This pptx covers the basics of almost all stds.Use this and for sure you'll get a good score. It is taken from very hugh yield and authenic sources. The animations Adds further beauty to the presentation. The animations itself are self explanatory just download and deliver you'll be very much appreciated for it no need to add further the pptx is well comprehensive.

1. Sexually transmitted disease
(STD)
Made by: DR.FIDWA ARSHAD ALI UNDERSUPERVISION OF LT.COL DR M.FAROOQ

3. Syphilis:
 Def: Std caused by a spirochete Treponema pallidum
 Clinical Features : based on clinical features it is divided into four main types
namely:
 1.Primary syphilis
 2.secondary syphilis
 3.Latent syphilis
 4.Tertiary syphilis
 5.Congenital syphilis

5. Primary Syphilis:
o Occurs 9-10 after infection
o Presents as Chancre i.e painless ulcer with clean base, raised indurated borders
usually in the genital areas
o Draining lymph nodes may be enlarged, mobile and rubbery
o Both chancre and lymph nodes are PAINLESS.
o Fate:
o Without treatment, the chancre will resolve within 2-6 weeks

6. Penile chancre, shaft
Source: Dr. John Toney, Southeast STD/HIV Prevention
Training Center Penile chancre, underside
of glans
Source: Public Health Agency of Canada

7. Secondary Syphilis:
 It occurs 6 - 8 weeks after chancre
 Clinical feature: It presents with low-grade fever, headache, malaise, and
generalized non-tender lymphadenopathy. "Snail track ulcer" in the mouth Non-
pruritic, symmetrical maculopapular rash on the soles and palms.
 Fate: 1. Without treatment the rash may last for up to 12 weeks.
 2. Condylomata Lata:• Flat wart-like peri-anal and mucous membrane lesions
 .Highly contagious

8. Palmar and plantar rash
Source: Connie Celum, Walter Stamm, Seattle
STD/HIV Prevention Training Center

9. Latent Syphilis:
 It refers to positive syphilis serology with no evidence of clinical disease.
 It is divided into two phases:
 Early Latent Syphilis:•
 No symptoms, positive serology within 2 years of infection• Patient is sexually
infectious.•
 Late Latent Syphilis:
 No symptoms, after 2 years of infection.
 Patient is NOT sexually infectious.

10. Tertiary Syphilis;
 occurs between 3 - 10 years after infection.
 The characteristic feature is a chronic granulomatous lesion called a"gumma".,
 The classic features are:
 General paresis (dementia)
 Cardiovascular findings (aortic root aneurysm, aorticregurgitation)
 Neurosyphilis (Tabes Dorsalis, Argyll-Robertson pupil,Meningo-vascular stroke)

13. Diagnosis:
 Dark-field microscopy = identifies motile spirochetes in primary &secondary
syphilis.
 Non-specific Tests:VDRL test (venereal diseases research laboratory)
 RPR test (rapid plasma reagin)
 Specific Test:
 FTA-ABS test (fluorescent treponemal antibody-absorbed test)
 TP-ELA test (treponemal antigen-based enzyme immunoassay test)

14. Treatment:
 Penicillin is the drug of choice for all the stages of syphilis.
 Doxycycline is used for penicillin-allergic patients.
 Pregnancy:Penicillin is the drug of choice
 .Penicillin-allergic patients:-
 Penicillin de-sensitization, followed by penicillin, OR Erythromycin for pregnant
woman and penicillin for newborn baby (to protect baby from syphilis as
erythromycin crosses placenta poorly)

16. Gonorrhea:
 It is caused by Neisseria gonorrhoeae:
 is a gram-negative diplococcus.
 Incubation period is 2 - 10 days.
 Mode of transmission = vaginal, anal, or oral sex

17. Clinical Features:
 In men : It commonly involves the anterior urethra.
 Urethritis with purulent urethral discharge .Dysuria; proctitis
 In women:80% of women who have gonorrhea are asymptomatic.
 Greenish-yellow discharge. Adnexal or pelvic pain.
 Disease spectrum is as follows:
 Vulva= Skene gland adenitis.
 Vagina= Vaginitis
 Cervix= Acute cervicitis
 Uterus= Acute endometritis
 Fallopian tube= Acute salpingitis

18. Complications:
 Acute prostatitis and epididymo-orchitis in men
 Bartholin's gland abscess
 Ectopic pregnancy
 Disseminated Gonococcemia
 Monoarticular septic arthritis
 Rash - hemorrhagic, painful pustules.
 Tenosynovitis
 Diagnosis & Treatment:
 Gram stain and culture is the Gold Standard.
 NAAT of urine.
 Treatment : Cefixime, OR Ceftriaxone (contraindicated during pregnancy)*

20. chlamydia
 It is caused by Chlamydia trachomatis; an obligate intracellular bacterium
 Serotypes:
 Serotypes A,B,C = Trachoma (follicular conjunctivitis with cornealscarring)
 Serotypes L1-L3 = Lymphogranuloma venereum
Lymphogranuloma venereum

21. Lymphogranulora Venereum (LGM):
 It is caused by chlamydia trachomatis serotypes L1, 2, 3.
 Clinical Features: Painless ulcer . Ulcer is small, transient and often unnoticed.
 Inguinal lymph nodes are tender, unilateral, matted, but multilocular.
 Treatment: Doxycycline, OR Erythromycin

22. Clinical Features:
 Clinical Features;80% of women who have chlamydia are asymptomatic.
 • Mucopurulent cervical discharge (classic finding)
 Cervical motion tenderness.
 Intermenstrual or post-coital bleeding
 Complications:Reiter's syndrome
 Fitz-Hugh-Curtis Syndromefibrosis
 .Infertility & ectopic pregnancy = from PID.
 urethritis, conjunctivitis, arthritis
 peri-hepatic inflammation

23. Diagnosis:
 Diagnosis is usually clinical.
 Gram stain of discharge may show neutrophils, but no bacteria(intracellular)
 Culture is the Gold Standard,
 Nucleic acid amplification test (NAAT) of urine for rapid diagnosis.- Treatment:
Azithromycin 1gm orally as a single dose,
 OR• Doxycycline orally for 7 days

24. Human Papilloma Virus (HPV):
 HPV has over 90 genotypes:
 HPV-6, 11, 16, and 18 most commonly infect the genital tract through sexual
transmission
 Clinical Features:
 Genotypes 6 and 11:
 Cause ano-genital warts, which may be single, multiple, exophytic or flat.
 Buschke -Lewenstein tumor :refers to a giant condyloma with local tissue
destruction
 Genotypes 16 and 18:
 Cause dysplastic conditions and cancers of genital tract Can affect penis, vulva,
vagina, cervix, perineum, or anus.

25. condyloma

26. Treatment:
 Podophyllotoxin = for home treatment of external warts (contraindicatedin pregnancy)
 Imiquimod cream = for home treatment of external warts (contraindicatedin pregnancy)
 Cryotherapy = for treatment of internal and external warts•
 Hyfrecation (electrofulgration that causes charring) = for external &internal warts
 Surgical removal
 Prevention:- Bivalent vaccine protection against HPV-16, 18
 Quadrivalent vaccine protection against HPV-6, 11
 Current recommendation are:
 HPV should be administered prior to the onset of sexualactivity.
 Typically at age 11 - 13, in a course of 3 injections

27. Sexually Transmitted genital leisions:
 Granuloma Inguinale:• Also known as "Donovanosis".
 It is caused by Klebsiella granulomatis.
 Clinical Features: Beefy-red ulcer; hypertrophic granulomatous lesions Pain less
 Diagnosis = Biopsy (Donovan bodies), which are intracellular bipolar staining
bodies.
 Treatment: Azithromycin, OR Doxycycline
Granuloma Inguinale
Donovanosis

28. Chancroid:
 Chancroid: It is caused by Hemophilus ducreyi; a gram-negative rod.
 Clinical Features:
 Painful ulcers (mnemonic: you cry with ducreyi):Ulcers are irregular, deep, and well-
demarcated with ragged undermined edge.
 Inguinal lymph nodes are tender, unilateral, matted and unilocular.
 Treatment: Single dose of oral azithromycin.
 OR Single dose of IM ceftriaxone.- Lymphogranulora Venereum (LGM):• It is caused
by chlamydia trachomatis serotypes L1, 2, 3.OClinical Features:Painless ulcer.Ulcer
is small, transient and often unnoticed.Inguinal lymph nodes are tender, unilateral,
matted, butmultilocular.o Treatment:Doxycycline, ORErythromycin

29. HIV
 Virology:•
 HIV stands for human immunodeficiency virus.•
 AIDS stands for acquired immunodeficiency syndrome.
 • AIDS is caused by:• HIV-1.HIV is a single-stranded RNA retrovirus.
 HIV belongs to Lentivirus group of retrovirus family.-
 HIV-2.It causes less aggressive disease than HIV-1.- It is restricted mainly to western Africa.
 Pathogenesis;
 • The virus attaches to the surface of CD4 (Helper) T-cells.• The virus then enters the cell and uncoats, and its RNA
is transcribed toDNA by reverse transcriptase.The virus destroys CD4 T-cells and therefore weakens cell -
mediatedimmunity.Each day:> 1010 virions are produced i.e. daily turnover of 30% of total viralburden.> 10P CD4
T-cells are destroyed i.e. 6-7% of total body DA cells
 .Mode of Transmission
 :Sexual:Man-to-manHeterosexual (most common route accounting for > 75%)
 Oral
 Parenteral:
 l:Blood (transmission risk is 90%)Injection drug users
 Occupation injury

30. Demographics

32. Pathogenesis

33.  Vertical:
 Vertical transmission
 occurs during pregnancy, during birth, and breastfeeding
 Vertical transmission is higher in developing countries (25-44%)than in industrialized countries (13-
25%).
 80% of vertical transmission occurs during child birth(labour)20% of vertical transmission occurs in
utero.
 Classification of HIV;
 • HIV can be broadly classified into following types depending on clinical features:
 o Primary infection Asymptomatic infection Mildly symptomatic infection Acquired immunodeficiency
syndrome (AIDS)
 Primary Infection:Primary infection is symptomatic in 70-80% of cases.
 Primary infection usually occurs 2 - 6 weeks after exposure.
 Primary infection coincides with:High plasma HIV-RNA levelsFall in CD4 count to 300 - 400 cells/mm
 ,

35. Clinical Features:
 Fever with rash Pharyngitis with cervical lymphadenopathy Myalgias and arthralgias Headache and mucosal
ulceration
 Asymptomatic Infection: It is category-A disease in Centers for Disease Control (CDC)Classification.
 • The patient is seropositive, but no evidence of disease.
 • The patient may have persistent generalized lymphadenopathy (PGL).•
 PGL is defined as enlarged glands at 22 extra-inguinal sites.
 • CD4 counts are normal (> 500/mm)CD4 count declines at a rate of 50 - 150 cells per year.
 Mildly Symptomatic Disease:
 • It is category-B
 disease in Centers for Disease Control (CDC) Classification

36. Clinical Features:
 presents with symptoms and diseases that are NOT AIDS definig illness,
 such as:• Oral hairy leukoplakiaRecurrent
 Oropharyngeal candidiasis- Recurrent vaginal candidiasis- Bacillary angiomatosis- Idiopathic thrombocytopenic
purpura Weight loss Herpes zoster Chronic diarrheaAIDS•
 It is category-C disease in Centers for Disease Control (CDC)Classification
 AIDS is defined by HIV with CD4 count < 200/mm?
 or opportunisticinfections
 or malignancy

37.  AIDS-defining diseases are:
 Esophageal candidiasis (not Oropharyngeal)
 • Cryptococcal meningitisCryptosporidial diarrheaCerebral toxoplasmosis
 Cytomegalovirus retinitis
 Disseminated mycobacterium avium intracellulare (MAI
 Pulmonary or extra-pulmonary TB
 Pneumocystis carinii (jirovecii) pneumonia (PCP)
 Extra-pulmonary coccidioidomycosis
 Extra-pulmonary Histoplasmosis
 Progressive multifocal leukoencephalopathy (PML)Malignancy:
 " Non-Hodgkin lymphoma
 Kaposi's sarcoma (most common)-
 Primary cerebral lymphoma.
 Invasive cervical cancer

38.  Diagnosis:
 • Best initial test= ELISA test.
 o Confirmatory test = Western blot
 Infected Infants : Diagnosed by PCR-RNA or viral culture
ELISA testing is unreliable because maternal HIV antibodies maybe present for up to 6 months
after delivery.
 • Viral Load:
 • PCR-RNA viral load test is used to Measure response to therapy (decreasing levels are good)
 Detect treatment failure (increasing levels are bad)Diagnose HIV in infants

39. Treatment:
 Indications for Treatment:
 CD4 count and Indications for Treatment:- ≥ 350 cells/mm?:
 Monitor 3 - 6 monthly
 Consider treatment if hepatitis B or C co-infected or > 55years of age< 350
cell/mm3.- 350 - 200 cells/mm?
 treat as soon as patient is ready< 200 cells/mm? = treat as soon as possible
Primary Infection is Indicator for Treatment
 Start treatment if: There is neurologic involvementCD4 count is <200 cells/mm? for
> 3 months AIDS-defining disease
 Choice of Drugs: Treatment of HIV is referred to as highly active retroviral
therapy(HAART).HAAR involves use of >3 drugs for better outcome and to
decrease resistance.

40. Regimen’s:
 Regimen 1:
 Two nucleoside reverse transcriptase inhibitors (NRTI), PLUS Non-nucleoside
reverse transcriptase inhibitor (NNRTI).
 Example:Efavirenz + Tenofovir + Emtricitabine:
 Regimen 2:• Two nucleoside reverse transcriptase inhibitors (NRTI), PLUS• Boosted
protease inhibitor (PI).
 Example:Ritonavir - boosted Atazanavir + Tenofovir + Emtricitabine
 Regimen 3:• Two nucleoside reverse transcriptase inhibitors (NRTI), PLUS• Integrase
Inhibitor (I), which inhibits final step of pro-viral DNAintegration
 Example:Raltegravir (II) + Tenofovir + Emtricitabine

41. Treatment During Pregnancy;
 All pregnant women should routinely be recommended for HIV testing.
 The medications used are same as that for non-pregnant EXCEPT for Efavirenz,
which is contraindicated due its teratogenicity.
 Therefore instead of Efavirenz a protease inhibitor should be used.
 If mother is HIV positive and is already taking HAART then continue medications.
 If mother is HIV positive with CD4 < 350 and HIGH viral load and is not on HAART:
 Start treatment immediately Zidovudine + Lamivudine + Protease inhibitor
 If mother is HIV positive with CD4 ≥ 350 and LOW viral load andis not on
HAART:Treatment is still required to reduce vertical transmission.

42.  Anti-retrovirals between 2nd& 3rd trimester and stoppingafter birth.
 Zidovudine monotherapy (starting from 12-14 weeks)
 if viralload is low (<10,000 copies/mL) and Caesarean section is planned.
 Other Measures to Reduce Vertical Transmission:Caesarean section if CD4 is low,
viral load is high, and patient not on HAART Caesarean section is not required if
patient is on HAART and viralload is low.

43.  Avoid breastfeeding
 Transmission rates:<1% = for Zidovudine monotherapy + Caesarean section<1% = for HART and
planned vaginal delivery
 When viral load is <50 copies/ mL.
 Post-exposure Prophylaxis : It is required for healthcare workers following occupational exposure to
HIV.
 It is also required for non-occupation exposure (e.g. Victims of rape, sexual exposure)
 British Recommendations :
 Agents = Zidovudine + Lamivudine + Lopinavir/ Ritonavir, Duration =4 weeks