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Sti(d)s by ferdinand
- 2. Definition: Sexual transmittedinfections are diseases transmitted via intercourse especially unprotected anal, oral and vaginal sex. STI are spread to children as well during pregnancy and childbirth.
- 3. Causes - Bacterial •Gonorrhea • Genital chlamydia • Syphilis • Chancroid - Viral • Genital papilloma virus • Genital herpes
- 4. - Protozoan • Trichomoniasis -Fungal • Genital candidiasis
- 5. Definition: It isan STI characterized by presence of secretions (pus) from anterior urethral accompanied by burning urethral discomfort when passing urine. Gonorrhea is transmitted through vaginal, anal and oral intercourse or prenatally. Cause - Neisseria gonorrhoeae a Gram negative intracellular diplococcus.
- 6. Signs and Symptoms -In general: purulent discharge of the mucous membranes - In women • Asymptomatic in 50% of the time • Dysuria • Vaginal discharge • Bleeding between periods • Swelling of the labial folds
- 7. - In men •Acute arthritis • Dysuria • Urethral purulent discharge • Prostatis • Epedidimatis
- 8. Investigations - Gram-stain ofurethral/vaginal discharge - Culture and sensitivity
- 9. Management For adult •Treatment ofuncomplicated anogenital infection → First choice recommended regimens Ciprofloxacin, 500mg orally, BID for 7 days (Contraindicated in pregnancy, children) Or Azithromycin, 2g orally, as a single dose Or
- 10. Ceftriaxone, 250mg byintramuscular injection,as a single dose Or Cefixime, 400mg orally, as a single dose Or Spectinomycin, 4g (trobicin) by IM injection, as a single dose Doxycycline, 100mg orally, twice daily for 7 days
- 11. Treatment ofcomplicated infection → Recommended regimens Ceftriaxone, 1g by IM or IV, once daily for 7 days OR Spectinomycin, 2g by IM, twice daily for 7days. → For gonococcal meningitis and endocarditis the same dosages apply but the duration of therapy will need to be increased to 4 weeks for endocarditis
- 12. Complications - Urethral strictures(narrowingof the urethra) - Pelvic inflammatory disease (PID) - Chronic pelvic pain - Infertility - Ectopic pregnancy - Gonococcal septicemia
- 13. • Gonococcal septicemia -Inneonates • Purulent conjunctivitis - Corneal erosion, perforation and blindness
- 14. Recommendations - Healtheducation and behaviors change - Screen /Treat partner for STI
- 15. It comprises Vulvo-vaginitisdue to Candidiasis (refer to fungal infections), Trichomonas vaginalis and Chlamydia infections
- 16. A. Trichomonas VirginalisInfection Definition: STI caused by this protozoan; a common cause of abnormal vaginal discharge
- 17. Signs and Symptoms -In men • Asymptomatic - In female • Vaginal pruritis • Malodorous yellow green discharge
- 18. Complication - Vulvo-vaginatis Investigations - Wetmonth microscopy - Culture
- 19. What isa wet mount? In a wet mount, the specimen is suspended in a drop of liquid (usually water) located between slide and cover glass. The water refractive index of the water improves the image quality and also supports the specimen.
- 20. Management - Metronidazole,2g orally, in a single dose OR - Tinidazole, 2g orally, in a single dose Alternative regimen • Metronidazole, 500mg orally, twice daily for 7 days Or • Tinidazole, 500mg orally, twice daily for 5 days
- 21. Recommendations - Allsexual partners should be notified and treated, - Patients should be advised against sexual intercourse until both patient and the partner(s) are treated
- 22. B.Chlamydia Infections Definition:Chlamydia infection is an STI characterized by urethral discharge Cause - infection with Chlamydia trachomatis
- 23. Signs andSymptoms - In female • Most of the time, asymptomatic • Vaginal discharge • Dysuria • Bleeding after intercourse • Abnormal vaginal bleeding
- 24. - In men •Most of the time, asymptomatic • Dysuria • Mucopurulent discharge • Itching sensation inside the urethra Complications - Pelvic inflammatory disease (low abdominal pain) - Infertility
- 25. Investigations - Culture -Serology Management - First choice • Azithromycin 1 g orally as one dose Or • Doxycycline 200 mg orally daily for 10 days for patients allergic to macrolide (azithromycin)
- 26. • For pregnantwomen, Erythromycin 500mg 4 times per day for 7 days Recommendations - All sexual partners should be notified and treated - Patients should be advised against sexual intercourse until both patient and the partner(s) are treated.
- 27. 2.1. Chancroid Definition: Chancroidis a Sexual Transmitted Infection (STI) characterized by painful necrotizing genital ulcers accompanied by usually unilateral adenopathy. Chancroid is transmitted sexually by direct contact with purulent lesions and by autoinoculation to non sexual sites such eyes and skin
- 28. Cause - Haemophilusducreyi (gram-negative bacterium) Risk factors - Endemic area - Low economic status - Prostitution
- 29. Signs andSymptoms - Lesions start as a tender papules that became pistular then erodes to form an extremely painful and deep single or multiple ulcers - Tender, unilateral lymph node
- 30. Complications - Phimosis -Urethral stricture - Urethral fistula - Super infection of ulcers with rapid destruction of genitalia known as a phagedenic chancroid
- 31. Investigations - Gramstain of ulcer exudates - Culture Management - First choice • Ciprofloxacin 500mg twice daily orally for 5 days OR • Erythromycin 500mg orally 6 hourly for 7 days
- 32. - Alternative • Sulfamethaxole(400mg)-trimetoprim(80mg) 2x2/days for15 days Recommendations - Follow up strictly medications - Screen/treat partners - HIV testing and counsel
- 33. Definition: Granulomainguinale is a chronic bacterial infection that affect the skin and mucus membrane in the genital lesions Cause - Gram negative calymatobacterium granulomatis (klebsiella granulomatis)
- 34. Signs andSymptoms - Nodule and papules at the site of inoculation - Single or multiples ulcerations of genital area - No adenopathy - Absence of healing if no treatment
- 35. Complications - Elephantiasisswelling of the external genital area - Extra genital involvement by auto inoculation or direct extension of lesions Investigation - Gram stain of ulcer exudates
- 36. Management - Sulphametoprim(400mg)-trimetrprim(80mg), 2x2 /days /10-20 days Or - Doxycycline 100 mg, 200mg a day for 10 days (avoided in pregnancy)
- 37. Definition: LymphoGranulomaVenereum is a cutaneous and sometime systemic STI that affects primarily lymphatic tissues of the groin Cause - Infection with Chlamydia trachomatis
- 38. Signs andSymptoms - First stage • A small painless, papule/ulcers - Second stage • Lymph node involvement resulting in painful buboes. • Enlargement of lymph nodes above and below the inguinal ligament result in the classic “groove sign.”
- 39. - Third stage •Rectal fistulas, especially in women, resulting in scarring and chronic lymphatic obstruction Complications - Scarring and local tissues destruction with fistula and stricture formation - Rectal stenosis - Elephantiasis of genital organs - Systemic spread
- 40. Investigations - Samplesfor culture - Serology Management Medical therapy • First-line treatment is usually with doxycycline 100mg twice-daily for 21 days, Or • Erythromycin 500 mg 4 times daily for 21 days
- 41. Surgical therapy •Buboes may be drained percutaneously to relieve symptoms. • Surgical excision is best avoided due to the risk of sinus or fistula formation
- 42. Recommendation - Thepatient should refrain from unprotected sexual intercourse until they and any contacts have completed treatment and follow-up.