This document discusses several sexually transmitted infections (STIs), including gonorrhea, chlamydia, syphilis, and HIV/AIDS. It describes the causative organisms, sites of infection, clinical features, complications, diagnosis, and treatment for each STI. STIs can cause local and distant infections and lead to serious complications like infertility, ectopic pregnancy, and pelvic inflammatory disease if left untreated. Proper diagnosis and treatment of STIs and prevention of transmission are important for individual and public health.

1. Sexually Transmitted
Infections

2. • Sexually transmitted infections (STIs) include
those infections, which are predominantly
transmitted through sexual contact from an
infected partner

3. GONORRHEA

4. Causative organism
• Neisseria gonorrheae - Gram-negative diplococcus

5. Site of invasion
• Columnar
• Transitional epithelium of the genitourinary tract.

6. Primary Sites of infection
• endocervix,
• urethra,
• Skene’s gland
• Bartholin’s gland.

7. Other sites of infection
• Oropharynx
• anorectal region
• conjunctiva

8. Clinical Features in adult
• 50 percent of patients with gonorrhea are
asymptomatic
• The clinical features are claasified as:
• Local.
• Distant or metastatic.
• PID

9. Local
• Urinary symptoms such as dysuria (25%)
• Excessive irritant vaginal discharge (50%)
• Acute unilateral pain and swelling over the labia due
to involvement of Bartholin’s gland

10. • There may be rectal discomfort due to associated
proctitis from genital contamination
• Others: Pharyngeal infection, intermenstrual
bleeding.

11. Distant or Metastatic
• Perihepatitis
• Septicemia

12. • Perihepatitis results from spread of infection to the liver
capsule.
• There is formation of adhesions with the abdominal wall.

13. • Septicemia is characterized by low grade fever,
polyarthralgia, tenosynovitis, septic arthritis,
perihepatitis, meningitis, endocarditis, and skin
rash.

14. COMPLICATIONS
• Infertility,
• ectopic pregnancy (due to tubal damage),
• dyspareunia,
• chronic pelvic pain,
• tubo-ovarian mass
• Bartholin’s gland abscess

15. DIAGNOSIS
• NAAT (Nucleic acid amplication testing)
• Thayer - Martin medium

16. TREATMENT
• PREVENTIVE
• CURATIVE

17. PREVENTIVE
• Adequate therapy for gonococcal infection and meticulous follow up
are to be done till the patient is declared cured.
• To treat adequately the male sexual partner simultaneously.
• To avoid multiple sex partners.
• To use condom till both the sexual partners are free from disease.

18. FOLLOW UP
• Cultures should be made 7 days after the therapy.
• Repeat cultures are made at monthly intervals following menses
for three months.
• If the reports are persistently negative, the patient is
declared cured.

19. CHLAMYDIAL INFECTIONS

20. CAUSATIVE ORGANISM
• Chlamydia trachomatis

21. INCUBATION PERIOD
6-14 days

22. SITE OF INVASION
• Columnar and transitional epithelium of the
genitourinary tract.
• SUPERFICIAL invasion

23. Site of infection
• Urethra
• Bartholin’s gland
• Cervix.

24. CLINICAL FEATURES
• 75% - non-specific and asymptomatic
• Dysuria,
• dyspareunia,
• postcoital bleeding
• intermenstrual bleeding

25. COMPLICATIONS
• Urethritis and bartholinitis
• Chlamydial cervicitis spreads upwards to produce
endometritis and salpingitis.
• Chlamydial salpingitis  infertility and ectopic
pregnancy

26. DIAGNOSIS
• Chlamydial nucleic acid amplification testing
• Polymerase chain reaction (PCR) is a very sensitive and specific test
(95%)
• ELISA  sensitivity less compared to NAAT
• Chlamydia can be demonstrated in tissue culture  100% specific

27. SYPHILIS

28. CAUSATIVE ORGANISM
• Treponema pallidum

29. MODE OF SPREAD
• Syphilitic lesion of the genital tract is acquired by direct
contact with another person who has open primary or
secondary syphilitic lesion.
• Transmission occurs through the abraded skin or mucosal
surface.

30. SITE OF INFECTION
• PRIMARY LESION  Labia (may be single/
multiple)
• Other sites:-
• Fourchette,
• Anus
• Cervix
• nipples

31. CLINICAL FEATURES
• Incubation period ranges between 9 and 90 days.
• PRIMARY  A small papule is formed, which is quickly eroded to
form an ulcer.
• The margins are raised with smooth shiny floor.
• The ulcer is painless
• The inguinal glands are enlarged and painless.
• The primary chancre heals spontaneously in 1–8 weeks leaving
behind a scar.

32. Secondary syphilis—
• Coarse, flat-topped, moist, necrotic lesions
• Systemic symptoms like fever, headache, and sore throat.
• Maculopapular skin rashes are seen on the palms and soles.
• Other features  generalized lymphadenopathy, mucosal
ulcers, and alopecia.

33. • LATENT SYPHILIS  dormant phase after secondary syphilis
• TERTIARY SYPHILIS when not treated. Damages CNS, CVS,
MUSCULOSKELETAL SYSTEM.
• GUMMA Deep punched ulcer with rolled out margins.
• It is painless with a moist leather base

34. DIAGNOSIS
• History of exposure to an infected person.
• Identification of the organism—Treponema
pallidum, an anaerobe.
• VDRL  +ve 6 weeks after initial infection

35. SPECIFIC TEST
• Treponemapallidum hemagglutination (TPHA) test,
• Treponema pallidum enzyme immunoassay (EIA),
• fluorescent treponemal antibody absorption (FTA-abs)
test
• Treponema pallidum immobilization (TPI) test.

36. FOLLOW UP:
• Serological test is to be performed 1, 3, 6, and 12
months after treatment of early syphilis.
• In late symptomatic cases, surveillance is for life
• The serological test is to be done annually.

37. HIV & AIDS

38. INCIDENCE
• Spreading fast and has become a global problem.

39. MODE OF TRANSMISSION
• Sexual intercourse
• Intravenous drug abusers.
• Transfusion of contaminated blood or blood products.
• Use of contaminated needles, needlestick injuries.
• Breastfeeding

40. • Perinatal transmission—The vertical transmission to the neonates
of the infected mothers is about 25–35%.
• The baby may be affected in utero (30%) through transplacental
transfer,
• During delivery (70–75%) by contaminated secretions and blood of
the birth canal.

42. Gynecological symptomatology
• Infection of the genital tract
• Vaginitis – recurrent candidiasis
• PID with other STIs
• Neoplasms of the genital tract are increased
• Increased incidence of wound infection

43. • Menstrual abnormality: Menorrhagia, amenorrhea, or
abnormal uterine bleeding may be due to associated
weight loss, thrombocytopenia or opportunistic
infections or neoplasms.

44. DIAGNOSIS
• CD 4 cells
• Detection of IgG antibody to Gp 120 (envelope glycoprotein
component)
• Viral P-24 antigen  Detected soon after the infection
• ELISA is extremely sensitive (99.5%) but less specific.
• Western blot or immunoblot—It is highly specific but complicated
and time consuming
• HIV RNA by PCR is the gold standard for diagnosis of HIV.

45. TREATMENT
• Safer sex with barrier methods
• Male circumcision reduces transmission by 50%.
• Use of blunt tipped needles to avoid needle stick injury during
surgery.
• HIV negative blood transfusion
• HIV negative frozen semen to use for artificial donor insemination.
• Termination of pregnancy in HIV positive women when requested.

46. • Wide spread voluntary counseling and testing
• Mother needs to be counseled as regard the risks and
benefits of breastfeeding. She is helped to make an
informed choice.