Gonorrhea , trichomoniasis , chlamidiosis , candidal and mycotic affection of the skin.

1. Gonorrhea, trichomoniasis, chlamidiosis, candidal and mycotic affection of the skin. Lector: Shkilna M.

2. CONTENT • Microbiology/Pathology of Neisseria gonorrhea. • Signs and Symptoms of Gonorrhea. • Complicationsof gonococci infection . • Disseminated Gonococci Infection. • Diagnosis and treatment of Gonococci Infection. • Chlamydia Infections in Women, Men, and Neonates. • Signs and Symptoms of Chlamydia. • Diagnosis and treatment of Chlamydia. • Signs and Symptoms of Trichomoniasis. • Diagnosis and treatment of Trichomoniasis.

3. What is gonorrhea? • Gonorrhea is a very common sexually transmitted disease, caused by a bacteria that easily grows and multiplies in warm, moist areas of the reproductive tract such as the cervix, the uterus, the fallopian tubes, and the urethra. This bacterium can also grow in the mouth, throat, eyes, and anus.

4. Infection • Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. • Ejaculation does not have to occur for infection to occur. • Gonorrhea can also be spread from mother to baby during delivery. This may cause blindness, joint infection, or a life-threatening blood infection in the baby. • People who have had gonorrhea and were treated may become infected again .

5. Gonorrhea: Gram Stain of Urethral Discharge On Gram stained slides, in gonococcal infection, the following are seen: Polymorphs. Gram-negative kidney-shaped extracellular andintracellular diplococci (ICDC).

6. Gram stain of urethral discharge showing gram negative, intracellular diplococci.

7. Gonorrhea Incubation Period -1-14 days. • Men have a 20% risk of getting the infection from a single act of vaginal intercourse with a woman infected with gonorrhea. The risk for men who have sex with men (MSM) is higher. • Women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with a man infected with gonorrhea. • An infected mother may transmit gonorrhea to her newborn during childbirth, a condition known as ophthalmia neonatorum

8. Signs and Symptoms • For men: • Burning while urinating • White, yellow, or green discharge from penis • Painful or swollen testicles • Many men experience no symptoms • Some have symptoms 2-5 days after infection, but they can take up to 30 days to appear

9. Signs and Symptoms • For women: • Pain or burning while urinating • Increased vaginal discharge • Irregular bleeding • Symptoms are often mild, but most women have no symptoms at all • Even when symptoms do occur, they are often mistaken for a bladder or vaginal infection

10. Gonococcal Bartholinitis • Tender swollen Bartholin’s gland with purulent discharge • Infection at other sites common

11. Bartholin’s Abscess • Painful swollen Bartholin’s glands • Fluctuant, tender • May have expressible purulent discharge

12. Chronic complications: Urethral stricture. Infertility. Acute complications: Infection of the glands . Ascending infection (prostatitis, cystitis, epididyrnitis). Infection of adjoining structures (periurethralabscess and infection of median raphe). Complicationsof gonococcal infection in males :

13. Complications in Women • Accessory gland infection • Bartholin’s glands • Skene’s glands • Pelvic Inflammatory Disease (PID) • May be asymptomatic • May present with lower abdominal pain, discharge, irregular menstrual bleeding and fever • Fitz-Hugh-Curtis Syndrome • Perihepatitis

14. DISSEMINATED GONORRHEACLINICAL PRESENTATION

15. Gonococcal Ophthalmiain the Adult • Marked chemosis and tearing • Typically purulent discharge, erythema

16. Gonococcal Ophthalmia in the Adult • Conjunctival erythema and discharge

17. Disseminated Gonococcal Infection • Gonococcal bacteremia • Sources of infection include symptomatic and asymptomatic infections of pharynx, urethra, cervix • Occurs in < 5% of GC-infected patients • More common in females

18. DGI Clinical Manifestations • “Dermatitis-arthritis syndrome” • Arthritis: 90% • Characterized by fever, chills, skin lesions, arthralgias, tenosynovitis • Less commonly, hepatitis, myocarditis, endocarditis, meningitis • Rash characterized as macular or papular, pustular, hemorrhagic or necrotic, mostly on distal extremities

19. DGI Skin Lesion • Necrotic, grayish central lesion on erythematous base

20. DGI Skin Lesion • Papular and pustular lesions on the foot

21. DGI Skin Lesion • Small painful midpalmar lesion on an erythematous base

22. DGI Skin Lesion • Pustular erythematous lesions

23. DGI Differential Diagnosis • Meningococcemia • Staphylococcal sepsis or endocarditis • Other bacterial septicemias • Acute HIV infection • Thrombocytopenia & arthritis • Hepatitis B prodrome • Reiter’s Syndrome • Juvenile Rheumatoid Arthritis • Lyme disease

24. Gonococcal Complications in Pregnancy • Postpartum endometritis • Septic abortions • Post-abortal PID Possible role in: • Gestational bleeding • Preterm labor and delivery • Premature rupture of membranes

25. Gonococcal Ophthalmia Neonatorum • Lid edema, erythema and marked purulent discharge • Preventable with ophthalmic ointment

26. Diagnosis • A doctor or a nurse can obtain a samplefrom parts of the body likely to be infected, such as the cervix, urethra, rectum, or throat, and send it to a lab for analysis. • Gonorrhea present in the cervix or urethra can be diagnosed through a urine sample. • A Gram stain is a quick lab test that can be done in a clinic or doctor’s office. This test allows the doctor to see the gonorrhea bacterium under a microscope and can be done for men and women.

27. GC Culture Specimen Streaking Cervical and Urethral

28. GC Culture After 24 Hours

29. Treatment • Several antibiotics can successfully cure gonorrhea • However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States. • Successful treatment is becoming more difficult. • Because many people with gonorrhea also have Chlamydia, antibiotics for both infections are usually given together. • In women, gonorrhea is a common cause of pelvic inflammatory disease (PID).

30. Chlamydia

31. What is Chlamydia? • Chlamydia, which is caused by the bacterium Chlamydia trachomatis, is the most frequently reported sexually transmitted disease in the United States. • Chlamydia is known as a “silent disease” because about ¾ of infected women and ½ of infected men have no symptoms. • Chlamydia can damage a woman’s reproductive organs. Serious complications that cause irreversible damage, such as infertility, can occur before a woman ever recognizes a problem and before any symptoms occur.

32. Infection • Chlamydia can be transmitted during vaginal, anal, or oral sex. • Women are frequently re-infected if their sex partners are not treated • Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth. Untreated chlamydia can lead to premature childbirth, and chlamydial infections of the eyes and respiratory tracts. Also, chlamydia is the leading cause of early infant pneumonia and conjunctivitis (pink eye) in newborns. • People who have had chlamydia and were treated may become infected again.

33. Chlamydia Infections in Women, Men, and Neonates Genitals Cervicitis PID Urethritis Eye (Conjunctivitis) Throat (Pharyngitis) Rectum (Proctitis) Eye (conjunctivitis) Lungs (pneumonia) • Genitals • (Urethritis) • (Epididymitis) • Rectum(Proctitis) • Throat (Pharyngitis) • Eye(Conjunctivitis) • Systemic • (Reiter’s Syndrome) 70-80% ASYMPTOMATIC >50% ASYMPTOMATIC

34. Signs and Symptoms • If symptoms do occur, they usually appear 1-3 weeks after exposure. • For women: • Initial infection is of the cervix and urethra: • Abnormal vaginal discharge • Burning while urinating • Infection spreads from cervix to fallopian tubes: • Lower abdominal pain • Low back pain • Nausea • Fever • Painful intercourse • Irregular bleeding • Cervical infection can spread to the rectum

35. Signs and Symptoms • For men: • Discharge from penis • Burning while urinating • Burning and itching around opening of penis • Rectal infection: • Rectal pain • Discharge • Bleeding • Throat infections can also occur through oral sex

36. CHLAMYDIAUNUSUAL PRESENTATIONS Trachoma Inclusion conjunctivitis Lymphogranuloma venereum

37. TRACHOMA

38. INCLUSION CONJUNCTIVITS

39. LGVCLINICAL MANIFESTATIONS

40. Diagnosis • Laboratory tests are done to diagnose chlamydia • Some are performed using a urine test • Other require a specimen from the penis or cervix

41. Complications

42. Treatment • There are several antibiotics that can successfully treat and cure chlamydia • Most common: Azithromycin (single dose) & Doxycycline (twice daily for a week) • To avoid re-infection, persons with chlamydia should abstain from sexual intercourse until they and their partners have completed treatment. • In women, untreated chlamydia can spread to the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). • Up to 40% of women with untreated chlamydia develop PID. • PID can cause permanent damage, leading to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancies.

43. Trichomoniasis

45. Symptoms • Between 10% and 50% of women infected with T. Vaginalis are asymptomatic. • Symptoms usually appear within 5 to 28 days of exposure. • Symptoms are nonspecific and cannot be used to differentiate trichomoniasis from other genital infections.

46. Profuse Watery Vaginal Discharge in Trichomoniasis

47. Proportion of asymptomatic trichomoniasis symptomatic 73% 77% asymptomatic Women Men Symptoms included penile or vaginal discharge or itching, dysuria, or lower abdominal pain.

48. Persistant vaginitis, 50% asympotmatic. Discharge 75%. Vulvar itching and burning 50%. Dyspareunia 50%. Dysurea 50%. Bad odor 10%. Strawberry cervix. Males: Urethritis and Prostatitis. Asymptomatic. Dysurea. Non purulent discharge. Non gonococcal urethritis. Clinical Aspects

49. Diagnosis • Clinical picture. • Microscopic morphology (wet mount) • Male vs female. • Antigen detection. • Look for other venereal diseases.

50. Wet mount microscopy Performed on vaginal swab specimens (or male urine sediment) resuspended in a drop or 2 of saline Organisms must be viable and motile Must be performed within 15 minutes of specimen collection 50 - 70% sensitivity with expert microscopist