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Sexually Transmitted Diseases

Sexually Transmitted Diseases

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Sexually Transmitted Diseases

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  1. Sexually Transmitted Diseases

  2. Chlamydia trachomatis √ Lymphogranuloma venerum √ Neisseria gonorrhoea √ HIV/Hepatitis B √ Papillomaviruses Herpes simplex I , II Treponema pallidium Trichomonas vaginalis Haemophilus ducreyi Pediculosis Pubis-Phthirus pubis Genital Chlamydial Infection Gonorrhoea √ HIV infection/Hepatitis Ano-Genital Warts √ Genital Herpes √ Syphilis √ Trichomoniasis √ Chancroid √ Crabs √ Sexually Transmitted Diseases √=notifiable In Ireland • Granuloma Inguinale √, Candidiasis √, Bacterial Vaginosis ,Hepatitis C, Molluscum contagiosum √, NSU √

  3. Suggested Reading • Sexually Transmitted Diseases Treatment Guidelines 2002, MMWR, May 10, 2002/Vol.51/ No. RR-6, Available at http:/www.cdc • National Disease Surveillance Centre, Annual Report 2001

  4. Introduction STD`s in Ireland • Overall rise in 2001 by 9.4% • Most common 2001 Anogenital warts • Syphilis Rose by 506.5% • Hepatitis B by 160% • Gonorrhoea, Genital Herpes and Chlamydia trachomatis by over 20% each

  5. Chlamydia species • Order: Chlamydiales • Family: Chlamydiaceae • Genus: Chlamydia • Four species: Chlamydia trachomatis, C. psittaci, C.pneumoniae and C.pecorum • Biovars: Trachoma and LGV • Serovars: Trachoma 14(A-K), LGV (L1.L2,L3)

  6. Pathogenesis of Chlamydiaspecies • Obligate Intracellular organism, small non-motile • Consists of both RNA and DNA , ribosomes, cell wall and divide by binary fission • But lack peptidoglycan, lack ability to produce own ATP, so energy parasites • Implications for therapy, diagnosis

  7. Pathogenesis of Chlamydiaspecies • Exists in 2 forms • Elementary Body: extracellular, infectious, metabolically inert, 300-350 nm • Reticulate Body : non-infectious, metabolically active, 800-1000nm • Chlamydiae have a heat shock protein-? Significance in serological tests • LPS-2-keto-3-deoxyoctonic acid-genus specific previously used in CFT and ELISA tests

  8. Genital Chlamydia Infection • Currently the most common bacterial sexually transmitted infection (STI) in the UK and one of the most common in Ireland, prevalence between 2 and 12%, in women attending GP`s • Genital chlamydial infection 1991-2001, increased by 122% • Highest rates among 16-19 year old females (791/100000) and 20-24 year old males • Although 34,000 in 16-19 yr 1999, estimated extra 100000 cases in that age group alone • Why? c

  9. Genital Chlamydia Infection • Caused by Chlamydia trachomatis • If untreated can cause serious complications • Those at risk , unprotected sexual intercourse, esp. more than one partner and those who change sexual partner • Eye Infection: Inclusion conjunctivitis

  10. Between 1991-2001 new episodes seen at GUM clinics in England Rose 669,291 to 1,332,910 and increase 2000-2001 19% Chlamydial Uncomplicated genital infection CHLAMYDIA

  11. CHLAMYDIA Courtesy PHLS

  12. Genital Chylamydial Infection-IRL Year 2001: 1649 confirmed cases vs 869 in 1999

  13. Genital Chlamydia Infection • Transmission by unprotected sex or genital contact ( not casual contact) • Pregnant women can pass it on to infants during birth • An infected person frequently has no symptoms and may pass on infection to another • Up to 50% of men and 70% of women are asymptomatic initially

  14. Genital Chlamydia Infection • Symptoms in women : unusual vaginal discharge, bleeding between periods, pain passing urine and lower abdominal pain • Symptoms in men: discharge from penis, burning and itching in the genital area, pain passing urine • Acute infection usually last a few days and occur 1-3 weeks after becoming infected

  15. Genital Chlamydia Infection • Serious effects on women if left untreated • One third of women with untreated chlamydia go on to develop pelvic inflammatory disease • PID: Chlamydia can travel to salpinges and ovaries and result in inflammation, 1/5 women with an episode of PID will become infertile • It is the dominant infectious cause of chronic pelvic pain, infertility and ectopic pregnancy • Incidence of EP in England 1/100000, accounts for 21% of deaths resulting from complications of pregnancy and childbirth

  16. Genital Chlamydia Infection • Consequences of PID not easily treated and life-long consequences • An infected mother can pass infection onto baby resulting in eye infection(4-10 days) and pneumonia(4-12 weeks) (treated with erythromycin syrup and eye ointment) • Complications rarer in men • Both may develop painful arthritis

  17. Genital Chlamydia Infection • Protection: reduce number of partners and use condoms correctly and consistently • Lymphogranuloma venerum-

  18. Genital Chlamydia Infection • Diagnosis by urethral swab in male, endocervical swab female and urine test, first void • In States use combined DNA Amplification for Neisseria gonorrhoea and Chlamydia trachomatis • Now use Ligase Chain Reaction Test (LCR) or Polymerase Chain Reaction (PCR) • However in the past chlamydial culture using cell lines used • Testing for other STI`s should be carried out , ideally in GUM clinics

  19. Genital Chlamydia Infection • Ideally diagnose early , as uncomplicated chlamydial infection is easy to treat and cure • Doxcycline I00 mg bd for seven days or azithromycin 1g-single dose • All current and recent sexual partners( 60 days) of an infected person need to be tested whether or not they have symptoms

  20. C.trachomatis causing blindness

  21. Gram Stain of Neisseria gonorrhoea

  22. Neisseria gonorrhoeae Year 2001: 349 confirmed cases

  23. Neisseria gonorrhoeae • Limited to the columnar and transitional epithelium • In males: presents as acute purulent discharge fron the urethra with dysuria 2-7 days after exposure • Highly sensitive gram stain • Very few are asymptomatic

  24. Neisseria gonorrhoeae • In female: infection followed by mucopurluent cervicitis which is often asymptomatic, some vaginal bleeding post intercourse or d/c • In 20% -endometritis,salpingitis with PID and subsequent infertility and ectopic pregnancy • Pharyngeal and anorectal lesions are usually asympyomatic • Conjunctivitis in newborn may cause blindness if not rapidly and adequately treated

  25. Neisseria gonorrhoeae • Septicaemia 0.5-1.0% -may develop endocariditis, arthritis, skin lesions,meningitis • Arthritis usually polyarticular and may cause permanent damage • Strictly a human disease

  26. Gram Stain Culture on selective media e.g New York City Media , plated as soon as possible Confirm as N.gonorrhoeae by two different methods Oxidase Positive Colistin Resistance Nitrate Reduction negative Acid only produced from glucose Hydroxyprolylaminopeptidase positive Antigen detection Test Sensitivity Testing(Problem of QRNG) Neisseria gonorrhoeae

  27. Neisseria gonorrhoeae • Period of communicability for months if untreated • Contact Tracing, Treatment • Increased Risk of HIV infection

  28. GC PHARYNITIS

  29. GC OPHTHALMIA NEONATURUM

  30. Genital Herpes • Caused by Herpes simplex virus(HSV) • HSV 1(30%) and 2 • Primary or first episode is often severe (2 weeks after exposure), patient feels unwell generally and often gross inflammination with vesciles around genitals or anus, 2-4 weeks to resolve • Dormant phase , reside in nerve supplying area- to Reactivation with or without symptoms

  31. Genital Herpes • In 1999 17500 attending with first attacks in UK • Ireland 331 cases 2001 • 20-24 age group, more common in women • Risk behavior • Very infectious if sores/vesciles present • Infected women may pass to virus onto their baby during birth, neonatal herpes potentially life threatening, if present at delivery requires caesarean section

  32. Genital Herpes • Diagnosis: viral culture of vesicle or HSV type specific glycoprotein assays, must test for other sexually td • Treatment : antiviral therapy(e.g acyclovir 400mg tds for 7 days) , this reduces the length of severity of infection • If frequent or severe recurrences , continuous therapy may be required • More common now than 20yrs ago • Persons more susceptible to HIV infection

  33. GENITAL WARTS • Veneral Warts/Condylomata acuminata • Cause: Human papillomaviruses(HPV) • Site: Penis, anus, vagina • Over 100 types identified, 1/3 genitally acquired • 2 nd Most Common STI diagnosised in STD clinics in UK and most common Ireland (2001-3993) HPV type 6,11

  34. GENITAL WARTS • Same risk factors: unprotected sex, more than one partner , frequently change partners • In 1999 70000 men attended STD clinics in UK with first attack • Age highest rates: women 16-24 and men 20-24

  35. GENITAL WARTS • Infectious and 2/3 exposed will develop warts within 3 months • An infected person may have no symptoms but transmit the virus • In women they may occur inside vagina and on cervix, around anus • Risk to Newborn rare • If untreated may take months or years to disappear

  36. GENITAL WARTS • Serious health concern as some types particularly HPV 16 and 18 associated with MALIGNANT and PREMALIGNANT lesions of CERVIX( I.e. Cervical Cancer) • PREVENTION, ABSTINENCE, USING CONDOMS AND REDUCTION OF PARTNERS • TREATMENT: caustic solutions(Podofilox , TCAetc), Freezing with liquid nitrogen , Surgery. • May Recur even if treated

  37. TREPONEMA • Order: Spirochaetales • Family: Spirochaetaceae • Genus: Treponema

  38. TREPONEMA • VENERAL: Treponema pallidum • Non-veneral treponematoses : yaws, bejel, pinta • Yaws: tropical rainforest T.pertenue • Pinta: Central america, Peru, Columbia, Equator • Bejel/Endemic syphilis: T.pallidum Middle East, Russia, Turkey

  39. EPIDEMIOLOGY • 1999 USA 35,600 CASES , 556 CASES OF CONGENITAL SYPHILIS • Age group: 20-39 years, M:F RATIO 3:2 • 2-5 FOLD INCREASE IN TRANSMISSION OF HIV IF EXPOSED

  40. Treponema • The spirochaetes causing these different infections are micro-aerobic, morphologically identical –tightly coiled helical rods, 5-15 um long and 0.1-0.5 um diameter- show only subtle antigenic differences

  41. SYPHILIS • Treponema pallidum • I ST isolated from syphilitic lesions in 1905 • STI, although may be congenital or acquired from blood transfusion • Untreated syphilis is a progressive disease

  42. SYPHILIS Pathogenesis T.pallidum enters tissues by penetration of intact mucosae or through abraided skin It rapidly enters the lymphatics Widely disseminated through the bloodstream and may lodge in any organ Exact infecting dose not known but in animals less than 10 organisms sufficient

  43. SYPHILIS • The bacteria multiply at the initial entry site and a chancre, a lesion characteristic of primary syphilis forms after an average of 3 weeks • Painless and usually on the external genitalia, or cervix, anus, perianal, mouth • Usually occur singly except in immunocompromised • Heals spontaneously 3-6 weeks and 1-12 weeks later lesions of secondary syphilis occur

  44. Primary chancre on the prepuceChancre of the retracted prepuce

  45. Primary chancre of the vulva

  46. Chancre of the glansChancre eroded, leaving an ulcer