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Sexually Transmitted Infections. Ataei .B , MD. MPH. مرد جوانی 4 روز بعد از تماس جنسی مشکوک دچار ضایعه دردناک الت تناسلی می شود د. در معاینه زخم نمای کثیف دارد وبه اسانی خونریزی می نماید. ودر لمس سفتی ندارد. غده لنفاوی بزرگ و دردناک نیز در ناحیه اینگوینال لمس میگردد. تشخیص بالینی شما چیست؟.

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Sexually transmitted infections

Sexually Transmitted Infections

Ataei .B , MD. MPH.


Case 1

مرد جوانی 4 روز بعد از تماس جنسی مشکوک دچار ضایعه دردناک الت تناسلی می شود د. در معاینه زخم نمای کثیف دارد وبه اسانی خونریزی می نماید. ودر لمس سفتی ندارد. غده لنفاوی بزرگ و دردناک نیز در ناحیه اینگوینال لمس میگردد.

تشخیص بالینی شما چیست؟

CASE 1


Etiology

Usual causes

Herpes simplex virus (HSV)

Haemophilusducreyi (chancroid)

ETIOLOGY


Usual initial laboratory evaluation

culture, direct FA, ELISA, or PCR for HSV; consider HSV-2-specific serology.

In chancroid-endemic area:

PCR or culture for H. ducreyi

Usual initial laboratory evaluation


Initial treatment

Herpes confirmed or suspected (history or sign of vesicles):

Treat for genital herpes with :

acyclovir,valacyclovir, or famciclovir

Initial Treatment


Initial treatment1

First episodes:

acyclovir (200 mg 5 times per day or 400 mg tid),

valacyclovir (1 g bid),

famciclovir (250 mg bid) for 7–14 days is effective.

Initial Treatment


Initial treatment2

Symptomatic recurrent genital herpes:

Short-course (1- to 3-day) regimens are preferred because of low cost and convenience.

Oral acyclovir (800 mg tid for 2 days), valacyclovir (500 mg bid for 3 days), or famciclovir (750 or 1000 mg bid for 1 day,

Initial Treatment


Initial treatment3

Chancroid confirmed or suspected (diagnostic test positive, or HSV and syphilis excluded, and lesion persists):

Ciprofloxacin 500 mg PO as single dose or

Ceftriaxone 250 mg IM as single dose or

Azithromycin 1 g PO as single dose

Initial Treatment


Case 2

بیمار 30 ساله ای 3هفته بعد از یک تماس جنسی مشکوک دچار یک پاپول روی دستگاه تناسلی شده است این ضایعه 3 روز بعد تبدیل به اولسر با جدار منظم می شود که بدون درد ودر معاینه سفت است وهمراه با لنفادنوپاتی بدون درد یکطرفه میباشد.

تشخیص بالینی شما چیست؟

CASE 2


Etiology1

Usual causes

Treponemapallidum (primary syphilis)

lymphogranulomavenereum

ETIOLOGY


Usual initial laboratory evaluation1

Dark-field exam,

direct FA,

PCR for T. pallidum;

RPR or VDRL test for syphilis (if negative but primary syphilis suspected, repeat in 1 week);

Usual initial laboratory evaluation


Initial treatment4

Syphilis confirmed (dark-field, FA, or PCR showing T. pallidum, or RPR reactive):

Benzathine penicillin 2.4 million units IM once to patient,

Preventive treatment

Recent (e.g., within 3 months)

Seronegative partner(s),

All seropositive partners

Initial Treatment


Management of syphilis in pregnancy

Every pregnant woman should undergo a nontreponemal test at her first prenatal visit

If at high risk of exposure, again in the third trimester and at delivery.

In the untreated pregnant patient with presumed syphilis, expeditious treatment appropriate to the stage of the disease is essential.

Management of Syphilis in Pregnancy


Recommended follow up evaluation after therapy for syphilis

Recommended Follow-Up Evaluation after Therapy for Syphilis


Case 3

جوان 23 ساله ای 4 روز بعد از تماس جنسی مشکوک به علت ترشح از مجرا و سوزش ادرار به مطب شما مراجعه می نماید.

تشخیص بالینی شما چیست؟

CASE 3


Urethritis

(1) mucopurulent or purulent urethral discharge,

(2) Gram stain of urethral secretions demonstrating 5 or more leukocytes per oil immersion microscopic field, or

Urethritis


Urethritis1

(3) a positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine demonstrating 10 or more leukocytes per high-power field.

Urethritis


Etiology2

Neisseriagonorrhoeae*

CAUSES OF NONGONOCOCCAL URETHRITIS

Chlamydia trachomatis (15–50%)*

Ureaplasmaurealyticum (10–40%)*

Mycoplasmagenitalium (30%??)

Trichomonasvaginalis (1–17%)*

Herpes simplex virus (primary) (?%)

ETIOLOGY


Treatment

Treatment

Initial Treatment for Patient and Partners

*Epidemiologic treatment of sexual partners is recommended


Alternative regimens

Ceftizoxime (500 mg IM, single dose)

or

Cefotaxime (500 mg IM, single dose)

or

Spectinomycin (2 g IM, single dose)

or

Cefotetan (1 g IM, single dose) plus probenecid (1 g PO, single dose)

or

Cefoxitin (2 g IM, single dose) plus probenecid (1 g PO, single dose)

Alternative regimens


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