Transcript Treatment
SEXUALLY TRANSMITTED
INFECTIONS
Dr B S Kumari
Associate Specialist
September 2015
OVERVIEW
Definition of Sexual Health
2. Epidemiology of STI’s
1.
-
Worldwide
UK
Sexually transmitted Infections
4. Physiological findings and Non STI’s in the
Genital Area
3.
Definition of Sexual Health (WHO)
Sexual health is a state of physical, emotional,
mental and social well-being related to sexuality;
Not merely the absence of disease, dysfunction or
infirmity.
Requires a positive and non judgemental
approach to sexuality and sexual relationships
Sexual rights of all persons must be respected,
protected and fulfilled
What is the burden of STI’s?
Worldwide &UK
World wide
More than 1 miilion people acquire STI’s every day
> 498 million new cases of curable STIs every
year(Chlamydia,Gonorrhoea,Trichomonas,Syphilis)
Most common is Trichomonal Vaginalis 276 million
Chlamydia 106 million
530 million have HSV2 genital herpes
290 million have Human papilloma virus
UK
450,000 new STI diagnosis in 2013 in UK
Most common Chlamydia(208,755 out of which 139,000 were in the 1524 yrs age group)
Global prevalence of STI
Rates of new STI diagnoses by LA of residence: England,
2013
England
London
• Data from routine GUM service returns & chlamydia data from
community services
• Data type: residence data
24
Public Health England: 2013 STI Slide Set
Whats the trend in STI’s in
UK?
CASE
75 yr old women
Husband died 15 yrs ago
No SI since last 15 yrs
c/o feeling sore down below since 2 weeks
No h/o similar symptoms in the past
On examination multiple tender ulcers on the
labia
Herpes antibody negative
STIs
Common bacterial infections
Chlamydia trachomatis
Neisseria gonorrhoea
Treponema pallidum (causes syphilis)
Lymphogranuloma venereum ( caused by chlamydia)
Haemophilus ducreyi (causes chancroid)
Klebsiella granulomatis (previously known as
Calymmatobacterium granulomatis) causes granuloma
inguinale or donovanosis.
Common viral infections
Human immunodeficiency virus (1&2)
Herpes simplex virus type 1 & 2
Human papillomavirus
Hepatitis B virus
Protozoal infection
Trichomonas vaginalis (causes vaginal trichomoniasis)
Classification on the Basis of Presentation
STD
Urethritis
Ulcerative
Chlamydia
Gonorrhoea
Non-specific urethritis
Genital Herpes
Syphilis
Chancroid
LGV
Donovanosis
Behcet`s Disease
Vaginal
Discharge
Systemic
Miscellaneous
Chlamydia
Gonorrhoea
Trichomonal infection
Candidiasis
Bacterial vaginosis
HIV
Hepatitis A
Hepatitis B
Hepatitis C
SARA
PID
Epididymo-orchitis
Genital warts
Molluscum
Contagiosum
Scabies
Pubic lice
*Not Transmitted sexually
Chlamydia Trachomatis
Most common sexually transmitted infection
5 -10% of sexually active women under 24 yrs and men between 20-24
yrs may be currently infected
Incubation period up to 2 weeks
Caused by serovars D-K
Risk Factors
Age under 25yrs
New sexual partner/ >1 sexual partner in the past year
New sexual partner being more important than number of
partners
Lack of consistent use of condoms
Symptoms of chlamydial infection
Men
- 50% asymptomatic
- Discharge and dysuria
Women
- 70-80% asymptomatic
- Discharge and dysuria
- Intermenstrual/ postcoital
- bleeding(cervicitis/endometritis)
- Abdominal pain
– 70% asymptomatic
Complications associated with Chlamydia
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Endometritis/ Salpingitis/ PID
Ectopic pregnancy
Infertility
Chronic pelvic pain
Pregnancy complications
Reiter’s syndrome
Epididimo-Orchitis
Fitz-Hugh Curtis syndrome
Chlamydia
Diagnosis
Nucleic Acid Amplification Technique (NAAT)
Specimen: urine (males), endocervical swab/self taken
vulvovaginal swab (females)
Sensitive 90-95%
Specificity 99% ( 93 – 100%)
Treatment
Azithromycin 1gm stat
(or)
Doxycycline 100mg bd 7 days
Gonorrhoea
Second commonest bacterial STI in UK
Neisseria gonorrhoea – intracellular, gram negative
diplococci
Incubation period 2-5 days but can be up to 2 weeks
Men symptomatic >80%, women asymptomatic 50%
Symptoms include dysuria, discharge, lower abdominal
pain
Extra-genital infection possible (pharyngeal)
Disseminated - skin lesions, arthralgia, arthritis and
tenosynovitis.
Gonorrhoea
Diagnosis
Test: NAAT , Culture and microscopy
Specimens : urine/urethral swab(males),endocervical ,throat
rectal swabs
Treatment
First Line – Ceftriaxone with Azithromycin
Increased resistance to Penicillins, Ciprofloxacin,
Tetracyclines.
Non-specific urethritis
Present in males
Diagnosis depends on symptoms ie discharge and
dysuria and microscopy showing pus cells
May be STI – usually chlamydia, less frequently
mycoplasma, ureaplasma sps.
May be trauma, allergic reaction, dermatitis
Treatment – similar to chlamydia treatment
(Azithromycin/Doxycycline)
SYPHILIS
•Classification
•Congenital
•Acquired
•Early
•(<2 years)
•Primary
•Late
•(> 2 years)
•Late latent
•Early
•<2years
•Tertiary
•Secondary
•Early latent
•<2years
Infectious Stage
•Late
•Stigmata
Primary Syphilis
Spirochaete – Treponema Pallidum
Primary chancre
Appears 10 – 90 days post-infection at site of
inoculation
Classically – solitary and painless BUT can
be multiple and painful and atypical
Often ignored when atypical
Resolves spontaneously within weeks
Primary Syphilis
Treponema pallidum
Primary Chancre
Secondary Syphilis
Around 6 weeks later
Alopecia, lymphadenopathy, snail track
ulcers, condylomata lata, maculopaular rash
(palms and soles), hepatitis……
Snail track Ulcers
Secondary Syphilis
Syphilis
Diagnosis
Direct: demonstration of Treponema pallidum
Dark field microscopy
PCR
Serology:
Non Specific
VDRL
RPR
Specific
TPPA
EIA
Treatment: Penicillin
Genital Herpes
Caused by herpes simplex virus
Same virus that causes cold sores
HSV-1 vs HSV-2
Spread by skin to skin contact – condoms do reduce risk of
transmission
Transmission occurs with or without lesions
Clinical features of Herpes
60% of primary genital HSV infections
asymptomatic
Multiple, painful ulcers
Flu–like symptoms
Can lead to urinary retention, especially in
women
First outbreak almost always worst
Recurrences decrease in frequency with time
Pathway of Herpes Infection
Genital Herpes
Diagnosis:
Clinical
HSV PCR, culture infrequently used
Treatment
Recommended regimens (all for five days):
Aciclovir 200 mg five times daily
Famciclovir 250 mg three times daily
Valaciclovir 500 mg twice daily
Reduces severity and duration of outbreak
No effect on recurrence rates
Low doses can be used prophylactically
Trichomonas vaginalis
A flagellated protozoan.
Found in the vagina, urethra and paraurethral glands.
Vulval itching, dysuria, offensive odour, strawberry cervix
Associated with preterm delivery and low birth weight.
Trichomonas vaginalis
Diagnosis
Clinical (strawberry cervix and discharge)
Posterior fornix vaginal wet film
TV culture
TV PCR based tests
Treatment
Metronidazole 2g orally in a single dose
Metronidazole 400 – 500mg bd 5/7
Partners need treatment
Genital Warts
Caused by human papilloma virus
Over 100 strains
Low risk types 6 and 11 causes visible lesions
High risk types 16 and 18 – vaccine preventable
types in UK.
HPV-16 and 18 contribute to over 70% of all cervical
cancer cases
HPV prevalence in normal cytology – 8.9%
Can be carried without symptoms
HPV
Genital Warts
Treatment usually topical – creams, cryotherapy, TCA, curettage
Molluscum Contagiosum
Could be sexually transmitted
Look like warts
Caused by pox-virus
Spread by skin to skin contact
Common in children
In adults, not commonly seen on face
Physiological findings
Pearly white papules
Fordyce Spots
Vulval Pappilomatosis
Epidermoid cyst
Non STI’s in genital area
Lichen planus
Lichen Sclerosis
Vulval Cancer
Fixed drug eruption
Systemic manifestations
of STI’s
Disseminated Gonococcal infection
Rash in secondary syphilis
Kaposi’s Sarcoma
Oral Candidiasis in HIV
CASE
On further questioning pt said she had sex
with a casual male 2 weeks prior to
presenting with symptoms
Herpes type 2 positive
Myth- older woman don’t have casual sex
Thank You