Transcript STD
STDs of Concern “Sores” (ulcers) Syphilis Genital herpes (HSV-2, HSV-1) Others uncommon Lymphogranuloma venereum Chancroid Granuloma inguinale • “Drips” (discharges) – – – – – Gonorrhea Chlamydia Nongonococcal urethritis / mucopurulent cervicitis Trichomonas vaginitis / urethritis Candidiasis (vulvovaginal, less problems in men) • Other major concerns – Genital HPV (especially type 16, 18) and Cervical Cancer Genital Ulcer Diseases – Does It Hurt? ► Painful Chancroid Genital herpes simplex ► Painless Syphilis Lymphogranuloma venereum Granuloma inguinale AIDS (Acquired Immune Deficiency Syndrome) • Caused by HIV (Human Immunodeficiency Virus) AIDS (Acquired Immune Deficiency Syndrome) Symptoms abdominal cramps coma coughing difficult or painful swallowing extreme fatigue fever lack of coordination mental symptoms such as confusion and forgetfulness Symptoms • • • • • • • • • ulcers in the genital region nausea pelvic inflammatory disease persistent or frequent yeast infections (oral or vaginal) persistent skin rashes or flaky skin seizures severe and persistent diarrhea severe headaches shortness of breath Transmission The AIDS virus is transmitted from one person to another through several methods: Blood or blood products Mother to infant Sexual contact Sharing of needles or syringes Syphilis • Caused by Treponema Pallidum Treponema Pallidum Treponema Pallidum Transmission In an infected person the bacterium spreads from the initial ulcer to the skin or mucous membranes of: – the anus of a sexual partner – the genital area – the mouth Transmission The bacterium can pass through broken skin on parts of the body. The syphilis bacterium is very fragile and infection is usually spread by an infected pregnant woman who can pass the bacterium to her unborn baby, which can result in the child being born with serious mental and physical problems sexual contact Symptoms An ulcer (a chancre ["shan-ker"]) appears within 10 days to 3 months after exposure, but usually within 2-6 weeks The chancre may be painless and can remain undetected inside the body, so may go unnoticed Symptoms The chancre usually appears on the part of the body exposed to the partner’s ulcer, such as: the anus the cervix the lips the penis the tongue the vagina the vulva other parts of the body Common symptoms include: a rash of flat, red lesions over the whole body (including the palms of the hands and soles of the feet) fever swollen glands broad-based papules (lumps or warts) in warm, moist sites mucous patches or snail-track ulcers in the mouth, appearing from 3-6 weeks after the chancre develops Common symptoms include: • • • • • • fatigue headache mild fever patchy hair loss sore throat swollen lymph glands throughout the body Symptoms in Pregnant Women Skin ulcers Rashes Fever Weakened or hoarse crying sounds Swollen liver and spleen Yellowish skin (jaundice) Anemia (low red blood cell count) Various deformities Primary Syphilis - Clinical Manifestations • Incubation: 10-90 days (average 3 weeks) • Chancre – Early: macule/papule erodes – Late: clean based, painless, indurated ulcer with smooth firm borders – Unnoticed in 15-30% of patients – Resolves in 1-5 weeks – HIGHLY INFECTIOUS Primary Syphilis Chancre Primary Syphilis Secondary Syphilis - Clinical Manifestations • Represents hematogenous dissemination of spirochetes • Usually 2-8 weeks after chancre appears • Findings: – – – – rash - whole body (includes palms/soles) mucous patches condylomata lata - HIGHLY INFECTIOUS constitutional symptoms • Sn/Sx resolve in 2-10 weeks Secondary Syphilis Rash Secondary Syphilis: Generalized Body Rash Secondary Syphilis Rash Secondary Syphilis Rash Secondary Syphilis Secondary Syphilis – Condylomata Lata More images of Syphilis More images of Syphilis More images of Syphilis More images of Syphilis More images of Syphilis More images of Syphilis Tertiary Syphilis - Joint “Drips” (Discharges) Gonorrhea Nongonococcal urethritis Chlamydia Mucopurulent cervicitis Trichomonas vaginitis and urethritis Candidiasis Gonorrhea • Caused by Neisseria gonorrhoeae Gonorrhea • Risk factors for getting gonorrhea include: – Having multiple sex partners – Having high-risk partner(s) – Having unprotected sexual contact (not using condoms). – Being a man who has unprotected sex with other men. – Starting sexual activity before age 18. Culture Culture Gonorrhea - Clinical Manifestations Urethritis - male Incubation: 1-14 d (usually 2-5 d) Sx: Dysuria and urethral discharge (5% asymptomatic) Dx: Gram stain urethral smear (-) > 98% culture Complications Urogenital infection - female Endocervical canal primary site 70-90% also colonize urethra Incubation: unclear; sx usually in l0 d Sx: majority asymptomatic; may have vaginal discharge, dysuria, urination, labial pain/swelling, abd. pain Dx: Gram stain smear (-) 50-70% culture Complications Gonorrhea Gonorrhea Gram Stain Genital Herpes Simplex - Clinical Manifestations • Direct contact – may be with asymptomatic shedding • Primary infection commonly asymptomatic; symptomatic • • • cases sometimes severe, prolonged, systemic manifestations Vesicles painful ulcerations crusting Recurrence a potential Diagnosis: – Culture – Serology (Western blot) – PCR Genital Herpes Simplex Genital Herpes Simplex Genital Herpes Simplex in Females Genital Herpes Simplex in Females Genital Herpes Simplex Nongonococcal Urethritis Nongonococcal Urethritis • Etiology: – 20-40% C. trachomatis – 20-30% genital mycoplasmas (Ureaplasma urealyticum, Mycoplasma genitalium) – Occasional Trichomonas vaginalis, HSV – Unknown in ~50% cases • Sx: Mild dysuria, mucoid discharge • Dx: Urethral smear 5 PMNs (usually 15)/OI field Urine microscopic 10 PMNs/HPF Leukocyte esterase (+) Perianal Wart Penile Warts Intrameatal Wart of the Penis (and Gonorrhea) Warts on the Thigh SO GUYS!! 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