This presentatin contains the topics syphilis, gonorrhea and noma.

1. BACTERIAL INFECTIONS
 Syphilis
 Gonorrhea
 NOMA
Shasvat raj
( 3rd year)

2. SYPHILIS ( LUES)
 SYPHILIS is a worldwide chronic infection produced by
Treponema pallidum .
 The organism is extremely vulnerable to drying , therefore
the primary modes of transmission are sexual contact or from
mother to featus.
 Although the risk of infection from blood transfusion is
negligible because of serologic testing of donors.
 Humans are the only proven natural host for syphilis.

3. Clinical features
 Types
1. Primary syphilis
2. Secondary sypilis
3. Tertiary syphilis
4. Congenital syphilis

5. Primary syphilis
 It is characterized by the chancre that develops at the site of
inoculation, becoming clinically evident 3 to 90 days after the initial
exposure.
 The majority of chancres are solitary, although multiple lesions may be
seen occasionally.
 The external genitalia and anus are the most common sites, and the
affected area begins as a papular lesion,which develops a central
ulceration.

6.  Oral cavity is the most common extragenital site. Oral lesion are seen
most commonly on the lip, but other sites include the tongue, palate,
gingiva, and tonsils.
 Males – upper lips are more frequently affected
 Females - lower lips
 Oral lesions appears as a painless ,clean based ulceration or rarely as a
vascular proliferation resembling a pyogenic granuloma.
 Reginal lymphadenopathy,vehich may be bilateral, is seen in most
patients.

8. Secondary syphilis
 Appears 4 to 10 weeks after the initial infection.
 Symptoms are painless lymphadenopathy,soar throat, malaise,
headache, weight loss, feaver, musculoskeletal pain.
 The rash also may involve the oral cavity and appear as red,
maculopapular areas.
 About 30 percent of patients have focal areas of intense exocytosis and
spongiosis of the oral mucosa, leading to zones of sensitive whitish
mucosa known as mucous patches.

12.  On ocassion, especially in the presence of a compromise
immune system , secondary syphilis can exibit an explosive
and widespread form known as lues maligna.

13. Tertiary syphilis
 This third stage of syphilis includes the most serious of all complications.
 Characterized by Aneurysm of ascending aorta, left ventricular
hypertrophy, aortic regurgitation and congestive heart failure may occur.
 Involvement of the central nervous system may result in tabes dorsalis,
general paralysis, psychosis, dementia, paresis, and even death.
 Gumma- appears as an inadurated, nodular, or ulcerated lesion thatt
may produce extensive tissue destruction.
 Intraoral lesion usually affect the palate or tongue .

15. Congenital syphilis
 It is described by sir Jonathan Hutchinson and he defined three
diagnostic features, known as Hutchinson’s triad.
1. Hutchinson’s teeth
2. Ocular interstitial keratitis
3. Eight nerve deafness
 Infant’s usually infected in utero by transplacental passage of
Treponema pallidum from infected mother at any time. Infection
may also occur from contact with an infectious lesion during
passage through birth canal .

16.  Untreated infant’s who survive often develop tertiary syphilis with
damage to the bone, teeth, eyes,ears and brain.
 The infection alters the formation of both the anterior (Hutchinson’s
incisors) and posterior dentition (mulberry molars, moon’s
 Interstitial keratitis of the eyes is not present at birth but usually
develops between the age of 5 and 25 years. The affected eye has an
opacified corneal surface, with a resultant loss of vision.

19. Diagnosis
 Aspects of syphilis diagnosis.
1. Clinical history
2. Physical examination
3. Laboratory diagnosis

20. Clinical history
 History of syphilis
 Known contact to an early cases of syphilis
 Typical singns or symptoms of syphilis in the past 12 months
 Most recent serologic test for syphilis

21. Physical examination
 Oral cavity
 Lymph nodes
 Skin
 Palms and soles
 Genitalia and perianal area
 Neurologic examination

22. Laboratory diagnosis
 Identification of Treponema pallidum in lesions
Darkfielf microscopy
Direct flurescent antibody
 Serological tests.
Nontreponemal tests – VDRL , RPR
Treponemal test

23. Treatment
 The treatment of choice is Penicillin.
 The dose and administration schedules vary according to the stage
, neurologic involvement,and immune status.
 For the patient with a true penicillin allergy, doxycycline is second
line therapy , although Tetracycline, erythromycin and ceftriaxone
also have demonstrated antitreponemal activity.

24. GONORRHEA
It is a sexually transmitted disease that is produced by
Neisseria gonorrhoeae.

25. Clinical features
 The infection is spread through sexual contact and most lesions occurs in the
genital areas.
 Indirect infection is rare because the organism is sensitive to drying
and cannot penetrate intact stratified squamous epithelium.
 Incubation period is typically 2 to 5 days.
 Affected areas demonstrate significant purulent discharge, but
approximately 10% of men and up to 80% of women who contract
GONORRHEA are asymptomatic.

26.  In men the most frequent site of infection is the urethra, resulting in purulent
discharge and dysuria.
 In women cervix is the primary site of involvement,and the chief complaints
are increased vaginal discharge, intermenstrual bleeding, genital itching,and
dysuria.
 The organism may ascend to involve the uterus and ovarian tubes, leading to
the most important female complications of gonorrhoeae PELVIC
INFLAMMATORY DISEASE (PID).
 The symptoms of PID include cramps and abnormal bleeding which may be
severe and mild. Long term complecations include leads to ectopic
pregnancies or infertility from tubal obstruction.

27.  Between 0.5% and 3% of untreated patients with gonorrhoeae will have
disseminated gonococcal infections from systemic bacteremia. The most
common signs of dissemination are myalgia, arthralgia, polyarthritis and
dermatitis.
 Most cases of oral GONORRHEA appear to be a result of fellatio,
although oropharyngeal GONORRHEA may result of gonococcal
septicemia, kissing.

28.  Therefore, the majority of oropharyngeal gonorrhoeae cases have been
reported in women or homosexual men.
 The common site of oropharyngeal involvement is the pharynx along
with the tonsils and uvula.
 Pharyngeal gonorrhoeae usually is symptomatic ,a mild to moderate soar
throat may occur and be accompanied by nonspecific, diffuse
oropharyngeal erythema.
 Involved tonsils typically demonstrate edema and erythema ,often with
scattered, small punctate pustules.

29.  Rarely, lesions have been reported in the anterior portion of the oral cavity, with
areas of infection appearing erythematous, pustules , erosive or ulcerated.
 Occassionally, the infection may stimulate NECROTIZING ULCERATIVE
GINGIVITIS.
 During birth , infection of an infant’s eyes can occur from an infected mother
who may be asymptomatic. The infection is called Gonococcal opthalmia
neonatorum and can rapidly cause perforation of the globe of the eyes and
blindness.
 Common signs of infection include significant conjunctivitis and a
mucopurulent discharge from the eye.

31. Diagnosis
 In male with a urethral discharge, a Gram stain of the purulent
material can be used to demonstrate gram negative diplococci
within the neutrophils.
 In women the confirmation of the diagnosis Is recommended by
culture of endocervical swabs.
Other diagnosis method include nucleic acid amplification test (NAATs).
It detects N. Gonorrhoeae specific DNA and RNA sequences.

32. Treatment and prognosis
 The primary therapy include fluoroquinolones such as ciprofloxacin,
levofloxacin, or ofloxacine.
 Oral ciprofloxacin remains first line therapy for most patients, those
at high risk for resistant disease should receive intramuscular
ceftriaxone.
 Prophylactic opthalmic erythromycin, tetracycline, or silver nitrate is
applied to the newborns eyes to prevent the occurance of
gonococcal opthalmia neonatorum.

33. NOMA
 Synonyms:- CANCRUM ORIS, OROFACIAL GANGRENE, GANGRENOUS
STOMATITIS, NECROTIZING STOMATITIS.
 The term Noma is derived from the Greek word Nomein, meaning to
devour.
 DEFINITION:- Noma is a rapidly progressive,polymicrobial, opportunistic
infection caused by components of the normal oral flora that become
pathogenic during periods of compromised immune status.

35. PREDISPOSING FACTORS
 Poverty
 Malnutrition or dehydration
 Poor oral hygiene
 Poor sanitation
 Unsafe drinking water
 Proximity to unkempt livestock
 Recent illness
 Malignancy
 An immunodeficiency disorder, including AIDS.

36.  Others common but less frequent predisposing illness include herpes simplex,
varicella, scarlet fever, malaria, tuberculosis, gastroenteritis and
bronchopneumonia.
 In the developed world, Noma has virtually disappeared except for an occasional
case related to HIV infection, severe combined immunodeficiency syndrome or
intense immunosuppressive therapy.

37. CLINICAL FEATURES
 Most common in children’s of age 1 to10 years.
 In adults with major debilitating disease. Eg.. Diabetes mellitus, Leukemia,
lymphoma, HIV infection.
 The infection often begins on the Gingiva as NUG, which may extend either
facially or lingually to involve the adjacent soft tissue and form areas called
NECROTIZING ulcerative mucositis.

39. The overlying skin becomes inflamed , edematous and
finally necrotic with the result that a line of
demarcation develop between healthy and dead
tissues, and large mass of tissue may Slough out ,
leaving the jaw exposed.

40. TREATMENT AND PROGNOSIS
 Penicillin and metronidazole are the first line therapeutic antibiotics for
necrotizing stomatitis.
 Since therapy is directed against the pseudomonas organisms and often consists
of piperacillin, Gentamicin or clindamycin.
 Surgical excision of gross necrotic area is recommended, but agressive removal
contraindicated to stop the extension of the process and create reconstruction
process.
 Necrotic bone is left in place to help hold the facial form but is removed as it
sequestrates. Reconstruction should be delayed for 1 year to ensure complete
recovery.

42. Thankyou 😄.