systemic manifestations, less pain, and
briefer duration of lesions and viral shedding
Recurrent infection is reactivation of prior HSV-1 or
HSV-2 infection in the presence of antibodies to the
same type of HSV
viral particles reside in nerve ganglia during latency
period.
lesions generally are fewer in number, less tender,
shed virus for shorter periods (2 - 5 days)

31. HSV1, HSV2

32. HSV 2
 Symptoms vary from one individual to another
 Active phase may include itching, burning, swelling,
and flu like symptoms
 Appearance of small painful blisters on genitals
rupture, crust over and heal
 Virus travels down nerve to ganglia near spine &
remains dormant until another outbreak and virus
travels up nerve to skin
 Control efforts for HSV 2 are difficult because 75%
are unaware they are infected

33. HSV 2 cont...
 There is no cure for HSV2, the drug acyclovir is prescribed for
minimizing the discomfort
 Sexual activity should be avoided when sores are active
 Antiviral drugs neither eradicate latent virus nor affect the risk,
frequency or severity of recurrences
complication
 Pregnancy complications:
 Cesarean delivery
 Neonatal complications:
 Acquires infection from mother
 Juvenile laryngeal papillomata (JLP)

34. Recommended Treatment
First clinical episode:
 Acyclovir 400 mg orally 5 times a day for 7-10 days, or
famciclovir 250 mg orally 3 times a day for 7-10 days, or
valacyclovir 1 g orally 2 times a day for 7-10 days.
Recurrent episodes:
acyclovir 400 mg orally 3 times a day for 5 days, or 800
mg orally 2 times a day for 5 days or famciclovir 125 mg
orally 2 times a day for 5 days.

35. HUMAN PAPILLOMA VIRUS
 HPV refers to a group of over 70 different types of
viruses 1/3 of which cause genital problems
 Most reproductive-aged women become infected
within a few years of becoming sexually active,
although most infections are asymptomatic and
transient.
 High-risk HPV types 16 and 18

36. HUMAN PAPILLOMA VIRUS cont...
Mucocutaneous external genital warts are usually
caused by HPV types 6 and 11 .
Genital warts or condyloma are usually spread by
direct contact on vaginal and/or anal areas.
Warts remain undetected when located inside
vagina, cervix or anus.

37. Female HPV

38. HUMAN PAPILLOMA VIRUS cont...
 Warts can be small to large, raised to flat, or single to clustered
 There is no cure for HPV although lesions can be removed
 Methods include: cryotherapy, chemicals, and laser therapy.
 HPV is associated with cervical cancer or cervical dysplasia
 Early detection reduces mortality
 Also linked to cancers of the oral cavity.

39. External Genital Warts
 For unknown reasons, genital warts frequently
increase in number and size during pregnancy.
 may sometimes grow to fill the vagina or cover the
perineum, thus making vaginal delivery or
episiotomy difficult

40. TREATMENT
Treatment in pregnancy:
 there could be an incomplete response to treatment
 lesions commonly improve or regress rapidly
following delivery so eradication of warts during
pregnancy is not always necessary.
 The goal is minimizing treatment toxicity to the
mother and fetus.

41. Management
Patient may apply podofilox 0.5% solution or gel 2 times a
day for 3 days, followed by 4 days of no therapy, for a total
of up to 4 cycles, or imiquimod 5% cream at bedtime 3
times a week for up to 16 weeks. Treatment area should be
washed with mild soap and water 6- 10 hours after
application
or podophyllin resin 10-25% in compound tincture of
benzoin in small amounts to each wart, repeat weekly if
necessary;
; or surgical removal.
 Vaginal warts:
cryotherapy with liquid nitrogen, or TCA 80-90%, or
podophyllin 10-25%

42. HEPATITIS B VIRUS
 Transmission is similar to HIV and HBV is more
easily transmitted than HIV
 Nearly 95 % of persons with HBV recover
 Vaccination for HBV recommended especially for
health personnel
 Hepatitis B virus is present in all body fluids
 Perinatal transmission accounts for 35-50% of
hepatitis B carriers
 70-90% of infants born to positive women will be
chronically infected
 it can be passed to the baby through the placenta
during pregnancy childbirth, as well as through breast
milk.

43.  Infants of all Hepatitis B s Ag positive patients
should receive:
 Immune globulin (HBIG)
 Vaccination for Hep B
 Vertical transmission rates are very low with
immunoprophylaxis.

44.  Severe HBV includes jaundice and may result in
prolonged illness or death
 Neonatal complications:
 Acquires infection from mother
 Life-long carrier
 Liver disease and liver cancer
 Pregnant women at risk for HBV infection during
pregnancy should be vaccinated.

45. Vaginal infection
 Vaginitis is an inflammation of the vagina caused by
infections.
- Bacterial Vaginosis, Trichomoniasis, & Vaginal Yeast
Infections are the three most common types of
Vaginitis.

46. Bacterail vaginosis
 Not an infection
 maldistribution of normal vaginal flora.
 Numbers of lactobacilli are decreased
 caused by Gardnella vaginalis
 Often no s/s…but some times it associated with:
vulvular vaginal irritation
 Greyish-white-foul smelling discharge

47. Treatment
 Metronidazole, 500 mg twice daily orally for 7
days.
 Alternatives are 0.75-percent metronidazole gel,
250-mg applicator-dose intravaginally three times
daily for 7 days
 2-percent clindamycin cream, one applicator dose
inserted intravaginally at bedtime for 7 days

48. Trichomoniasis
 Trichomonas: may be transmitted through
nonsexual contact too
( a “fomite: ex. Toilet seat)
 Commonly seen vaginal infection as well as a STI
 Caused by Trichomonas vaginalis

49.  Asymptomatic for years
 Large amount of frothy foul smelling creamy to
green color discharge
 Redness, swelling, itching, burning of the genital
area
 Painful intercourse and dysuria, and prostatitis in
men

50. TREATMENT
 Metronidazole orally in a single 2-g dose

51. Candidiasis
 Fungal or yeast infection
 Normal habitat is mouth, throat, large
intestines and vagina
 Propagates in areas that is moist and warm
 Mucous membrane and tissue folds
 Candida albican also found in patients
currently on antibiotic therapy (develop a
secondary infection)
 < bacteria -altering natural protective organisms,
normal flora is off balance!

52. Signs and Symptoms
 Vaginal discharge that causes itching and possible
irritation
 Discharge appears watery, thick, tenacious and may
contain white cheese-like particles
 Burning sensation on urination
 Symptoms > severe prior to menstruation
 less responsive to treatment during pregnancy

53. Diagnostic Test
 Microscopic identification of spores and hypae on
a glass slide prepared from a discharge specimen
and potassium hydroxide
Management
 Nystatin
 Ketoconazole
 Clotrimazole
 Fluconazole
 Itraconazole
 Gresofluvin