Sexually transmittedSexually transmitted
The term sexually transmitted diseaseThe term sexually transmitted disease
applies to infection which specificallyapplies to infection which specifically
transmitted by sexual contact.transmitted by sexual contact.
- The causative organism is theThe causative organism is the
spirochaete bacterium treponemaspirochaete bacterium treponema
- Mode of infection other than sexualMode of infection other than sexual
contact is through blood transfusion andcontact is through blood transfusion and
From the pregnant mother to her fetus.From the pregnant mother to her fetus.
Primary syphilis causes a local (usuallyPrimary syphilis causes a local (usually
genital) pain less ulcer (chancre) whichgenital) pain less ulcer (chancre) which
usually heals in 2- to 6 weeks.usually heals in 2- to 6 weeks.
- The inguinal glands are markedlyThe inguinal glands are markedly
enlarged firm, but not tender.enlarged firm, but not tender.
- The incubation period is from 9 to 90 days.The incubation period is from 9 to 90 days.
Secondary or systemic stageSecondary or systemic stage:-:-
- Occurs 6 weeks to 6 months fromOccurs 6 weeks to 6 months from
exposure .exposure .
- Characterized by fever, malaise,Characterized by fever, malaise,
skin rash involving the palms and soles,skin rash involving the palms and soles,
mucosal ulceration (snail track), moist wartmucosal ulceration (snail track), moist wart
in the genital and anal area calledin the genital and anal area called
condylomata lata and generalizedcondylomata lata and generalized
Tertiary syphilis:-Tertiary syphilis:-
- May affect the nervous or cardio vascular- May affect the nervous or cardio vascular
system with progressive destructivesystem with progressive destructive
lesions or gumata.lesions or gumata.
- Is by dark examination under microscopy- Is by dark examination under microscopy
to see the spirochaetes in exudate takento see the spirochaetes in exudate taken
from the chancre or by serological testsfrom the chancre or by serological testswww.doctor.sdwww.doctor.sd
Which are positive two weeks afterWhich are positive two weeks after
the VDRL measures antibodies tothe VDRL measures antibodies to
treponemal cardiolipin and it is non specifictreponemal cardiolipin and it is non specific
to syphilis.to syphilis.
The definitive diagnosis is by fluorescentThe definitive diagnosis is by fluorescent
treponemal antibody absorption test (FTA-treponemal antibody absorption test (FTA-
ABS) and the treponema pallidumABS) and the treponema pallidum
immoblization test (TPI).immoblization test (TPI).
Is with procaine penicillin 600.000 unit I.MIs with procaine penicillin 600.000 unit I.M
daily for (10) days.daily for (10) days.
Benzathin penicillin 2.4 million unit I.M.Benzathin penicillin 2.4 million unit I.M.
Erythromycin, Cephalosporin andErythromycin, Cephalosporin and
Tetracycline are an alternative.Tetracycline are an alternative.
- Is caused by the intracellular gram-Is caused by the intracellular gram-
negative diplococcus neisserianegative diplococcus neisseria
- It is a world wide problem.It is a world wide problem.
- It is highly infective, primarly affect, theIt is highly infective, primarly affect, the
urethra endocervix, bartholin gland andurethra endocervix, bartholin gland and
rectum and commonly ascends to producerectum and commonly ascends to produce
acute pelvic inflammatory disease it mayacute pelvic inflammatory disease it may
also cause monarticular arthritis andalso cause monarticular arthritis andwww.doctor.sdwww.doctor.sd
Aphthalmia neonatorum.Aphthalmia neonatorum.
In the female symptoms are often mild orIn the female symptoms are often mild or
absent the classical history is urethritis andabsent the classical history is urethritis and
vaginal discharge.vaginal discharge.
The incubation period is about two weeksThe incubation period is about two weeks
- Is by culture of urethral, endocervical and- Is by culture of urethral, endocervical and
rectal swabs transported in Stuart'srectal swabs transported in Stuart's
enriched medium and incubated in aenriched medium and incubated in a
carbon dioxide rich environment.carbon dioxide rich environment.
- The majority of strains are sensitive toThe majority of strains are sensitive to
Penicillin –resistant strains respond toPenicillin –resistant strains respond to
Cephalosprins and Gentamicin.Cephalosprins and Gentamicin.
3) Chamydia:-3) Chamydia:-
Chlamydia trachomatis is an obligateChlamydia trachomatis is an obligate
intracellular organism containing both DNAintracellular organism containing both DNA
and RNA and therefore havingand RNA and therefore having
characteristic of both bacteria and viruses.characteristic of both bacteria and viruses.
Urogenital infection is caused by subtypesUrogenital infection is caused by subtypes
L1,L2, L3.L1,L2, L3.
Infection cause little in the way of symptomsInfection cause little in the way of symptoms
Discharge from vagina and cervix, mild pelvicDischarge from vagina and cervix, mild pelvic
discomfort or dysuria.discomfort or dysuria.
Infection include trachoma, conjunctivitis,Infection include trachoma, conjunctivitis,
non gonococcal urethritis, non specificnon gonococcal urethritis, non specific
cervicitis granuloma venereum and probablycervicitis granuloma venereum and probably
- Chalamydia detection in the laporatory hasChalamydia detection in the laporatory has
been notoriously difficult.been notoriously difficult.
- Tissue culture demonstrate, the intracellularTissue culture demonstrate, the intracellular
organism which is the most reliable methodorganism which is the most reliable method
- Giemsa stain for urethral, cervical or other- Giemsa stain for urethral, cervical or other
discharge shows multinucleated cells withdischarge shows multinucleated cells with
intracytoplasmic inclusion bodies.intracytoplasmic inclusion bodies.
- Antichamydial antibodies can be detected by- Antichamydial antibodies can be detected by
the enzyme linked immunosorbent assaythe enzyme linked immunosorbent assay
Treatment :-Treatment :-
-drug of choice is Doxycycline alternative are-drug of choice is Doxycycline alternative are
Tetracycline or Erythromycin 500mg 1x4x14Tetracycline or Erythromycin 500mg 1x4x14
(4)(4) Lymphogranuloma venerum:-Lymphogranuloma venerum:-
- Caused by chlamydia trachomatis sub typeCaused by chlamydia trachomatis sub type
L1,L2,L3 .L1,L2,L3 .
- Incubation period is about 7 to 14 days.Incubation period is about 7 to 14 days.
- The infection starts with small vulval papuleThe infection starts with small vulval papule
which breaks down to form painless ulcer.which breaks down to form painless ulcer.
- The infection spread by lymphatics toThe infection spread by lymphatics to
involve the whole vulva and perineal area,involve the whole vulva and perineal area,
the inguinal glands are enlarged and maythe inguinal glands are enlarged and may
form abscesses. There is much sepsisform abscesses. There is much sepsis
leading to scarring and fibrosis, someleading to scarring and fibrosis, some
Fistula and lymphatic blockage leads toFistula and lymphatic blockage leads to
elephantiasis of the vulva.elephantiasis of the vulva.
- Like chlomydia- Like chlomydia
Treatment :-Treatment :-
- Tetracycline or Erythromycin 500 mgTetracycline or Erythromycin 500 mg
1x4x21 days.1x4x21 days.
5)Genital Herpes:-5)Genital Herpes:-
- The DNA virus herpes simplex has twoThe DNA virus herpes simplex has two
main subtypes 1 and 2 both of which maymain subtypes 1 and 2 both of which may
infect the genital tract the majority of casesinfect the genital tract the majority of cases
being HSV2being HSV2
The primary attack causes tingling andThe primary attack causes tingling and
burning sensations in the infected areaburning sensations in the infected area
followed by the appearance of smallfollowed by the appearance of small
vesicles on the cervix, vagina orvesicles on the cervix, vagina or
surrounding skin, which break down intosurrounding skin, which break down into
multiple small painful ulcers which slowlymultiple small painful ulcers which slowly
resolves (10 days) and the virus migratesresolves (10 days) and the virus migrates
via sensory nerve to the sacral gangliavia sensory nerve to the sacral ganglia
where it remains quiescent until reactivationwhere it remains quiescent until reactivation
occur. Inguinal and sometimes femoraloccur. Inguinal and sometimes femoral
lymph nodes are enlarged and tenderlymph nodes are enlarged and tender
Recurrent attacks are generally milderRecurrent attacks are generally milder
Complications are rare and includeComplications are rare and include
Meningitis proctitis and pharyngitis .Meningitis proctitis and pharyngitis .
- Usually clinical aided by isolation of virus in- Usually clinical aided by isolation of virus in
tissue culture.tissue culture.
Treatment :-Treatment :-
i with acycloviri with acyclovir
o One tablet 200mg “5” times daily for(5)One tablet 200mg “5” times daily for(5)
o Local cream in mild and recurrent infection.Local cream in mild and recurrent infection.
o 5 mg/kg body weigh “8” hourly for 5days5 mg/kg body weigh “8” hourly for 5days
intravenously in severe infection.intravenously in severe infection.
6)6) Genital warts (condylomataGenital warts (condylomata
- Are cause by a small DNA virus, the humanAre cause by a small DNA virus, the human
papilloma virus of which there are manypapilloma virus of which there are many
subtypes. Type 6.11 and 18 are commonlysubtypes. Type 6.11 and 18 are commonly
associated with genital warts.associated with genital warts.
- The condylomata may be exophytic softThe condylomata may be exophytic soft
fleshy projection usually present in clustersfleshy projection usually present in clusters
and rarely single or endophytic or flat.and rarely single or endophytic or flat.
- Warts may regress spontaneously or mayWarts may regress spontaneously or may
enlarge significantly commonly inenlarge significantly commonly in
- there is association between warts andthere is association between warts and
Cervical and vulval cancer.Cervical and vulval cancer.
- Is by clinical grounds or by histological- Is by clinical grounds or by histological
examination of biopsy.examination of biopsy.
- Is by podophyllin a local cytotoxic agent- Is by podophyllin a local cytotoxic agent
which can be applied to the affected areawhich can be applied to the affected area
“contraindicated in pregnancy ”or by local“contraindicated in pregnancy ”or by local
ablation with laser, cryocautary orablation with laser, cryocautary or
7)Granuloma venrum:-7)Granuloma venrum:-
caused by gram negative bacilli whichcaused by gram negative bacilli which
appears as intracellular bodies calledappears as intracellular bodies called
Donovan bodies.Donovan bodies.
• The lesion starts as a red papule whichThe lesion starts as a red papule which
develop into a beefy red ulcerated mass ofdevelop into a beefy red ulcerated mass of
granulation tissue- inguinal glands enlargegranulation tissue- inguinal glands enlarge
but donot suppurate .but donot suppurate .
Diagnosis :-Diagnosis :-
• By showing Donovan bodies in sampleBy showing Donovan bodies in sample
taken from the edge of the ulcer.taken from the edge of the ulcer.
• Tetracycline or Erythromyin 500mg”6”Tetracycline or Erythromyin 500mg”6”
hourly for 21 dayshourly for 21 days
8)8) Chancroid (soft sore):-Chancroid (soft sore):-
• A genital ulcer accompanied byA genital ulcer accompanied by
suppurative lymphadenopathy.suppurative lymphadenopathy.
• Incubation period 2-7 days.Incubation period 2-7 days.
• The ulcers are usually multiple and painful.The ulcers are usually multiple and painful.
• The causative organism is a gram-The causative organism is a gram-
negative bacillus haemophililus ducreyi.negative bacillus haemophililus ducreyi.
• By demonstration of the organism in theBy demonstration of the organism in the
discharge obtained from the ulcer or lymphdischarge obtained from the ulcer or lymph
node stained by gram stain ornode stained by gram stain or
immunoflurosent stain .immunoflurosent stain .
- Sulfamethoxazole 1 mg “4” times daily forSulfamethoxazole 1 mg “4” times daily for
21 days.21 days.
9) Trichomonas vaginitis:-9) Trichomonas vaginitis:-
• Flagellate protozoan with flour anteriorFlagellate protozoan with flour anterior
flagella, undulating membrane and a longflagella, undulating membrane and a long
tail. It is ovoid or pear shape slightly largertail. It is ovoid or pear shape slightly larger
than a leucocyte.than a leucocyte.
• Causes 1/3 of all cases of vulvo. Vaginitis.Causes 1/3 of all cases of vulvo. Vaginitis.
• The main presentation is vaginal discharge,The main presentation is vaginal discharge,
pain and soreness of the vulva and itchingpain and soreness of the vulva and itchingwww.doctor.sdwww.doctor.sd
The discharge is classically profuse,The discharge is classically profuse,
greenish, frothy malodorous (fishy).greenish, frothy malodorous (fishy).
The vaginal wall may shows smallThe vaginal wall may shows small
strawberry spots.strawberry spots.
The presence of the organism isThe presence of the organism is
conformed by simple microscopy 1 drop ofconformed by simple microscopy 1 drop of
Discharge + 1 drop of Saline.Discharge + 1 drop of Saline.
- With metronidazole (200mg three times- With metronidazole (200mg three times
daily for “7”day, or a single dose of 2gm)fordaily for “7”day, or a single dose of 2gm)for
both partners.both partners.
10) Gardnerella vaginalis:-10) Gardnerella vaginalis:-
Is a gram negative facultative anaerobicIs a gram negative facultative anaerobic
Cause a frothy, grey, malodorous dischargeCause a frothy, grey, malodorous discharge
the odour increase if the smear is treatedthe odour increase if the smear is treated
with 10% koh.with 10% koh.
epithelial cells with bacilli attached to theepithelial cells with bacilli attached to the
surface (clue cells) are characteristic.surface (clue cells) are characteristic.
- By Metronidazole- By Metronidazole
11) Acquired immuno deficiency syndrome:-11) Acquired immuno deficiency syndrome:-
Caused by human immuno-deficiency virusCaused by human immuno-deficiency virus
(HIV) which is a retro virus(HIV) which is a retro virus
Mode of infectionMode of infection
- Both homosexual and hetrosexualBoth homosexual and hetrosexual
- Blood and blood product, transfusionBlood and blood product, transfusion
- Vertical transmission from mother to herVertical transmission from mother to her
baby in utero or during delivery or duringbaby in utero or during delivery or during
lactation (breast milk).lactation (breast milk).
HIV attack the cells which hasHIV attack the cells which has
surface specific receptors known as CD4, thesurface specific receptors known as CD4, the
chief target cells for this virus are T4 helperchief target cells for this virus are T4 helper
lymphocytes. Their depletion leads tolymphocytes. Their depletion leads to
profound effect on cellular immunity. Theprofound effect on cellular immunity. The
virus also attack macrophage andvirus also attack macrophage and
The virus makes a DNA copy of the RNAThe virus makes a DNA copy of the RNA
genome( proviral ) which integrates in hostgenome( proviral ) which integrates in host
cell DNA.cell DNA.
Some patient have symptoms of acuteSome patient have symptoms of acute
infection (fever, malaise, myalgia,infection (fever, malaise, myalgia,
lymphadenopathy, pharyngitis, rash) otherlymphadenopathy, pharyngitis, rash) other
do not.do not.
Chronic infection is largely asymptomatic,Chronic infection is largely asymptomatic,
but intermittent constitutional symptomsbut intermittent constitutional symptoms
may occur (fever, night sweats, diarrhoea,may occur (fever, night sweats, diarrhoea,
weight loss). During this period the patient isweight loss). During this period the patient is
After a latency of 2 to 5 yrs 6-30% of chronicAfter a latency of 2 to 5 yrs 6-30% of chronic
HIV infected patient progress to AIDS.HIV infected patient progress to AIDS.
AIDS patient present with:-AIDS patient present with:-
- tumours( Kaposi sarcoma, non Hodgkin’stumours( Kaposi sarcoma, non Hodgkin’s
lymphoma, mouth and ano rectal squamouslymphoma, mouth and ano rectal squamous
- Opportunistic infection with viruses.Opportunistic infection with viruses.
bacteria, fungi and protozoa (pneumocystisbacteria, fungi and protozoa (pneumocystis
diagnosis :-diagnosis :-
- elisa if positive, it should be repeated to- elisa if positive, it should be repeated to
decrease the false positive reaction whichdecrease the false positive reaction which
is about 4:1.is about 4:1.
- Western blot test must be done forWestern blot test must be done for
confirmation .confirmation .
- the onset of Aids my be delayed and thethe onset of Aids my be delayed and the
severity reduced by combination of antiseverity reduced by combination of anti
retroviral treatment (zidovudine indinavir)retroviral treatment (zidovudine indinavir)
but there is no cure.but there is no cure.
- surveillance, health education, screening- surveillance, health education, screening
and counseling are important.and counseling are important.