2. STD
s
• STDsare diseasesand infections
which are capable of beingspread
from person to personthrough:
– sexual intercourse
–oral-genital contact or innon-sexual
ways.
–IV drugs
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6. NEISSERIA
GONORRHOEAE
• 3rd most common STDi
• It is aG-vediplococci
• Infects the endocervix mucopurulent
cervicitis
• Majority of infections areasymptomatic
• It is aleading causeof PID
• Dx endocervical culture
• Ngonorrhea & chlamydia coexist in 50%of
patients
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9. Effects on
Pregnancy
• Canalso be spread from mother
to child during birth
• Cancausefertility problems, birth
defects, skin problems, arthritis,
blood poisoning, and heart and
brain infections
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15. Syphilis
Symptoms
1/12/2013 15
• Syphilis is amulti-stage disorder:
Primary stage-
painless, infectious chancre
• Several days-few months after infection
• Genitals, mouth, rectum, other areas
• Sometimes there is no chancre
• Ulcer heals; many may think there is noproblem
18. Syphilis
Symptoms
Secondary stage
Infectious rash
• 3-6 weeks following infection
• Hands,soles of feet; other areas
• Feverand flu-like symptoms may also be
apparent
• Rashtypically heals after severalweeks
Condylomata Lata
• Wart-like lesions (on female, male,CDC)
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20. 28
Secondary Syphilis -
Clinical Manifestations
• Representshaematogenous dissemination
of spirochetes
• Usually 2-8 weeks after chancreappears
• Findings:
– rash - whole body (includespalms/soles)
– mucous patches
– Condylomata lata - HIGHLYINFECTIOUS
– constitutional symptoms
• Sn/Sxresolve in 2-10weeks
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Syphilis
Symptoms
• Latent Stage
Infection hides in body, often centralnervous system
Infected person canremain in this stage foryears
There may be no symptoms for alongtime
Diseasebegins to attackorgans
Latent further divided into early, late, or unknown stages
based on when infection occurred
• Late/Tertiary Stage
Severesymptoms develop: paralysis/numbness; blindness;
heart disease;dementia
32. Chlamyd
ia
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FEMALE SYMPTOMS:
Vaginal discharge (white or grey) or burning
with
urination
Lower abdominal
pain
Bleeding between menstrual
periods. Low-grade fever (later
symptom)
MALE SYMPTOMS:
Discharge from the penis and/or burning
when urinating
Burning and itching around the opening of
the penis Pain and swelling in the testicles
Low –grade fever (associated with epididymitis
–
inflammation of the testicles)
38. Herpes Simplex Virus (HSV-2), which
is related to the viruses that belongs to
the samefamily of viruses that cause
chicken pox and shingles
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39. About
Herpes
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• Transmission via vaginal, oral, anal sex
• Transmission of virus canalso occur through fingers
(touching asore, then touching amembrane)
• Transmission of virus possible when no sorespresent
• Transmission to fetus possible, but not typicallyif
herpes wascontracted before pregnancy
If pregnant woman contracts herpes towardend of
pregnancy, transmission to fetus morelikely
If pregnant woman hasactive herpes, Cesareanperformed
• Transmission may occur outside body contact, but no
proof
40. HERPES
GENITALIS
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• It is arecurrent sexually transmitteddisease
• Causedby Herpes simplex virus
HSV-1
HSV-2
10%of genital lesions
90%of genital lesions
• HSV-1& 2 also infect the orofacial skin inreversed %
• Thevirus causesprolonged lifelong infection of the
nerve cells of the affectedarea
1-PRIMARY(FIRST)INFECTION multiple vesicles
which will ulcerate forming shallow superficialulcers
over the externalgenitalia
• There is often simultaneous involvement ofthe
vagina & cx
41. Herpes
Symptoms
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• Most common symptom isblisters
First (primary) outbreak occurswithin
afew weeksof contact
May continue for acouple weeks,
longer for those withcompromised
immune system
May feel painful, itchy,tingle/burn
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HERPES
GENITALIS
• It causessevere pain, itching, vaginal discharge &
painful urination urine retention that may require
catheterization
• Associated with fever, general malaise & headache
• It takes 2-4 weeks toheal
2-SECONDARY(RECURRENT)HERPES
• Theviruses that are already present in the nerve
cells will be reactivated by various stresses suchas
generalized illness, menses,emotional stress or
trauma
• It is lesspainful, circumscribed, not associatedwith
generalized symptoms & lasts an averageof 7days
46. Herpes Simplex 1
& 2
• 45 million peoplein
the United States
ages12 and older
haveherpes
• 1 out of 5 of the
total adolescent and
adult population, are
infected with Herpes
Simplex
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49. HERPES
GENITALIS
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• There may be an association between the Herpes
virus & precancerous & cancerousconditions of
the genital tract . Thevirus hasbeen detected in
in squamous cell carcinoma of the cxvagina &
vulva
• It was not proven to acausative factor for these
cancer
• Transmissionof AIDSvirus is increased in the
presence of genital ulcers causedbyinfections
such asHerpes or Syphilis
50. Herpes Type 2
(HSV-2)
• Causelesions around
and on the genital
areas
• Bumpsform on the
lips and sometimesin
the mouth, tongue,
and throat
• Blisters crust over and
heal within 10-16days
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51. 63
Epidemiology of Genital
Herpes
• Oneof the 3 most common STDs,increased 30%from
late 70sto early90s
• 25%of USpopulation by age35
• HSV-2:80-90%, HSV-1:10-20%(majority of infections
in someregions)
• Most casessubclinical
• Transmission primarily from subclinicalinfection
• Complications: neonatal transmission, enhanced HIV
transmission, psychosocial issues
Sores
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Effects on
Pregnancy
•Type 2 Viral shedding from
cervix, vagina, vulva plays the
primary role in transmittingthe
disease from mother to infant
•About 60%of newbornsinfected
and not treated will die or be
severely damaged
56. HERPES
GENITALIS
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• Dx Viral culture of asuspiciouslesion
Blood test for detection ofantibodies helpful
to
Dxasymptomatic individuals or to confirm apast
infection
• Rx Acyclovir 200mg orally 5 times /day for 10days
duration of ulcerative
lesions Improve the
symptoms
Usedfor 1ry infection
-2ry infection no Rx
-Supportive care keeping the area clean & dry
xylocaine jelly
Applying compresses
Tylenol
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HERPES
GENITALIS
• Patients with recurrence ≥ 6 years prophylactic
Acyclovir 400 mg twice aday
• T
oreduce sexual transmission couples should avoid direct
sexual contact (by abstinence or using condom) when the
infected individual hasalesion or experiencing aprodrome
“tingling, itching, or pain felt before the recurrent lesion
appear”
• 1ry infection in pregnancy close to delivery risk of
transmission to the newborn 50%
• If the mother have active lesions elective C
Sshould be
performed
• Infection to the newborn is devastating disseminated
infection with CNSinvolvement & 50%mortality
58. LYMPHGRANULOMA
VENEREUM
“Adiseaseof Tropical Countries”
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• Causedby Chlamydiatrachomatis, serotype L1,2,3
• Achronic infection of the lymphatictissue
• ♂ : ♀ 5 : 1
• Incubation period 4-21 days
• Involves : Vulva most frequent site
Cx,urethra, rectum
• 3 phasesof the disease
-Primary phase
Shallow , painless ulcer of the vestibule, labia orperirectal
Healswithout Rx
-Secondaryphase
1-4 wk after 1ry
Painful lymphadenopathy in the inguinal or perirectalareas
59. LYMPHGRANULOMA
VENEREUM
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2/3 unilateral adenopathy
½ Systemic symptoms “malaise & fever
• Tertiary phase
-The nodes enlarged, tender , matted together &adherent
to the overlaying skin “bubos”
-7-15 days the bubo rupture spontaneously multiple
draining sinuses& fistulas
-Extensive tissue destruction of the genitalia &anorectal
region elephantiasis, multiple fistulas & stricture
• Treatment
-Doxycycline 100 mg bd for 21 days
60. GRANULOMA INGUINALE
(DONOVANOSIS)
“Adiseaseof Tropical Countries”
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• Causedby G-ve, nonmotile , encapsulated rod
Calymmatobacterium granulomatous
• Transmitted sexually & by close nonsexualcontact
• Incubation period 1-12 wk
• Dx Donovan bodies in specimen taken from theulcers
dark staining bacteria with safety pin appearance
in the cytoplasm of mononuclearcells
• Painlessred ulcer with fresh granulationtissue
• Multiple ulcers of the vulva destroy normal vulvar
architecture scarring & lymphatic obstruction marked
enlargement of thevulva
• Rx Tatracycline 500 mg qid for 3 wk
62. Human
Papillomavi
rus (HPV)
• 20 million people
are currently
infected with HPV
• Very common
amongst sexually
active college
students
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63. Human Papilloma
Virus
.
• NOTCurable!!!
• It causesgrowths of tiny,skin-
colored, cauliflower-like warts to
appear on the penis, vulva,vagina,
and the cervix, in or aroundthe
anus or the throat.
• Spreadby sexual or skin to skin
contact with someone who hasHPV
• Symptoms: Irritation or itchingin
both men and women. HPVis
extremely dangerous for women
because it canlead tocervical
cancer.
• Warts caused by HPVaretreated
with an ointment, lasersurgery,
burning it withacid or freezing it
with liquid nitrogen!
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64. Signs &
Symptoms
• Most common
manifestation of
HPViswarts
• Includes warts on
skin suchas
plantar warts orin
the genital area,
known asgenital
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67. Signs &
Symptoms
• May be associated with
discomfort suchasitching,
burning, or tenderness inthe
genital area
• Most women with HPVdonot
have any symptoms at all
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68. Signs &
Symptoms
• Include fever,
general muscle
aches,swollen
lymph nodes in the
neck, flu-like
symptoms
• Increasedsalivation
and sometimes
bleeding in the
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69. Treatme
nt
• No effective treatment
• Warts may be treated with agents
designed to reduce or removethe
warts, including creams, oral
medications, or surgery
• Theinfection usually goesaway
without treatment, but for high risk
HPV
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71. 71
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HPV and Cervical
Cancer
• Infection is generally indicated by the detectionof
HPVDNA
• HPVinfection is causally associated with cervical
cancer and probably other anogenital squamous
cell cancers(e.g. anal, penile, vulvar,vaginal)
• Over 99% of cervical cancers have HPVDNA
detected within thetumor
• Routine Pap smear screening ensures early
detection (and treatment) of pre-cancerous
lesions
HPV and Cervical Cancer
73. HIV/AID
S
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• HIVis the virus that causesAIDS
• Thedefinition of AIDSrelatesto
CD4+T-cells Count
• Healthy adults usually haveCD4+
T-cell counts of 1,000 ormore
• Aids and some HIVsufferers have
lessthan 200 CD4+T-cells
74. Modes of
Transmission
• blood
• blood products
• sexualfluids
• People canbe
infected and NOT
look sick or even
haveAIDSbut can
still transmit HIV
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75. Signs &
Symptoms
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• rapid weight loss
• dry cough
• recurring fever or profuse nightsweats
• profound and unexplainedfatigue
• swollen lymph glandsdiarrhea
• white spots or unusual blemishes onthe
tongue, in the mouth, or in the throat
76. Effects of
Pregnancy
• 70%transmission
occurs at the time of
delivery 30%amount
occurs antenatally
(before delivery)
• Asignificant
contributor to
transmission is
breastfeeding
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77. TREATMENT IN
PREGNANCY
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• Zidovudine monotherapy vertical
transmission
25% 8%
• Standard triple therapy should beoffered
• Zidovudine should be included in the Rxto prevent
perinatal transmission
• Zidovudine IV intrapartum
to the neonate for the first 6 wk of life
• Elective C
Srecommended if
-Women did not receive antiretroviraltherapy
-Monotherapy
-Detectable viral load >500 RNAcopies/ml
-Viral load determination notdone
-No prenatal care
79. Treatme
nt
• Antiviral drugs drug’s
that boost the
immune system have
allowed many people
with HIVto resist
infections, stay
healthy, and prolong
their lives, but these
medications are not a
cure
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80. STD increases HIV
susceptibility
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• STDcausesinfection and
desquamation of squamousor
columnar cells producing an
inflammatory response
• Results in increased number of
HIVtarget cells (lymphocytes) on
mucous membrane surfaces and
aportal of entry forHIV
STD/HIV Inter-Relationships
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STD increases HIV
transmission
For aperson with HIV,having an
STD:
• Brings inflammatory cellsloaded
with HIVto the genitaltract
• Increases HIVviral shedding from
mucous membranes
82. HEPATI
TIS
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• Hepatitis A, B,and C all can be transmittedsexually
• Hepatitis Bis the most common & itssexual transmission is
the mostefficient
• Hepatitis A& B canbe prevented by vaccination
• Sexualtransmission accounts for 45%of newcases
• Hepatitis Bimmunoglobulin's post exposure prophylaxis
within 14days
• Pregnant mothers with Hepatitis B transmit the infection to
their infants during or afterbirth
Newborn infant should receive Immunoglobulin's+
Vaccination within 12 hrs of birth
83. • Parasitic Infection of the vagina in women and urethra
in men.
• Mostly passedthrough sexualcontact. It is also spread
through damp towels, bathing suits or wash clothes
shared with an infectedperson.
• There are frequently nosymptoms.
– Men: discharge from penis, mild discomfort in penis and swellingin
genitalia.
– Women: green to yellow discharge with bad odor, vaginal itching,painful
urination, inflammation in genitals. Sometimes in lowerabdomen.
• Trichomoniasis canusually be cured with the
prescription drug, metronidazole, given by mouth in a
single dose
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84. TRICHOMONIASIS
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• Causedby aprotozoan Trichomonas vaginalis
• Symptoms diffuse malodorous yellowish green
discharge
vulvar irritation
• Dx microscopy of vaginal secretion sensitivity 60-70%
culture more sensitive
• Rx Metronidazole 2 gm orally single dose
• Husband should be treated & they should avoid intercourse
until they arecured
• VaginalTrichomoniasis hasbeen associated with adverse
pregnancy outcome PROM,preterm delivery & low BWt.
• Metronidazole is safein pregnancy
85. PID(Pelvic Inflammatory
Disease)
• Caused by a
complication of
bacterial vaginosis
and/or
gonorrhea/chlamydia.
• Sexually active women
aged 15- 25 are at highest
risk for developing PID.
• Awoman’sgenitaltract becomes
inflamed and infected
causing swelling, scarring,
fever and pain.
• PID is a major cause
for infertility.
• Symptoms: Abdominal
and pelvic pain, vaginal
bleeding, discharge and
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86. Candidia
sis
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occur on male genitals. It can also appear in the mouth and throat as white
sores.
•Contrary to popular belief, Candidiasis is rarely transmitted by sexual
contact. It is generally passes by
•Everyone has this fungus on and inside their bodies. Most of the time it is
harmless and keeps the bacterial levels in your body in check, but if there is
an overgrowth of this fungus it can lead to a variety of problems
• Some symptoms include:
•In Women: A thick white discharge that looks like cottage cheese,
itching and burning as well as a rash on the outer lips of the vagina.
•In Men: Soreness, itching and redness of the head of the penis,
scrotum and foreskin. (Uncircumcised men are more likely to develop
yeast because it thrives in moist areas)
•
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SCABI
ES
• Scabiesis afairly common infectious diseaseof the skin causedby amite.
Scabiesmites burrow into the skin producing pimple-like irritations or
burrows.
• Scabiesmites are transferred by direct skin-to-skin contact. Indirect
transfer from undergarments or bedclothes canoccur only if these have
been contaminated by infected people immediately beforehand.Scabies
canalso be transmitted during sexualcontact.
• Themost prominent symptom of scabiesis intense itching particularly at
night. Theareasof the skin most affected by scabiesinclude thewebs and
sidesof the fingers, around the wrists, elbows and armpits, waist, thighs,
genitalia, nipples, breasts and lower buttocks.
• Skinlotions are available through aphysician's prescription forthe
treatment of scabies.
91. ECTOPARASITIC
INFESTATION
PEDICULOSIS PUBIS
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• Humansare the only reservoir for pubiclice
• Canbe transmitted by sexual& close
nonsexual contact
• Pruritus is the most commonsymptom
• Rx Washing the area with pediculicide
formulations
Washing the clothes & linens withvery
hot water
94. What STD screening tests
would you order?
1 2 3 4
17%
39% 39%
6%
1. Urine for GCand CTand
syphilis serology
2. Urine for GCand CTand
syphilis and HSV-2
serology
3. Urine and rectal GCand
CTtests, pharyngeal GC,
and syphilis serology
4. Urine, rectal and
pharyngeal GCand CT
,and
syphilis and HSV-2
serology
95. STI
Prevention
• Abstain from sexual
intercourse—
vaginal, oral, or
anal
• Bein a
monogamous
relationship with an
uninfected partner
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96. • Reduce Number of Partners
• Get to know the Person
• Get tested together
• Try celibacy
• Learn about HIV/STDs together
• Talk to your partner about what
you know
• Howmanycanyouthink of…?
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