Presentation about SYPHLIS, the treatment

Syphilis disease

1. Sexually transmitted infection Dr. mona bakheet

2. Urethritis is inflammation of urethra ,is most common sexually transmitted illness in men. it is divided into 2 categories : Gonococcal urethritis and non-gonococcal urethritis. Gonococcal urethritis is caused by e.g. gonorrhoea and non-gonococcal is more common and caused by chlamydia. Symptom of urethritis is: Urethritis dose not always have symptom Burning micturition. White or cloudy discharge from the vagina or penis . An irritated or sore tip of penis 3

3. Diagnosis & treatment Swab test Urine test. Treatment : urethritis is usually treated with antibiotics ,it may take a week or two for symptoms to disappear completely. Any current sexual partners may also need treatment. Avoiding having sex until finish treatment 4

4. Compilation : Epididymitis- where the infection spread to the testicles. Pelvic inflammatory disease (PID) :where the infection spread to fallopian tube or womb. 5

5. Gonorrhoea Is sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoea ,gram –negative diplococci ,involve the genitals, mouth ,or rectum. Can affect people of any age but it is particularly common among teens and young adult. It transmitted by oral , anal ,or vaginal sex. Incubation period:2-7 days (usually 5 days). 6

6. Clinical features In men: Acute anterior urethritis Acute posterior urethritis Local complication like prostitis . In women: Asymptomatic Urethritis/cervicitis Local complications like pelvic inflammatory disease

7. Diagnosis urine tests smear Culture confirmatory tests for identification: oxidase + ve Glucose fermenter with acid production serological test 9

8. Gonococcal infection in male Present with acute gonococcal urethritis. Burning sensation in urethra with itching and irritation at the tip of penis. Dysuria At first there is profuse serous discharge and then become purulent with in 24 hours. On examination external meatus become red and oedematous and tender inguinal lymphadenopathy may be found. 11

9. Complication If infection extends to posterior urethra 1- increased dysuria and frequency of micturition 2- haematuria 3- frequent painful erection 4- may be with general constitutional symptoms (headache ,malaise ,fever) 5- prostatitis, vesiculitis ,epididymitis 6- scaring urethra or epididymis and subsequently infertitily . 12

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11. Gonococcal infection in women Cervicitis Urethritis Proctitis Accessory gland infection (skene ,Bartholin) Pelvic inflammatory disease conjunctivitis 14

12. Gonorrhoea in pregnancy The prevalent of gonorrhoea in pregnancy is approximately 1-10% Gonorrhoea infection could be associated with pelvic inflammatory disease in early pregnancy. Later in pregnancy gonorrhoea may be associated with premature rupture of membrane , preterm labour , and post partum infection. Pregnant women infected with gonorrhoea should be treated with cephalosporin, and not with quinolones or tetracycline's. 15

13. Extragenital gonorrhoea Anorectal Oropharyngeal Conjunctivitis

14. Diagnosis Demonstrating gonococcal from oral ,rectal, or genital sites. Blood or synovial fluid culture ---- gonococci Direct fluorescent antibody test(+ ve )from skin lesions. 17

15. Treatment Penicillin In case allergic to penicillin :ceftriaxone 250 mg IM single . If coexisting chlamydia infection Azithromycin single dose 1 gm orally. 18

16. Non- gonococcal urethritis Non –gonococcal urethritis is inflammation of urethra due to factors other than gonococci. Causes chlamydia trachomatis, Ureaplasma urealyticum ,trichomonas vaginalis ,candida species ,herpes simplex ,group B streptococci ,mycoplasma genitalium. The second most common cause is mycoplasma genitalium , which account for 15%to 20%of NGU. Clinical features of chlamydia in men: Urethritis IP 2-3 weeks mild urethritis with slight mucoid or mucopurulent discharge ,worse in early morning. 19

17. Diagnosis Gram –stained urethral smear(polymorphonuclear leucocytes+ epithelia cells+no organism ) bacterial urethritis. Culture Urine glass test . 20

18. Clinical feature in women Barthoinitis Cervicitis PID Decrease pregnancy rate.

19. syphilis Is a sexually acquired ,chronic ,infection caused by Treponema pallidum & is characterised by a variety of clinical manifestations. Mode of infection Direct contact Accidental Indirect Classification of syphilis :syphilis is classified into two broad categories, acquired and congenital . Incubation period 9-90 days(average 21). 22

20. Natural history of untreated patient 33% Arrested by host (serological test negative) 33% not progress (positive RPR) 33% Tertiary syphils 23

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22. Acquired syphilis Primary syphilis TP is introduced in to tissues through a small abrasion in skin or mucosa usually as a result of sexual intercourse . As the organism multiplies , the host tissues react and become infiltrated with lymphocytes and plasma cells which are concentrated in perivascular lymphatics . Involvement of vessel wall then occurs with proliferation resulting in endarteritis obliterans with subsequent local tissue destruction (chancer). This is followed 1-2 weeks by regional lymph node affection. 25

23. Acquired syphilis Secondary syphilis It develops as consequence of survival and extensive multiplication of TP through blood stream . This starts 3-10 weeks after apparent of chancer .the signs include : Skin rash (75%): 1) macular 2) popular 3)papulosquamous 4) chondylomata Lata 5) pustular .6 Annuler Generalised lymph adenopathy (50%). Mucous membrane lesion(33%). Chancer may be present(healing or healed) in 1/3 of cases. 26

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27. Secondary (3–10 weeks post chancre; dissemination to other tissues; clears in 3–12 weeks, but relapses in 25%) Prodromal signs (e.g., malaise, fever, lymph node enlargement, and arthralgia) Papulosquamous/maculopapular generalized rash (“copper colored”) w/ papules/plaques on palms/ soles (Fig. 5-9) “Moth eaten” alopecia Split papules (syphilitic perlèche) Mucous patches in oropharynx (condyloma Lata-like lesions of the mouth) Hypopigmented macules on neck (“necklace of Venus”) Condyloma Lata

28. Acquired syphilis Tertiary Syphilis : months to years after secondary – the period in between is called latency. Gummas (skin, bones, liver, and organs) Cardiovascular syphilis (e.g. aortitis) Neurosyphilis (e.g., paresis, meningitis, ataxia, tabes dorsalis, optic atrophy, gummas, and Argyll-Robertson pupil (accommodates to light, but does not react) 32

29. Acquired syphilis Latent syphilis : between the secondary and tertiary clinical stages of syphilis many years of latency ensue. The latent syphilis are subdivided in to early and late .during latency , the patient is a symptomatic with no sign on clinical examination. 33

30. Congenital syphilis Is transmitted from mother to baby during pregnancy or at birth Sign of early congenital syphilis: general feature of marasmus (senile face) due to dehydration----wrinkling of face ,café-au-lait . mucous membrane :mucous patches on lips mouth ,throat or larynx Syphilitic rhinitis(syphilitic snuffles) skin lesion : macules and papules bullous eruption (earliest eruption _syphilitic pemphigus) condyloma Lata radiating fissures at mouth angles leaving linear scars (Rhagades) syphilitic alopecia 34

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33. Congenital syphilis lymph nodes rubbery discrete and non tender viscera: Nephrotic syndrome and acute glomerulonephritis Bilateral orchitis Pneumonia alba Meningitis or meningoencephalitis Hepatomegaly Chorioretinitis (pepper and salt fundus) 37

34. Congenital syphilis BONE Osteochondritis (parrots pseudo paralysis) Periostitis Syphilitic dactylitis of proximal phalanges 38

35. Congenital syphilis LATE CONGENITAL SYPHILIS interstitial keratitis nerve deafness neuro syphilis bone involvement gummata osteo periostitis,(sabre tibia ,parrots node , higoumenakis sign )bilateral hydro arthrosis(Cluttons joint) dental abnormalities (Hutchinson teeth) paroxysmal cold haemoglobinuria 39

36. Diagnosis of syphilis Is made from clinical history and physical examination, supported skin by laboratory and serological testing. dark felid examination serological tests for syphilis : venereal disease research laboratory (VDRL) rapid plasma regain (PRP) Specific tests include: Enzyme immunoassay(EIA) Treponema pallidum haemagglutination (TPHA) Treponema pallidum particle agglutination assay(TPPA) Florescent tropnemal antibody test(FTA-ABS)

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42. Chancroid Is sexually transmitted infection ( STI ) caused by the small fastidious Faculatatively anaerobic gram- negative streptobacillus haemophilus ducreyi ( H.ducreyi ) .( rof fish) od with rounded ends tendncy to group in parallel short chains ( school of fish ) Its characterized by painful genital ulcers and painful swollen lymph glands in the inguinal and buboes Ip 3-10. Signs and symptoms : There are local ulcer and no systemic manifestation are present ,the ulcer characteristically: Ranges in size from (3-50mm) It is painful 46

43. Chancroid Has sharply define ,undermined borders Has irregular border Has abase that is covered with a Gray or yellowish –Gray material easily bleed if traumatized Painful swollen lymph nodes occur in 30-60% of patients Dysuria and dyspareunia in female About half of infected men have only a single ulcer, women frequently have four or more ulcers, with fewer symptoms 47

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45. complications Extensive lymph node inflammation may develop Large inguinal abscesses Super infection Phimosis can develop in long –standing lesion by scarring and thicking of foreskin

46. Diagnosis Culture Serology 51

47. Treatment Antibiotics : macrolides single oral dose (1 gram) of azithromycin, a single IM dose (250mg) of ceftriaxone oral (500mg) of erythromycin three times a day for seven days or oral (500mg) of ciprofloxacin twice a day for three days 52

48. Lymphogranuloma venereum LGV is a sexually transmitted infection (STI) caused by chlamydia trachomatis(L1 L2 L3) LGV affected heterosexuals ,through direct contact with lesions , ulcers or another area where bacteria are located. Signs and symptoms: IP 3-30 days Primary infection: small painless genital papules ,or shallow ulcers Secondary infection: occur 2-6 weeks after the primary infection ,painful and swollen lymph glands develop in the groin area 53

49. anal/rectal pain ,discharge ,bleeding ,tenesmus , constipation. patients may present with perirectal fistulas, abscesses , strictures and rectal stenosis . 54

50. Diagnosis History and physical examination Blood test ,which looks for antibodies against chlamydia trachomatis Nucleic acid amplification test (NAAT),which look for c.trachmatis 55

51. Treatment Antibiotics Doxycycline 100 BID for 3 weeks Erythromycin (pregnancy) 56

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53. Granuloma inguinale Is a sexually transmitted infection (STI) caused by the bacteria kelbsiella ( calymatobacterium ) granulomatis . It is also called donovanosis ,Donovan bodies(macrophages with intracellular bacilli) which are cellular components that are seen when scraping from the genital skin lesions are viewed under microscope.

54. Signs and symptom Firm papule or subcutaneous nodule at the site of contact that later ulcerates Most commonly affected penis(corona , glans ,and prepuce), the vulva (labia minora and fourchette) ,and anal area. Types : Ulcer vegetative most clinical presentation Nodular type Hypertrophic (verrucous) type 59

55. Signs and symptom Necrotic type Cicatricial (sclerotic) type Complication : the infection can spread to the inguinal region where it can cause swelling and ulceration. This is pseudo bubo. Chronic granuloma inguinal including bleeding ,secondary infection ,swelling from lymphoedema ,and significant scaring causing destruction of genital architecture 60

56. Diagnosis & treatment Direct microscopy of Giemsa- stained Looking for characteristics Donovan bodies Treatment Antibiotics : azithromycin or doxycycline or erythromycin for 3weeks 61

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