This document provides information about sexually transmitted diseases like gonorrhea and syphilis. It describes how they are transmitted and their typical symptoms. For gonorrhea, it outlines the clinical features and complications and recommends treatments like ceftriaxone. For syphilis, it discusses the primary, secondary, and tertiary stages and how they present clinically. It also provides details on diagnosis for both diseases through tests like nucleic acid amplification and serological tests.

1. SEXUALLY TRANSMITTED
DISEASE
SUBMITTED TO: MRS. SAPNA SINGH (PROFESSOR)
SUBMITTED BY: MS. RAJSHREE DESHMUKH

2. INTRODUCTION
• Sexually transmitted disease(STDs)which are transmitted
through sexual contact from an infected partner.
• other modes of transmission include placental (HIV,
syphilis), by blood transfusion or infected needles (HIV,
hepatitis B or syphilis) or by inoculation into the infant's
mucosa when it passes through the birth canal
(gonococcal, chlamydial or herpes).

3. THE REASONS FOR INCREASING INCIDENCE ARE:
• Rising prevalence of viral infections like HIV, hepatitis B and C
• Increased use of "Pill' and IUCD which cannot prevent STI and
there is increased promiscuity and permissiveness
• Lack of sex education and inadequate practice•
• Increased rate of overseas travel labia
• Increased detection due to heightened aware ness.

4. GONORRHOEA
• The causative organism is Neisseria gono rrhoeae- a gram-negative
diplococcus.
• The incuba- tion period is 3-7 days.
• the primary sites of infection are endocervix, urethra, Skene's gland
and Bartholin's gland. The organism may be localised in the lower
genital tract to produce urethritis, bartholinitis or cervicitis. Other
sites of infection are oropharynx anorectal region and conjunctiva.
• As squamous epithelium is resistant to gonococcal invasion,
vaginitis in adult is not possible but vulvovaginitis is possible.

5. CLINICAL FEATURES- ABOUT 50 PER ASYMPTOMATIC. THE CLINICAL
FEATURES OF ACUTE GONOCOCCAL INFECTION ARE DESCRIBED AS FOLLOWS:
LOCAL. DISTANT OR METASTATIC & PID
LOCAL-
• Urinary Symptom such as dysuria (25%).
• Excessive irritant vaginal discharge (50%).•
• Acute unilateral pain and swelling over the labia ,due to
involvement of Bartholin's gland.
• There may be rectal discomfort due to asso-ciated proctitis from
genital contamination.,Others: Pharyngeal infection, intermenstrual
bleeding.

6. SIGNS
• Labia may be swollen and looks inflammed
• The vaginal discharge is mucopurulent.
• The external urethral meatus and the openings of the Bartholin's ducts look
congested. On squeezing the urethra and giving pressure on the Bartholin's
glands, purulent exudate out through the openings. Bartholin's gland may be
palpably enlarged, tender with fluctua tion, suggestive of formation of abscess
• Speculum examination reveals congested ecto- cervix with increased
mucopurulent cervical secretions out through out the external os.

7. DISTANT OR METASTATIC
• There be features of perihepatitis and septi- caemia.
• Perihepatitis results from spread of infection to the liver capsule. There is
formation of adhesions with the abdominal wall. This is not infrequently (5-10%)
associated with acute PID Septicaemia is characterised by low grade
fever,perihepatitis, meningitis, endocarditis and skin rash, leads to chronic pelvic
inflammatory disease.

8. COMPLICATIONS
• Acute pelvic inflammation leads to chronic pelvic
inflammatory disease.
• adequately treated. Infertility, ectopic
pregnancy(due to tubal damage), dyspareunia,
chronic pelvic pain, tubo-ovarian mass and
Bartholin's gland abscess are commonly seen.

9. DIAGNOSIS
• Nucleic acid amplification testing (NAAT) of urine or
endocervical discharge is done.
• First voidmorning urine sample (preferred) or at least one hour
since the last void sample should be tested.
• NAAT is very sensitive and specific (95%). In the acute phase,
secretions from the urethra, Bartholin's gland and endocervix are
collected for gram stain and culture.

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

11. TREATMENT-CURATIVE
• The specific treatment for gonorrhoea is single dose regimen of any one of the
following drugs
• RECOMMENDED DRUGS IN ACUTE GONORRHOEA (CDC 2006)
• Ceftriaxone125 mg Ciprofloxacin125 mg IM-
• Ofloxacin 400 mg
• Cefixime300 mg
• Levofloxacin400 mg

12. SYPHILIS
• Syphilis is caused by the anaerobic Spiro chaeta
Treponema pallidum,
• Syphilitic lesion of the genital tract is acquired by direct
contact with another person who has open primary or
secondary syphi- lithic lesion.
• Transmission occurs through the abraded skin or mucosal
surface.

13. CLINICAL FEATURES
• The incubation period ranges between 9-90 days.
• The primary lesion (chancre) may be single or multiple and is usually located in
the labia. Fourchette, anus, cervix and nipples are the other sites of lesion. 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 without any surrounding
inflammatory reaction. The inguinal glands are enlarged, discrete and painless.
• The primary chancre heals spontaneously in 1-8 week leaving behind a scar.
• The tubes are not affected and infertility does not occur unless associated with
gonococcal infection.

14. • Secondary syphilis Within 6 weeks to 6 months from the
onset of primary chancre, secon- dary syphilis may be
evidenced in the vulva in the form of condyloma lata.
• These are coarse, flat- topped, moist, necrotic lesions and
teeming with Treponema. Patient may present with systemic
symptoms like fever, headache and sore throat.
Maculopapular skin rashes are seen on the palms and soles.
• Other features include generalised lymphadenopathy,
mucosal ulcers and alopecia.

15. • The primary and secondary stage can last upto two years
and during the period, the woman is a source of infection.
• Latent syphilis-It is the quiescence phase after the stage
secondary syphilis has resolved. It varies in duration from
2 to 20 years.
• Tertiary syphilis- About one-third of untreated patients
progress from late latent stage to tertiary syphilis. It
damages the central nervous, cardiovascular and
musculoskeletal system.

16. DIAGNOSIS
• History of exposure to an infected person.
• Identification of the organism - Treponema pallidum, an
anaerobe.
A smear is taken from the exudate which is obtained after
teasing the primary chancre (base and edge) with a swab
dipped in normal saline. It is examined under dark ground
illumination through a microscope. The treponemata
appear as motile bluish white cork-screw shaped organisms.

17. • 3. Serological test-
• (a) VDRL: This is the common flocculation test
performed and is positiveafter 6 weeks of initial
infection.
• (b) The specific tests include Treponema pallidum
haemagglutination (TPHA) test, Treponema
pallidum enzyme immunoassay (EIA), fluorescent
treponemal antibody absorption (FTA-abs) test and
Treponema pallidum immobilisation (TPI) test.