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Sexual transmitted disease
(STDs)

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Definition
*Genital tract infections
It is infection affect on genital tract and affect
all age groups from adolescents to
postmenopausal women
Sexual transmitted diseases
Are diseases and infections which are capable of
being spread from person to person through:
a. sexual intercourse: Vaginal
b. oral-genital contact: Oral, Anal, or Skin-to-
skin.

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Natural Defense mechanisms against Ascending infection
 Vulva:
 The Vulva covered by thick skin – like
epithelium.
 Vagina:
• During childbearing period, estrogen helps in
making the acidity of the vaginal secretion
which destroys most pathologic organisms.
• Lined by well stratified squamous
epithelium.
• Closure by applications of its anterior and
posterior wall.

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 3-Cervix:
 Closed by mucus plug, which is also bacteriolytic.
 4-Uterus:
 Monthly shedding of superficial layers of
endometrium
 5-The tubal Ciliary movement and tubal peristalsis
is towards the uterine cavity

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Factors predisposing to genital tract
infection
 General factors:
 General ill health.
 Chronic diseases as Diabetes.
 Malnutrition.
 Use of immuno-suppressive drugs.
 Before puberty and after menopause.
 Thin vaginal epithelium
 Decrease vaginal acidity PH (6-7)
 Absence of cyclic shedding of endometrium.

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CONT.
 During Menstruation:
 Cervical mucus plug is discharged.
 Vaginal acidity is neutralized by the menstrual
discharge.
 During Pueriperium:
 The cervix is dilated.
 Vaginal acidity is neutralized by the lochia.
 Laceration if present predisposes to infection.
 Row placental site.
 Degenerated blood clots offer a medium for infection.

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TYPES OF GTIs
 Female genital tract infection divided into :
1. Lower genital tract infection:
 Bartholinitis
 Vulvitis
 Vaginitis
 Cervicitis
1. Upper genital tract infection:
 Endometritis.
 Salpengitis
 Pelvic inflammatory disease (P.I.D)
 Tubo.ovarian abscess (T.O.A)

8. Types of STDs and their Pathogenic
Causes
A. Bacterial
1. Gonorrhea
2. Chlamydia
3. Syphilis
B. Fungal
Candidiasis
C. Protozoal
Trichomoniasis
D. Viral
1. Human Papilloma
Virus
2. Herpes Simplex
Virus (HSV)
3. Hepatitis B
4. HIV/AIDs
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9. Mode of transmission
1. Body fluid with the germ in it.
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a. Semen
b. Vaginal fluid
c. Blood
d. Fluid in sores or
blisters
a. Saliva
b. Tears
c. Sweat
d. Urine
e. Ear wax

10. Methods of Transmission
2- Sexual Intercourse
• vaginal
• anal
• oral
3- Blood-to-blood contact
4- Sharing needles or other drug-use
equipment
5- Tattoo or body piercing
6- Infected mother to her baby
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11. Common Signs & Symptoms
of STDs
1. Sore (either painful or painless) or lesion on the
vulva
2. Blood in urine
3. Burning sensation when urinating
4. Rashes
5. Itching
6. Bumps
7. Warts
8. Unusual vaginal discharge
9. Pelvic Pain
10.Post coital bleeding
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Candidiasis (Moniliasis)
Definition:
Fungus infection caused by Candida albicans
yeast.

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Predisposing factors
1-Antibiotic administration
2-Oral contraceptives, leads to increased glycogen content of the
vagina and altered glucose metabolism
3-Pregnancy high estrogen level and increased glycogen leads to
increased vaginal acidity
4-Steroids and immunosuppressive, lower the immunity
5-Male partner infection
6-Diabetes, increased glycogen deposition and low immunity

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Diagnosis
(A) Symptoms:
 Vaginal discharge: thick Scanty,
white and curd-like, adherent
odorless
1. Pruritus vulvae: Usually severe.
2. Vulval pain and soreness.
3. Dyspareunia: From tender vagina.

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Diagnosis
(B) Signs:
1. The vulva: Inflamed, red and tender.
2. The vagina: Inflamed, red and tender + white
patches adherent in the vagina and cervix.
removal of the discharge leaves a bleeding
surface

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Treatment
1) Treatment of the predisposing factors.
2) Boiling synthetic underwear clothes.
3) Alkaline vaginal douche: Sodium bicarbonate
(1%) twice daily.
4) Fungicidal
Mycostatin (Nystain)
.Vaginal pessaries /12 hrs for 2 weeks, then
once daily for 2 weeks
. Oral tablets one week to treat intestinal
candidiasis
2-Imidazole derivates:Ticonazole
3-Treat of diabetes

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Trichomonas vaginitis
Definition:
Parasitic infestation caused by motile
Trichomonas vaginalis.
Predisposing factors:
1-Weakly acidic vaginal (PH=5-6)
2-Male partner infection

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Diagnosis
(A) Symptoms:
1. Vaginal discharge: Sudden
purulent yellowish white,
frothy offensive discharge.
2. Pruritus vulvae.
3. Dysuria and frequency of
micturition.
4. Vaginal tenderness: 
Dyspareunia.

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Diagnosis
(B) Signs:
1. Vulva: Inflamed, red and
tender.
2. Vagina: Inflamed, red and
tender.(strawberry vagina)
3. Red spots: Seen on cervix
and vagina.

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Treatment
1. Vaginal douches: Diluted acetic acid.
2. Metronidazole (Flaggyl): 1 tablet (200-mg.)
/12 hours orally for 1 week.
3. Tinidazole (Fasigen): (500 mg. /tablet) Orally
2 tablets /12 hours (4 tablets).
 Clotrimazole vaginal pessaries used during pregnancy
4- Recurrent and resistant infections necessitate screening for
STDs
 N.B.,: The husband should be treated at the same time

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Bacterial vaginosis
 It is caused by polymicrobial synergistic
infection with anaerobes and gardnella
(together )
 and presents by abnormal vaginal discharge in
the absence of inflammatory reaction.

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risk factors:
 1-frequent sexual intercourse.
 Repeated alkalinisation of vagina
 2-Repeat Douching
 use (IUDs).
 pregnancy

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Symptoms
 50% of women with BV are asymptomatic
 2-Vaginal discharge: profuse, thin homogenous
grey (non irritant)
 But not associated with much irritation or
dysuria.
 2-foul-smelling (fishy odor): particularly
noticeable around the time of menses or
following sexual intercourse
 Signs
 The vagina is red and inflamed
 vaginal PH more than 4.5

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Diagnosis
 Depends upon the presence of the symptoms and
signs
 Treatment:
Antibiotics
1-Metronidazole (tablets): 500 mg orally twice daily for 7 days (Flagyl)
 2-Clindamycin (tablets): 300 mg orally twice daily for 7 days
 3-Metronidazole (gel):5g intravaginally once daily for 5 days
 4-Clindamycin (cream): 5g intravaginally once daily for 5 days
 3-Treatment of infected sexual partners and avoid sexual intercourse

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Candida Trichomonas
Bacterial
Vaginosis
Color White White/Yellow White/Gray
Consistency Curd-like Frothy Homogenous
Odor No Bad Fishy
Pruritus +++ ++ & Dysuria +
Vaginal PH Acidic Alkaline Alkaline
Treatment Anti-fungal
Anti-protozoa
Anti-biotic
Differential diagnosis of important infections

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Cervix
Thick
purulent
discharge
Trichomonas
Bacterial Vaginosis
White
adherent
discharge
Monilia
Yellowish
discharge
Differential diagnosis of important infections

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Human Papilloma Virus or HPV
(Genital Warts)
• Is a viral infection caused by Human Papilloma Virus
• One of the most common STIs
• About 75% of people will have at least one HPV
infection during their lifetime.
• There are over 100 types of HPV
• Low-risk HPV types: cause genital warts
• High-risk HPV types: may cause cancer of the cervix
• There is NO CURE, but vaccination is available to
prevent certain types of HPV

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HPV – Signs & Symptoms
• Many people with low-risk types have no symptoms
• Other HPV types may cause:
a. Warts on vulva, cervix, penis, scrotum, anus or in the
urethra
b. Itchiness
c. Discomfort and bleeding during sex

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Preventive measures
1-Health education of all women about healthy lifestyle like nutrition,
exercise, hygienic care.
2- drying completely after bathing.
3- wearing fresh undergarments.
4- wiping from front to rear after defecation
5- The vaginal area should be washed with water.
6- perfumed soaps, shower gels, and vaginal deodorants should be
avoided.
7-duching is never recommended.
8- healthy diets and behaviors as well as minimizing stress as all
these factors can affect the pH balance of the vagina.
9- avoiding other people's wet towels and hot tubs,
10- safe-sex procedures, such as condom use.

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1. Educate all especially adolescent, public, school administrator and parents
about risk of transmission, signs and symptoms and ways to avoid STDs.
2. Marriage counseling and sex education
3. Periodic selective examination for early detection of diseases.
4. Screening surveys as annual pelvic examination with pap smear
and follow up of any abnormalities.
5. 6. Selective examination for woman at risk for STDs.
6. 7. Effective diagnosis and treatment of infected people to arrest
disease and prevent further complications.
Preventive measures

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