Transcript SEXUALLY TRANSMITTED INFECTIONS (STI*s)

Romeo D. Dolar Jr, MD
FPOGS,FPASMAP,DPAPSHPI
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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…..
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A. Bacterial
B. Viral
C. Protozoan
D. Ectoparasites
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Gonorrhea – Neisseria gonorrhea
Chlamydia - Chlamydia trachomatis
Chancroid - Haemophilus ducreyi
Granuloma inguinale – Klebsiella granulomatis
Bacterial vaginosis – gardnerella vaginalis,
Mobiluncus, Bacteroides and Mycoplasma
Lymphogranuloma venereum – C. trachomatis
Syphilis – Treponema pallidum
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HIV – human immunodeficiency virus
HPV – human papilloma virus
HSV - herpes simples virus
Molluscum contagiosum
Heapatitis B virus
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Trichomoniasis – Trichomonas vaginalis
Pediculosis pubis – Phthirus pubis
Scabies – Sarcoptes scabiei
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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
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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,
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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
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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
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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
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
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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
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
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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
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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
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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
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Treatment :
METRONIDAZOLE 500 mg BID x 7 days
Metronidazole gel intravaginally
Clindamycin cream intravaginally
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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
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Treatment :
DOXYCYCLINE 100 mg BID x 21 days
Erythromycin base 500 mg QID x 21 days
Surgical reconstruction of fistulas n strictures
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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 condyloma
latum and generalized LA resolving in 2 to 6
wks
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Tertiary SY- with multi organ involvement
Endartiritis with aortic aneurysms, aortic
insufficiency, tabes dorsalis, 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
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
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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
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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..give ceftraixone 2 gms OD x
10-14 days IM/IV
Conenital SY – give ACP 100,000-150,000 u/kg/day
given in divided doses
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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
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Diagnosis: screening/ELISA/Western Blot
Treatment: Care /counselling/anti retroviral
drugs such as AZT/vaccines
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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
Treatment:
Vaccines – Gardasil/Cervarix
Podofilox cream/gels
Imiqiumod cream
Cryotherapy/ CO2 laser/ Electrocautery/ Cone
biopsy/TCA 80-90%/ Surgical Excision
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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
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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
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
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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
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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
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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
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
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