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  1. 1. Sexual transmitted infections. Mbilinyi christian Cosmas emiliana
  2. 2. What is a Sexually Transmitted Infection or STI?  STI’s are infections that are spread from person to person through intimate sexual contact.  STI’s are dangerous because they are easily spread and it is hard to tell just by looking who has an STI.  1 in 4 sexually active teens has an STI Common STI  Chlamydia  Gonorrhea  Genital Herpes (HSV-2)  Genital Warts (HPV)  Hepatitis B
  3. 3.  Syphilis  Trichomoniasis
  4. 4.  Gonorrhea  Is caused by Neisseria gonorrhoeae, a Gram-negative diplococcus. Signs and symptoms  The manifestations in males presents more early as compared to female.  In males.; o A purulent discharge associated with dysuria is the first sign of infection. The discharge, which is presumably caused by chemotactic factors such as C5a released when anti gonococcal antibody binds complement, may become more profuse and blood tinged as the infection progresses.
  5. 5. o In female  Women often are asymptomatic. So it takes so long for gonorrhea to be diagnosed in women.  The most common symptom is vaginal discharge. including purulent or mucopurulent endocervical discharge,  Other cervical abnormalities., eg erythema, friability, and edema of the zone of ectopy.  Pelvic inflammatory disease (PID) is a serious complication in 10% to 20% of women with acute gonococcal infection and can lead to infertility and
  6. 6. Treatments; of uncomplicated gono.. Ceftriaxone  Ceftriaxone, a third-generation cephalosporin, is given as a single, small-volume IM injection (e.g., 125 mg diluted with normal saline or 1% lidocaine solution). Ceftriaxone eradicates anal and pharyngeal gonorrhea and is also safe in pregnancy.  Other injectable cephalosporins (notably ceftizoxime, cefoxitin, and cefotaxime) have been found to be safe and highly effective, although efficacy in pharyngeal infections is not as well-established.  Because a high percentage of patients with gonorrhea are also coinfected with C. trachomatis, a single dose of azithromycin or a 7-day course of doxycycline is recommended to be taken concurrently for a presumed infection  Many strains exibit resistance to penicillin, tetracycline , floroquinolones
  7. 7.  All partners who have had sexual exposure to patients with gonorrhea are advised, within 60 days should be treated.  This is especially true when the partner is pregnant because gonorrhea during pregnancy is associated with chorioamnionitis and prematurity, as well as neonatal infection.  Pregnant women can be treated safely with cephalosporins and azithromycin for gonorrhea and Chlamydia. Doxycycline should be avoided during pregnancy
  8. 8. o Anorectal and Pharyngeal Gonorrhea  The most prevalent bacterial STI among the homosexual male population is gonorrhea  pharyngeal and anorectal gonococcal infections are often asymptomatic, a large reservoir of carriers in the homosexual male population may exist. o Symptoms  Rectal gonorrhea produces the syndrome of proctitis with anorectal pain, mucopurulent anorectal discharge, constipation, tenesmus, and anorectal bleeding
  9. 9. treatment  The treatment of choice for patients with anorectal and/or pharyngeal gonorrhea is ceftriaxone 125 mg IM as a single dose.  Azithromycin or doxycycline should be given to those with rectal gonorrhea to treat possible coexisting rectal chlamydial infection.  Patients should be advised to avoid further unprotected sexual activity and should be counseled and tested for infection with HIV.  And an altenative drug like the cephalosporins should be given if a patient do not torelate penicillin.
  10. 10. Complications of Gonorrhea
  11. 11. Pelvic Inflammatory Disease  The term pelvic inflammatory disease (PID) commonly refers to a variety of inflammatory disorders of the upper female reproductive tract.  PID also has been used to connote an infection that occurs acutely when either vaginal or cervical micro-organisms traverse the sterile endometrium and ascend to the fallopian tubes.  Acute salpingitis also may be used to describe an acute infection of the fallopian tubes. Therefore, the terms PID and salpingitis are used interchangeably in this discussion to denote an acute infection involving the fallopian tubes.
  12. 12.  Etiology  Most cases of PID are caused by C. trachomatis and N. gonorrhoeae. Some micro-organisms that comprise the vaginal flora are also associated with PID, including Gardnerella vaginalis, H. influenzae, and Streptococcus agalactiae.  Facultative enteric Gram-negative bacilli and a variety of anaerobic bacteria have also been isolated from the upper genital tract of up to 70% of women with acute PID.  Women diagnosed with acute PID should be tested for C. trachomatis and N. gonorrhoeae and screened for HIV
  13. 13. o Symptoms  abdominal pain often occurs soon after the menstrual period, Vaginal discharge, menorrhagia, dysuria, and dyspareunia o Signs  include cervical motion tenderness, uterine tenderness, or adnexal tenderness white blood cells (WBC) on saline microscopy of vaginal secretions, elevated erythrocyte sedimentation rate, or an elevated C-reactive protein Treatment;
  14. 14. o Disseminated Gonococcal Infection(gonorrhoea bacteremia) Signs and Symptoms  include fever, occasional chills, a mild tenosynovitis of the small joints, and skin lesions o Treatment  Patients with gonococcal arthritis and bacteremia should be hospitalized for treatment with ceftriaxone 1 g IV daily until clinical improvement, such as decreased fever and pain, is sustained for 24 to 48 hours, at which time therapy may be switched to an appropriate oral agent. Symptoms and signs of tenosynovitis should be improved markedly within 48 hours.
  15. 15. o Treatment of gonococcal endocarditis and meningitis. It is rare but life threatening, septic emboli, valve damage of CHF.  Require high-dose IV therapy such as ceftriaxone (1–2 g IV every 12 hours) for 10 days or more in the case of meningitis and for 4 week o Neonatal Disseminated Gonococcal Infection:  Acquired when fetus passes through infected birth canal, leading to acute purulent, conjuctivitis 4 weeks after birth, it can lead to blindness Treatments  Neonatal DGI and meningitis can be treated with either ceftriaxone or cefotaxime for 7 days; however, if meningitis is documented, 10 to 14 days of treatment is required. Ceftriaxone is given at 25 to 50 mg/kg (IV or IM) Q 24 hr and cefotaxime is given
  16. 16. Chlamydia trachomatis  A disease caused by chlamydia trachomatis, a gram negative intracellular bacteria this is the main cause of non gonococcal urethrites in males.  Has 15 serovars. Serovar d-k, are transmitted sexually and are responsible for NGU.(urethritis, epididymis, proctitis, cervicitis and salpingitis.)
  17. 17. o Symptoms,  Males; mucopurulent discharge, after 1-3 weeks of intercourse, dysuria and pruritis.  Females; cervicitis, mild vaginal discharge, salpingitis is a complication. o Treatment  Tetracyclines are the drugs of choice(tetracycline, minocyclines and doxycyclines) 7-21 days., aternatively erythromycin is used(in pregnancy or in allerge).
  18. 18. Lymphogranuloma Venereum  The cause of LGV is usually C. trachomatis serovars L1, L2, or L3, which is different from those serovars responsible for chlamydia urethritis.  Three stages of LGV infection are recognized in heterosexual men.  During stage I, a small genital papule or vesicle appears between 3 and 30 days after exposure. The patient usually is asymptomatic; the ulcer heals rapidly and leaves no scar  Stage II is characterized by acute, painful lymphadenitis with bubo formation (the inguinal syndrome) it often is accompanied by pain and fever, Without treatment, the buboes may rupture, forming numerous sinus tracts that drain chronically
  19. 19.  Late or tertiary manifestations include perirectal abscesses, rectovaginal fistulae (in women), rectal strictures, and genital elephantiasis. Appropriate treatment of stage II LGV usually prevents these late complications.  An acute anorectal syndrome of LGV occurs in homosexual men who acquire the infection through rectal receptive intercourse. In these cases, a primary anal ulcer may be noted with associated inguinal adenopathy
  20. 20. treatment  include the use of doxycycline 100 mg PO BID or erythromycin base 500 mg PO QID for 21 days.Surgical intervention may be needed for later forms of the disease. Azithromycin 1 g weekly for 3 weeks may be effective, but clinical data on its use are lacking.
  21. 21. syphilis  Def; is a chronic systemic infection due to Treponema palidum. The microorganism penetrate the epithelium and spread via the lymphatic system.  Symptoms; after sexual intercourse a primary chancre develops. This is a small macule becoming a papule that breaks down into ulcer. The ulcer is painless and does not bleed on trauma.  Stages of syphilis.;  Primary stage: it is the most infectious stage, even the superficial lesions are infectious. The chancre heals after 6-8 weeks, leaving no scar,
  22. 22.  Secondary stage; this stage is manifest by a widespread maculopapular skin rash that involves the palms, soles, trunks and extremities and the mucous membrane. In adition the patient has fatigue, malaise,headache, fever, weight loss and general lymphadenopath. Untreated lesions heals in 4-12 weeks,, this is the latent stage of syphilis, the early latent is infective, bt late latent is non infective.  Tertiary stage, this is the late stage, it involves every organ., the skeletal system, cardiovascular, cns . Though it is a non infective stage, it is a very destructive stage.
  23. 23. Treatment.  Penicillin G is the drug of choice for the treatment for all stages of syphilis
  24. 24. Neurosyphilis  Neurosyphilis can present at any stage of syphilis.  neurosyphilis may be asymptomatic or accompanied by a variety of manifestations; the most common syndromes are meningovascular syphilis, general paresis, tabes dorsalis (locomotor ataxia), and optic atrophy Treatment  recommends treatment of neurosyphilis with aqueous penicillin G, 3 to 4 MU IV every 4 hours, or 18 to 24 MU/d continuous infusion, for 10 to 14 days
  25. 25. Congenial syphilis  Acquired by transplacental infection of the fetus. Occasionally a child is born with syphilitic penphigus, bulbous eruption, often 2-3 weeks after birth the skin lesion erupts. The child has severe dehydration, malnutrition, long bone destruction. 20 yrs later CNS may be involved, leading to deafness, blindness, or juvenile paresis and finally death.  Treatment;  Procaine penicillin G. 1.2 mu for 10 days, tetracycline 500mg, or you can give, erythromycin, cephalothin, cephaloridine.., i n pregnancy, inorder to cure fetal spirochaetemia, ppf daily 0.6 mu for 7 days is the
  26. 26. Jarisch-Herxheimer Reaction  Is a benign, self-limited complication of antitreponemal antibiotic therapy that develops in a high proportion of patients within a few hours after treatment of secondary syphilis and less often after primary.  The cause of JHR is not well understood, but is probably related to release of cytokines.  Clinical manifestations include fever, chills, myalgias, headache, tachycardia, and hypotension  Usually self-limiting in non-pregnant patients, the primary risk of this reaction in pregnant women is miscarriage, premature labor, or fetal distress. Pregnant women should seek medical attention if contractions or a change in fetal movements are noted.  Antibiotic treatment should not be discontinued.