1. Sexually transmitted diseases (STDs) are caused by bacteria, viruses, parasites or fungi transmitted through sexual contact. Common STDs discussed in the document include syphilis and gonorrhea. 2. Syphilis is caused by the spirochete Treponema pallidum and can cause severe complications if untreated, affecting the cardiovascular or nervous systems. Gonorrhea is caused by the bacterium Neisseria gonorrhoeae and can infect the genitourinary tract and sometimes spread to other body sites. 3. Both syphilis and gonorrhea are treated with antibiotics but antibiotic resistance has emerged, requiring careful treatment selection. Prevention relies on abstinence or con

1. Sexually transmmited
diseases
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2. 2
STDs:
 Group of communicable diseases
transmitted by sexual contact.
 Caused by a wide range of bacterial, viral
,protozoal and fungal agents and
ectoparasites.
 Previously known as veneral diseases.

3. 1.SYPHILIS
 Causative organism:
caused by spirochaetes-
TREPONEMA PALLIDUM
 Word derived from the name
of the mythological
handsome boy ,syphilus who
was cursed by Greek God
Apollo with the disease.
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4.  T.pallidum- a coiled spiral filament 10 µm long that moves
actively in fresh preparations
 The organism is rapidly destroyed by heat,cold,&
antiseptics.
 The organism cant be stained by the usual methods & can
be seen in the exudates & tissues by:
• Dark ground illumination in fresh preparations
• Fluorescent antibody technique
• PCR as a research method
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5. Epidemiology
o infected 12 million people in 1999 .
90% of cases in thedeveloping world.
o affects 700,000 - 1.6 million pregnancies a
year. spontaneous abortions, stillbirths, and
congenital syphilis.
o Sub-Saharan Africa -20% of perinatal deaths.
o Since 2000, rates of syphilis have been
increasing in the US, UK, Australia and Europe
primarily among men who have sex with men.5

6. o Due to unsafe sexual practices.
o Syphilis increases the risk of HIV transmission
and co-infection is common.
o Untreated it has a mortality of 8% to 58%
with a greater death rate in males.
o 19th and 20th century-less severe symptoms,
due to widespread availability of effective
treatment and decreasing virulence of the
spirochete.
o With early treatment few complications
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7. IMMUNOLOGYThe pathogenesis of lesions appear to be due to host immune
response.
2 types of serological tests for syphilis:
A.Treponemal serological test
Measure antibody to T.pallidum antigen & are as under:
1)Fluorescent treponemal antibody-absorbed(FTA-ABS)test.
2)Agglutinin assays
eg:microhaemagglutination assay for T.pallidum(MHA-TP) & Serodia
TP-PA which is more sensitive
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8. 3)T.Pallidum passive haemagglutination(TPHA) test
B.Non-treponemal serological test
 these measure non-specific antibodies IgM & IgG immunoglobulins
directed against cardiolipin-lecithin-cholesterol complex & are more
commonly used.
These are as under:
1)Reiter protein compliment fixation(RPCF):
Test of choice for rapid diagnosis
2)Veneral disease research laboratory(VDRL) test
Wassermann described a compliment fixing antibody against antigen of
human syphilitic tissue.This antigen is used in VDRL test
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9. MODE OF TRANSMISSION
• Sexual intercourse resulting in lesions on
glans penis,vulva,vagina & cervix
• Intimate person-to-person contact with
lesions on lips,tongues or fingers
• Transfusion of infected blood
• Materno-foetal transmission in congenital
syphilis if mother is infected
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10. STAGES OF ACQUIRED SYPHILIS
3 stages depending upon the period after
which the lesions appear and the type of
lesions.
 Primary syphilis
• Chancre appear on genitals or extra
genital sites in 2-4 weeks after exposure
to infection
• Initially the lesion is painless papule
which ulcerates in the centre so that the
fully developed chancre is an indurated
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11. 11
• The canchre heals without scarring
even in the absence of treatment.
• Antibody tests are positive in 1-2
weeks after the appearance of
canchre.

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• Secondary syphilis
• Patient develops mucocutaneous lesions
and painless lymphadenopathy in 2-3
months after exposure
• ML may be in the form of mucous
patches on mouth,pharynx and vagina.
• Antibody tests are always positive at
this stage.it is a highly infective stage
.Spirochaetes can be easily demonstrated in
mucocutaneous lesions

13. Tertiary syphilis
After about 2-3 years following first exposure
tertiary lesions appear.
• much less infective than other 2 stages and
spirochaetes can be demonstrated with
great difficulty.
• The lesions are of 2 types:
1.syphilitic gumma
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• it is a solitary localised rubbery lession with
central
necrosis seen in organs like liver,testis,bone and
brain.
2.Diffuse lessions of tertiary syphilis.
• the lessions appear following widespread
dissemination of spirochaetes in the body.these
lesions are as under;
 Cardiovascular syphilis
• The walls of aorta is weakened and dialated due
to syphilitic aortitis and results in aortic
aneurysm,incompetence of aortic valve and

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 Neurosyphilis may manifest as:
o Meningovascular syphilis affecting chiefly
the meninges.
o Tabes dorsalis affecting the spinal cord.
o General paresis affecting the brain.

16. CONGENITAL SYPHILIS
 May develop in foetus of more than 16 weeks who
is exposed to maternal blood
 A major cause of still birth
 Pregnancies in women with primary & secondary
syphilis often end in spontaneous
abortion,perinatal death or a child with congenital
syphilis
 Antibiotics used to treat are
penicillin,doxycycline,and erythromycine
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17. Major morphological features are:
 Saddle shaped nose deformity due to
destruction of bridge of nose
 The characteristic Hutchinson’s teeth which
are small widely spaced,peg-shaped permanent
teeth
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 Mucocutaneous lesions of acquired
secondary syphilis
 Bony lesions like epiphysitis and
periostitis
 Interstitial keratitis with corneal opacity
 Diffuse fibrosis in liver and interstitial
fibrosis of lungs
 One of the most serious consequence of
congenital syphilis –neurological damage with
mental retardation

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20. PREVENTION
 Abstinence from intimate physical contact with an
infected person is effective , as is the proper use of
a latex condom.
 Congenital syphilis - by screening mothers during early
pregnancy and treating those who are infected
 The first-choice treatment for uncomplicated syphilis -
single dose of im benzathine penicillin or a single dose
of oral azithromycin.
 Doxycycline andtetracycline are alternative choices; but
not recommended for pregnant women,due to risk of
birth defects.
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21. GONORRHEA
An acute ,infectious sexually transmitted
disease of mucous membranes of the
genitourinary tract,eyes,rectum & throat.
Causative organism
Caused by gram-negative oxidase-
positive,diplococcus,Neisseria gonorrhoea.
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Pathogenesis
A venereal disease;name employed by Galen
First step in infection is adhesion of gonococci to
urethra or other mucosal surface.
 The incubation period is 2-8 days.
 In men, the disease start as an acute urethritis
with a discharge containing gonococci in large
numbers.infection extends along the urethra to
prostrate,seminal vescicle & epididymis

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 In women the initial infection involves
urethra and cervix uteri.It may extend to
Bartholin’sglands,endometrium&fallopian
tube.pelvic inflamatory disease and
salpingitis may lead to sterility.
 Conjunctivitis may occur,usually due to
autoinoculation by patients fingers

24.  Blood invansion may occur from the
primary site of infection & may lead to
metastatic lesions such as
arthritis,ulcerative endocarditis.
 A non venereal infection is gonococcal
opthalmia in newborn - direct infection
during passage through birth canal.
-controlled by instilling 1% silver nitrate
solutio
into the eyes of newborn. 24

25. EPEDEMIOLOGY
 WHO -88 million cases of
gonorrhea occur each year,.
 2010 - 900 deaths down from
1,100 in 1990.
 In UK 196 per 100,000 males
20 to 24 years old and 133 per
100,000 females 16 to 19 years
old were diagnosed in 2005.
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26.  In 2004, the rate of reported gonorrheal
infections was 113.5 per 100,000
persons.
 According to the CDC, "Overall, African
Americans are most affected by
gonorrhea. Blacks accounted for 69% of
all gonorrhea cases in 2010.
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27. Diagnosis:
Traditionally, gonorrhea was diagnosed
with gram stain and culture;
PCR-based testing methods are becoming
common.
.All people testing positive for gonorrhea
should be tested for other sexually
transmitted diseases such
as chlamydia, syphilis, and human
immunodeficiency virus
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28. TREATEMENT
 Antibiotic resistancehas developed to a
number of agents,
including macrolides, clindamycin,
and rifampin.
 Ceftriaxone, a third-
generation cephalosporin antibiotic, may
be as effective as penicillin-based
treatment.
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 CDC reccomendation for
uncomplicated
gonorrhea:
 Ceftriaxone 125mg single IM dose
or
 Ciprofloxacin 500mg single oral dose
plus
doxycycline 100mg twice daily for 7
days
or
 Erythromycine 1g single oral dose.

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CONTROL OF GONORRHEA
Consist of early detection of cases
,contact tracing,health education
and other general measures.
As the disease does not confer
any immunity vaccination has no
place in prophylaxis.