1 / 36

SEXUALLY TRANSMITTED INFECTIONS (STI’s)

SEXUALLY TRANSMITTED INFECTIONS (STI’s). Romeo D. Dolar Jr , MD FPOGS,FPASMAP,DPAPSHPI. Sexually transmitted infections. Venereal disease = Sexually transmitted dse Used interchangeably The oldest described condition in medical history

teagan
Download Presentation

SEXUALLY TRANSMITTED INFECTIONS (STI’s)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SEXUALLY TRANSMITTED INFECTIONS (STI’s) Romeo D. DolarJr, MD FPOGS,FPASMAP,DPAPSHPI

  2. Sexually transmitted infections • Venereal disease = Sexually transmitted dse • Used interchangeably • The oldest described condition in medical history • Caused by several organisms…bacterial, viral,protozoan,ectoparasites • Transmissible by sexual contact, exchange of body fluids…..

  3. Classification of STI’s • A. Bacterial • B. Viral • C. Protozoan • D. Ectoparasites

  4. Bacterial STI’s • Gonorrhea – Neisseria gonorrhea • Chlamydia - Chlamydia trachomatis • Chancroid - Haemophilusducreyi • Granuloma inguinale – Klebsiellagranulomatis • Bacterial vaginosis – gardnerellavaginalis, Mobiluncus, Bacteroides and Mycoplasma • Lymphogranulomavenereum – C. trachomatis • Syphilis – Treponemapallidum

  5. Viral STI’s • HIV – human immunodeficiency virus • HPV – human papilloma virus • HSV - herpes simples virus • Molluscumcontagiosum • Heapatitis B virus

  6. Protozoan/ Ectoparasitic STI’s • Trichomoniasis– Trichomonasvaginalis • Pediculosis pubis – Phthirus pubis • Scabies – Sarcoptesscabiei

  7. Bacterial STI’s • Gonorrhea - gram negative diplococci, humans are the natural host with predilection for columnar and transitional epithelium…. • In women – mild or asymptomatic causing cervicitis ,PID , urethritis and actue pharyngitis • In males – mostly asymptomatic but causes urethritis ,prostatitis and epididymitis • In newborn – causes blindness, sepsis and joint infections

  8. Gonorrhea • 75% cases among adolescents 15-29 yo • Transmission occurs thru single sexual exposure among young age group, multiple sexual partners, failure of contraception use, promiscuity, lifestyle…. • Clinical presentation – 2-5 days from exposure and lasts for at least 30 days….MUCOPURULENT yellowish/greenish discharge… lower abdominal pain, fever,

  9. Gonorrhea • Dysuria, proctitis and pharyngitis • Disseminated gonococcal infection occurs in 3% of men than women eg.. Arthritis, pustular or vesicopustular skin lesions, septicemia, endocarditis ,meningitis and osteopyelitis, with increased risk of infertility and HIV exposure • Diagnosis – GRAM Stain/ Thayer Martin culture medium,Nucleic acid amplification test

  10. Treatment for Gonorrhea • DOC- Cephalosporins….CEFTRIAXONE 125 mg IM…CEFIXIME 400 mg oral (single treatment) • Quinolones – ciprofloxacin 500mg oral, ofloxacin 400 mg, levofloxacin 500 mg oral for 7 days • Alt regimen – Spectinomycin 2 gms IM • Azithromycin – 2 gms orally single dose • All should be tested for chlamydia and HIV

  11. Chlamydial STI’s • Gram negative intracellular bacteria caused by C. trachomatis… most commonly reported STI • Common coinfection with gonorrhea • 75 % of women are asymptomatic • Watery discharge • Urethritis ,pyuria, fever ,lower abdominal pain • May cause conjunctivitis and pneumonia in infants

  12. Chlamydial STI’s • Diagnosis – Culture…scraping from the cervix of women and urethra of males…Nucleic acid amplification using PCR • DOC : DOXYCYCLINE 100 mg BID x 7 days oral Azithromycin 1 gm oral…Ofloxacon 400 mg BID x 7 days..Erythromycin base 500 mg QID x 7 days….Levofloxacin 500 mg x 7 days OD Sequelae - PID ,Infertility, Ectopic pregnancy

  13. Chancroid STI’s • Caused by H. ducreyi… an gram negative coccobacillus…. • Genital ulcerative disease • Known cofactor of HIV transmission • Starts as small papules progressing into painful ulcers in 2 -3 days..if left untreated may lead to buboes,inguinal ulcers and regional lymphadenopathy • Diagnosis- Cultures not available , PCR

  14. Chancroid STI’s • Treatment: Azithromycin 1 gram oral Ciprofloxacin 500 mg oral BID x 7 days Ceftriaxone 250 mg IM single dose Erythromycin base 500 mg QID x 7 days like any other STI’s treat both sexual partners

  15. Granuloma inguinale STI’s • Caused by K. granulomatis ; DONOVANOSIS • Another genital ulcerative disease…gram negative intracellular…PAINLESS, beefy red, friable ulcers w/o lymphadenopathy ,with inguinal groin swelling caused by the SC spread of the granuloma leading to lymphedema and elephantiasis of the ext genitalia. • Diagnosis – ID of lesions,scraping of ulcers shows mononuclear cells with inclusion cysts…donovan bodies( pleomorphic rod like organisms

  16. Granuloma inguinale STI’s • Treatment : DOXYCYCLINE 100mg BID x 3 wks Ciprofloxacin 7500 mg BID x 3 wks TMP/SMZ 160/800 mg BID x 3 wks Erythromycin base 500 mg QID x 3 wks Azithromycin 1 gm x 3 wks

  17. Bacterial vaginosis • Caused by changes and replacement of the normal H2O2 producing lactobacillus with high concentrations of gardnerella , bacteroides and mycoplasma • Most common vaginal discharge and odor • Homogenous grayish discharges(FISHY odor) • Ph greater than 4.5 • Diagnosis - Pap smear and ID of discharge

  18. Bacterial vaginosis • Treatment : METRONIDAZOLE 500 mg BID x 7 days Metronidazole gel intravaginally Clindamycin cream intravaginally

  19. Lymphogranulomavenereum (LGV) • Caused by C. trachomatis producing local and regional ulcerationd and destructions of genital tissues • 21 to 34 days after exposure a primary genital ulcer develops…. Lesions resolves spontaneously…2 to 6 weeks later..unilateral or femoral lymphadenopathy develops later buboes and ruptures…. Fistula and strictures develop …. • Diagnosis – serology and exclusion of other causes of inguinal LA…compliment fixation test

  20. LGV • Treatment : DOXYCYCLINE 100 mg BID x 21 days Erythromycin base 500 mg QID x 21 days Surgical reconstruction of fistulas n strictures

  21. Syphilis • Caused by a spirochete..T.pallidum • Transmitted thru sexual contact..blood and from mother to baby • IP 10 to 90 days starts as painless,ulcerated hard chancre..primary lesions resolvesd in 2-6 wks(Primary SY) • 2ndary SY-bacteremic stage in 6 wks to 6 months as maculopapular rashes on palms soles and mucous membrane with condylomalatum and generalized LA resolving in 2 to 6 wks

  22. Syphilis • Tertiary SY- with multi organ involvement • Endartiritis with aortic aneurysms, aortic insufficiency, tabesdorsalis, optic atrophy and gummatous lesions • Latent SY- no evidence of any manifestations… diagnosed serologically..EARLY ((less than a year) Late (more than a year or of unknown duration) • Congenital SY – seen in preg women with abnormalities noted

  23. Syphilis • Diagnosis: Darkfield exam – to detect spirochetes in primary and secondary stages Non treponemal test- RPR/ VDRL quantitative and correlates with disease activity Treponemal test – FTA-ABS/ TP PA… poorly correlates with disease activity

  24. Syphilis • Treatment: 1ry,2ry,early latent and asymp recent contacts BENZATHINE Pen G 2.4 M units single dose IM Doxycycline 100 mg BID x 2 wks Tetracycline 500 mg QID x 2 wks Late ,latent and neuro SY BENZATHINE Pen G 2.4 M units IM x 3 wks Doxycycline 100mg BID x 4 wks Tetracycline 500 mg QID x 4 wks

  25. Syphilis • NeuroSY acqueous crystalline pen g 18-24 M units .day given 3-4 M units q 3-4 hrs or continuous IV x 10-14 days alt drug – procaine pen 2.4 M u daily with probenecid 500 mg QID x 10-14 days allergic to pen..giveceftraixone 2 gms OD x 10-14 days IM/IV Conenital SY – give ACP 100,000-150,000 u/kg/day given in divided doses

  26. VIRAL -HIV Seen in 1981..retrovirus causing deficiencies with malignancies ,oppurtunistic infections and death IP : 2 wks-4 wks…17 yrs Transmission is both vertical and horizontal among hetero, homosexuals, IV drug use, blood transfusion STI’s enhanced its susceptibility 80-90% are asymptomatic carriers Initial s/s…colds ,fever, myalgia etc...later infections Progresses to AIDs

  27. HIV • Diagnosis: screening/ELISA/Western Blot • Treatment: Care /counselling/anti retroviral drugs such as AZT/vaccines

  28. Human Papilloma virus (HPV) • Cause of genital mucocutaneous lesions • Caused by a double stranded DNA virus… thru sexual contact …more than 30 types of HPV seen in the genital tract… • HPV 6 and 11 causes of external warts • HPV 16,18,31,33,35 asso with CIN and SIL • Asymptomatic…with warty like lesions • Diagnosis: ID, Pap smear, Colposcopy

  29. HPV • Treatment: Vaccines – Gardasil/Cervarix Podofilox cream/gels Imiqiumod cream Cryotherapy/ CO2 laser/ Electrocautery/ Cone biopsy/TCA 80-90%/ Surgical Excision

  30. Herpes simplex virus (HSV) • Caused by HSV 2 double stranded DNA genital pathogen • HSV 1 causes 13-15% of genital infections • Reservoir of herpetic genital infection affecting the inguinal ganglias with increased risk of acquiring HIV infections • Primary lesions as vesicoulcerative ,shallow, coalescing painful ulcers x 2-3 wks • Diagnosis: ID lesions/PCR /Cultures

  31. HSV 2 • Treatment: Acyclovir 200-800 mg QID x 7-10 days Famcyclovir 250 mg TID Valcyclovir 1 gm OD Acyclovir gels/creams/ Vit B complex Pain relievers

  32. Molluscumcontagiosum • Caused by double stranded DNA poxvirus of several wks incubation • Small (1-5mm) umbilicated papules on the genital /nongenital sites • Diagnosis: ID of the papule with hyperkeratotic plug of an acanthotic epidermis Wright’s Stain Treatment: self limited (6-9 mos)/Cautery/Laser vaporization/cryotherapy

  33. Hepatitis B virus (HBV) • Transmitted thru IV tranfusion of infected blood products…IV drug use …sexual intercourse….mostly asymptomatic • IP: 6 wks to 6 mos. • Diagnosis: HBsAg • Treatment: Vaccines for NR px Supportive/Counselling/Interferon alpha and lamivudine

  34. Protozoan- Trichomoniasis • Caused by T. vaginalis, exclusively thru sexual intercourse with exchange of body fluids • Profuse yellow green frothy discharge with vaginal pruritus from an asymptomatic male after 5 to 28 days exposure • PINGPONG infection producing a strawberry cervix • Causes PID,infertility acute urethritis epidydimitis and prostatitis • Diagnosis: Hanging wet mount falling leaf like motility • Treatment: METRONIDAZOLE 500 mg BID x 7 days

  35. Ectoparasites- Pubic louse • Caused by pubic crab louse..with eggs(nits) on the base of the hair follicles..after 7 days nymph arises to become adults in 2-3 wks • Intense vulvar itching and pruritus • Diagnosis: ID of the nits and nymph in the pubic area • Treatment: Permethrin/Kwell lotion/Lindane/proper cleaning of sheets and beddings..treat the whole family

  36. Scabies • Caused by mite found anywhere on the skin • Transmitted thru close sexual contact/clothes and beddingsaffects the arms, breast, palms, hands Great dermatologic imitator Diagnosis: ID of linear burrows in mineral oil Treatment: Kwell/Permethrin/Lindane

More Related