This document discusses sexually transmitted infections (STIs). It defines STIs as communicable diseases transmitted through sexual or close bodily contact. STIs can be caused by bacteria, viruses, parasites or fungi. Common STIs and their causative agents are described. The document outlines factors contributing to the spread of STIs and their clinical presentations. Complications of untreated STIs are also discussed. The document provides details on laboratory diagnosis and treatments for various STIs. It emphasizes the importance of prevention, control, and education in reducing the burden of STIs.

1. SEXUALLY TRANSMITTED
INFECTIONS
DrVishal Kulkarni MBBS MD (Microbiology)

2. Definition
STIs are group of communicable diseases that are
transmitted predominantly or entirely by sexual
contact or close bodily contact with infected
individual.

3. Factors
predisposing
to STIs
• Social
stigma/fear/ignorance
• Inappearant infections
• Inadequate facilities/follow
up/lack of contact tracing
• Age- teenagers with
multiple partners
• Changing customs & habits

4. Bacterial STDs Causative Bacteria
Syphilis Treponema pallidum
Gonorrhoea Neisseria Gonorrhoeae
LymphogranulomaVenereum ChlamydiaTrachomatis
Vaginosis Gardenella vaginalis
Chancroid / Soft sore Hemophilus ducreyi
Granuloma inguinale Calymmabacterium granulomatis

5. Viral STDs CausativeViruses
Genital Herpes HSV 1 & 2
Wart like nodules Molluscum contagiosum virus (pox)
Cytomegalic inclusions CMV
Genital papilloma Papilloma virus
AIDS HIV
Hepatitis HBV
Parasitic STDs Parasites
Trichomoniasis Trichomonas vaginalis
Fungal STDs Fungal agents
Vulvovaginal candidiasis Candida albicans

6. Clinical Presentation
Vaginal discharge
 Profuse watery ---Bacterial vaginosis
 Thick white discharge--- Candidosis
 Frothy---Trichomoniasis
Cervical/ Urethral discharge
Genital ulcer- Ulceration , pain, lyphadenopathy
- Chancre
- Single, indurated, painless,
nontender, no bubo

7. - Chancroid
- Single/multiple, soft,
- painful, markedly tender
- with marked LN swelling
- & bubo formation.
- Genital Herpes
- Multiple, soft, painful,
- markedly tender
- Bubo
- Suppurating in inguinal regions
- Pelvic Inflammatory disease
- Lower abdominal pain, vaginal discharge & fever

8. Gonnorhoeal infection
Gonnorhoeal infection
Herpes simplex lesions Papillomatous lesion
(HPV)

9. Complications of STIs
- Infertility
- Ectopic pregnancy
- PIDs
- Premature births/still births/birth defects
- Heart diseases
- Degenerative nerve diseases
- Perinatal infections

10. Lab diagnosis of STIs
Collection of specimens
- Urethral discharge
- Vaginal discharge
- Cervical specimens
- Fluid or scraping from ulcer or vesicle
- Blood- For serological tests & for culture
Transport
- Immediate transport & inoculation is necessary.
- Modified stuart’s medium
- Amies charcoal transport media

11. Processing of specimen

12. Microscopic
examination-
Direct
examination
T. vaginalis
Dark ground
microscopy
T. pallidum
Electron
microscopy
Herpes
genitalis
Staining
Wright &
Giemsa
H. genitalis,C.
trachomatis
Gram stain
H.ducreyi, N.
gonorrhoeae

13. T.Vaginalis T. palliidum Herpes simpex virus
C. trachomatis
N. Gonorrhoeae Gardenella vaginosis

14. Culture
Tissue Culture,
Mc Coy, Hela
Chlamydiae,
H. genitalis
Thayer Martin
N.
gonorrhoeae
Chocolate agar
H. ducreyi
Gard. vaginalis

15. Serology
ELISA, CFT
H. genitalis, C.
trachomatis, H.
ducreyi
VDRL,TPHA,TPI T. pallidum
Western blot, RIA,
reverse HI,
countercurrent IE
For detection of Abs
in various bacterial &
viral infections

16. Other tests
- Freis test for C. trachomatis
- Limulus amoebocyte lysate assay test
- For detection of endotoxin of Gram negative bacteria
- Nucleic acid hybridization assay
- DNA hybridization assay

17. Prevention & control of STDs
- Sexual abstinance or Use of barrier methods of
contraception
- Establishments of STD clinics
- Adequate Laboratory facilities
- AdequateTreatment facilities
- Contact tracing & theirTreatment
- Adequate follow up
- Epidemological surveys
- Sex education in school, colleges.
- Legal support

18. Treatment
Antibiotics-
 Ampicillin, penicillin, erythromycin,
 tetracyclin, septran, doxycyclin.
Antifungals for candidiasis-
 Topical clotrimazole, nystatin, miconazole
Metronidazole forTrichomoniasis
Antivirals-
 Herpes
-Topical ether, acyclovir ( topical & systemic), iodine( topical)
 Genital warts
- 25% podophyllin in tincture of benzoin, 5 fluorouracil or liquid nitrogen
 Molluscum contagiosum
- Iodine, phenol or liquid nitrogen

19. Nongonococcal Urethritis
Definition-
- Infection of urethra by pathogens other than N.
gonorrhoeae.
- NGU is most common of all STDs with more than
double incidence of gonorrhoeae.
Aetiology
- ChlymydiaTrachomatis (30-50%)
- Ureoplasma ureolyticum
- Gardenella vaginalis
- Herpes, CMV
- T. vaginalis
- candida albicans

20. Pathogenesis
- Source of infection
- Patient or carrier
- Mode of transmission
- Through sexual intercourse
- IP- 1 week to 1 month
Clinical Features-
- Acute mucopurulant urethral discharge
- Clinically indistinguishable from gonorrhoea

21. Lab diagnosis
Specimen-
- Urethral discharge,Cervical discharge, prostatic
fluid or urine.
Microscopy , culture and serology.
Treatment
- tetracycline, erythromycin for bacterial infection
- Nystatin, miconazole for candida
- Metronidazole forT. vaginalis
- Topical ether, iodine prep, acyclovir & idoxuridine
for HSV