Clinical immunology is the study of diseases caused by disorders of the immune system (failure, aberrant action, and malignant growth of the cellular elements of the system). It also involves diseases of other systems, where immune reactions play a part in the pathology and clinical features.

1. Presentation 3

2.  In this section you will look at diseases that are
transmitted through sexual contact. Sexually
transmitted diseases can be further divided into
two as follows:
 Sexually transmitted diseases associated with
discharge production
 Sexually transmitted diseases associated with ulcer
formation

3.  Under this category, you will cover the following
sexually transmitted infections:
 Gonorrhoea
 Chlamydia
 Trichomonas vaginalis

4.  Gonorrhoea is a sexual transmitted infection that is
caused by a bacterium Neisseria gonorrhoeae
which is gram negative diplococci. The risk of
getting the infection is higher in women than in
men when they engage in unprotected sexual
contact with an infected person (Todd et al., 2002).

5. The incubation period is two to 10 days. A small
number of people may be asymptomatic or show
no symptoms for a lifetime. About 10% of people
with gonorrhoea are asymptomatic or have sub-
clinical disease (Todd et al., 2002).

6.  In women, the urethra, paraurethral
glands(are glands located on the anterior wall of the
vagina) or ducts, bartholin’s ducts or glands or
endocervical canal may be infected. Lower abdominal
pain, dyspareunia (painful sexual intercourse) and
intramenstral bleeding(is uterine bleeding at irregular
intervals, particularly between the expected menstrual
periods). may be indicative of pelvic inflammatory
disease (Todd et al., 2002).

7.  The following are some of the investigation that can be
used to confirm the diagnosis of gonorrhoea:
 Rapid diagnostic tests can be performed to facilitate
immediate diagnosis and treatment.
 Identification of N. gonorrhoeae from culture taken from an
infected site. Culture offers a readily available, specific,
sensitive and cheap diagnostic test that readily allows
confirmatory identification and antimicrobial susceptibility
testing.

8.  Nucleic acid amplification tests (NAATs) and nucleic
acid hybridis action tests. NAATs are more
sensitive than culture and can also be used as
diagnostic or screening tests on specimens that are
collected using non-invasive procedures such as
urine and vaginal swabs.

9.  The antibiotics used to treat gonorrhoea include first line regiment, second
line regiment and other drugs.
 First line regiment includes the following:
 Norfloxacin 800mg as a single dose.
 Ciprofloxacin 500mg orally in single dose.
 Ofloxicin 400mg orally as a single dose.
 Cefixime or suprax 400mg orally.
 Cefotaxime 250mg by intramuscular injection.
 Ceftriaxone (rocephin) 250mg IM in single dose.
 Enoxacin 400mg orally in single dose(Nordberg, 2005)

10.  Cefixime 400mg as a single dose.
 Cefoxitin 2gm IM as single dose.
 Cefotaxime 2gm IM as a single dose.
 Spectinomycyin 2gm IM in single dose.
 Azithromycin 1mg orally as single dose (Nordberg,
2005)

11.  The following prevention measures go a long way towards
controlling gonorrhoea:
 Education and counselling on safer sexual behaviour among
persons at risk.
 Identification of asymptomatic infected persons and of
symptomatic persons unlikely to seek diagnostic and treatment
services.
 Effective diagnosis and treatment of infected persons.
 Evaluation, treatment and counselling of sex partners of persons
infected with gonorrhoea.

12.  Chlamydia infection is a sexually transmitted
infection (STI) caused by the bacterium Chlamydia
trachomatis. Chlamydiae are small obligate intra-
cellular parasites which were once considered to be
viruses (Murrey et al., 1990).

13.  Trichomoniasis is a sexually transmitted infection
caused by a protozoan parasite called Trichomonas
vaginalis. See the following diagram for an
illustration of the parasite. Trichomonas vaginalis
is a pear-shaped organism with a central nucleus
and four anterior flagella.

15.  The risk factors associated with contracting the
trichomoniasis infection include the following:
 Being sexually active
 Having more than one sex partner or having a
partner with more than one sex partner
 Not using condoms

16.  These symptoms are different in men and women.
The symptoms of trichomoniasis usually appear
within five to 28 days of exposure in women.
 Men often do not have symptoms of trichomoniasis
and usually do not know they are infected. But
when symptoms do occur, they include the
following:

17.  Irritation inside the penis
 Mild discharge
 Slight burning after urination or ejaculation

18.  Greenish-yellow, frothy vaginal discharge with a
strong odour
 Painful urination
 Vaginal itching and irritation
 Discomfort during intercourse
 Lower abdominal pain (rare) (Murrey, 1990).

19.  In females, trichomonas vaginalis may be found in
urine sediment, wet preparations of vaginal
secretions or vaginal scrapings.
 In males, it may be found in urine, wet
preparations of prostatic secretions or following
massage of the prostate gland.

20.  The most effective drug for treatment of
trichomonas is metronidazole. However, if
infection recurs, the patient's sexual partner(s)
must also be treated.
 Alternative regimens include the following:
 Tinidazole 2g orally in a single dose (Murray et al.,
1990)

21.  The following measures are useful in the prevention of
trichomoniasis:
 Use condoms correctly every time you have unprotected sex.
 Limit the number of sex partners, and do not go back and forth
between partners.
 Practice sexual abstinence, or limit sexual contact to one
uninfected partner.
 If you think you are infected, avoid sexual contact and see a
doctor.

22.  Sexual partner(s) should be treated simultaneously.
 Patients should be advised to avoid sexual
intercourse until they and their partner(s) have
completed treatment.
 Give patients clear and accurate written
information.