practical alexandria uni STD.pptx2.pptx

er

1. SEXUALLY TRANSMITTED DISEASES

2. Causative Organisms Bacterial: 1- Neisseria gonorrhoeae (Gonorrhea) 2- Haemophilus ducreyi ( Chancroid (soft chancre) 3- Treponema pallidum (Syphilis) 4- Chlamydiae : - Chlamydia trachomatis (D  K) (Non-specific urethritis ) - Chlamydia trachomatis (LGV) strains ( Lymphogranuloma venereum ) 5- Mycoplasma : - Ureaplasma urealyticum (Non-specific urethritis )

3. Causative Organisms Viral 1- Herpes simplex (type 2 mainly) (Genital herpes) 2- Papilloma virus (Genital warts) 3- Hepatitis B and may be C (Hepatitis) 4- HIV(AIDS) 5- Cytomegalovirus (CMV infection) 6-Pox virus ( Molluscum contagiosum ) Fungal Candida albicans (Vaginal thrush, balanitis ) Protozoal Trichomonas vaginalis ( Trichomonas genital infections)

4. NEISSERIA GONORRHEA Laboratory diagnosis 1- Specimen

5. In the chronic stage Prostatic discharge With the patient in the knee chest position enter the index finger per rectum and do massage of the prostate this may express some exudate for examination, and culture. If no discharge available get drops of urine sample after massage .

6. Laboratory diagnosis 2. Microscopic examination of specimens

7. Gram stain of urethral pus

8. Methylene blue stain for neisseria from smear cocci intra & extra cellular

9. Culture The urethral discharge or cervical swab is inoculated on chocolate blood agar incubated immediately in CO 2 enriched aerobic atmosphere at 37  C for 48 hours. The plates are examined after 48 hours and the colonies are identified by : - Oxidase test (positive). - Gram stained film (Gram negative diplococci ). = Production of acid from glucose. -Recently, coagglutination test using monoclonal antibodies has become available and this test may be used for identification of an isolate .

10. N.gonorrhoeae

11. Gram stain of Neisseria from culture

12. Immunological tests

13. MYCOPLASMA Laboratory Diagnosis 1. Specimens: upper genital tract specimens, urethral swab or urine. 2. Microscopic examination of specimens for mycoplasmas is obviously useless.

14. Laboratory Diagnosis 3. Isolation: Isolation form specimens is possible but it takes time (2 or more weeks) and is difficult. Special media for Mycoplasma , 10% CO 2 , At 37°c . Ureaplasma require 30% serum, 10% urea in the medium producing tiny colonies fried egg appearance

15. Urogenital Mycoplasmas Differentiation of genital mycoplasmas by growth inhibition with specific antisera . Ureaplasma has specific urease activity in fluid medium.

16. Laboratory diagnosis Serological tests: rarely used.

17. Mycoplasma By Electron Microscope

18. CHLAMYDIA Laboratory diagnosis 1- Specimen

19. Laboratory diagnosis 2. Microscopic examination Cytologic examination of cell scrapings stained with Giemsa stain for the presence of chlamydial inclusion bodies (valuable in ocular infection).

20. Tissue culture

21. IF

22. ELISA TEST

23. LIFE CYCLE OF CHLAMYDIA

24. Case 1

25. Case 2

26. Case 3

27. SYPHILIS T. Pallidum is the pathogenic treponema species known to cause syphilis.

28. Serological tests Cardiolipin antibody tests VDRL RPR Trepomemal antibody tests FTA-Abs TP-PA and TP-HA

29. VRRL

30. Rapid plasma reagin The rapid plasma reagin (RPR) test works on the same principle as the VDRL. It is available as a kit. The patient's serum is mixed with cardiolipin on a plastic-coated card that can be examined with the naked eye.

31. RPR

32. Fluorescent Trepomemal Antibody Test

33. Treponema Palladium Hemagglutination Test TPHA

34. LAB DIAGNOSIS OF SYPHILIS

35. Lab Diagnosis Of Syphilis Each stage of syphilis requires certain laboratory investigations . Primary stage : Specimens: Exudate from a chancre . Any suspected penile or female genital syphilitic lesion (chancre) should be squeezed gently using the gloved hand to obtain a serous exudate . Bleeding should be avoided because RBCs may mask the spirochetes as they are of almost the same size.

36. Detection of Trepomema 1- A drop of the exudate is placed on a slide and covered by a coverslip then is examined under dark ground microscopy to demonstrate typical motile Treponema pallidum .  

37. Detection of Trepomema 2. Exudate is spread on a slide, air dried, fixed and stained with fluorescein -labeled anti- treponemal serum then examined by means of immunofluorescence microscopy for typical fluorescent spirochetes.

38. Detection of Trepomema 3 . Nucleic acid probe and PCR techniques could be also used for detection and identification of Treponema pallidum in the exudate .

39. Serology   Cardiolipin antibodies ( reagin ) may be negative in early primary syphilis because they can only be detected after appearance of the chancre by about 10-14 days, but fluorescent treponemal (FTA) test may be positive earlier because it can detect IgM anti- treponemal antibodies.

40. Secondary stage   Specimens   Exudate from skin lesions, mucous patches or condyloma lata should be examined for the presence of Treponema pallidum in a similar way to that described above, i.e. dark ground microscopy and immunofluorescent microscopy, nucleic acid probe and PCR techniques.   Serology   Both groups of antibody tests, cardiolipin and antitreponemal , usually show strongly positive results in secondary syphilis.  

41. Latent syphilis Serum samples: All serological tests are characteristically positive although the patient appears well.   Late syphilis Serum samples : Serological tests for syphilis are almost always positive but the cardiolipin antibody tests may be negative in patients with old syphilis or partially treated syphilis while the treponemal antibody tests remain positive.   CSF samples The cardiolipin and treponemal antibody tests for syphilis are usually positive in the CSF in a patient with active neurosyphilis .