Sexually transmitted diseases

causative agent, prevention and control of syphilis, gonorrhoea, AIDS

1. Sexually transmitted diseases (std) DEVIPRIYA P V M PHARM Syphilis Gonorrhoea AIDS.

2. Sexually transmitted diseases STD are a group of communicable diseases that are transmitted by sexual contact and caused by a wide range of bacterial, viral, protozoal and fungal agents and ectoparasites . Control of STDs: STD control programme launched in 1949. Contact tracing: Once a case of STD is detected it is treated and the sex partner is also treated to prevent the recurrence. If the patient has more than one sex partner all of them must be traced and treated simultaneously. Cluster testing is done

3. Syphilis Syphilis is a chronic infection caused by treponema pallidium . The disease has a course of 30 years. Causative organism: The treponema pallidium is a spirochaete . It is a delicate spiral filament with 6 to 12 coils Mode of transmission: It is transmitted by having sexual contact with an infected person. Congenital syphilis is due to the transmission of syphilis of the foetus from infected mothers.

4. The disease has 3 stages: Primary stage: The primary lesions(chancre) develops at the site of inoculation. Incubation period is 10 days to 10 weeks Secondary stage: From 3 rd to 6 th month. The patient feels malaise, headache, sore throat and low regular fever. Tertiary stage: The lesions appear almost anywhere (skin, bone, tongue, testes, liver, aorta and CNS). Specific treatment: For early primary ( seronegative ) syphilis procaine penicillin 600,000 units intramuscularly per day is given for 10 days. For seropositive primary cases and for seconadary cases the double dose is given for 20 days.

5. Gonorrhoea Gonorrhoea is the infection of the mucous membrane of the genitourinary tract with Niesseria gonorrhoea . Causative agent: Niesseria gonorrhoea is a diplococcus . It is a gram negative intracellular organism Mode of transmission: Transmitted during the sexual intercouse with an infected person. In male, the infection starts in the anterior part of the urethra and tends to spread to the prostrate and to epididymis . The patient complaints of dysuria , increased frequency of micturition and a white discharge from urethra.

6. In female the infection is mainly in the urethra, the bartholinian glands and the cervix of the uterus. The patient complaints of dysuria and vaginal discharge. Incubation period: 3 to 10 days. Specific treatment: A single intamuscular injection of 6000,000 units of procaine penicillin.

7. AIDS (Acquired immunodeficiency syndrome) Causative organism: HIV virus(Human Immunodeficiency virus) is an RNA virus. It is a retrovirus that contains the enzyme reverse transcriptase. The virus affects the immune system and the body become vulnerable to various infections. Mode of transmission: (1)Sexual transmission: Any vaginal , oral or anal sex can spread AIDS as the virus is excreted with the vaginal or semen secretions. (2)Blood contact: Blood transfusion or through needles of injection (3)Placental transmission: From infected mothers to foetus through placenta

8. The HIV virus invades the T 4 lymphocytes, where it multiplies. The cells burst and other healthy T 4 lymphocytes are infected. The quantity and quality of these cells is decreased and the defence mechanism of body is destroyed HIV Virus

9. Incubation period is about 10 years. Treatment: Traetment of opportunistic infections with suitable drugs. ANTI RETROVIRAL DRUGS: (I)Reverse transcriptase inhibitors: (a) Nucleosides (given orally) Zidovudine , Didanosine , Zalcitabine , Lamivudine , Stavudine , Abacavir . (b) Non Nucleosides (given orally): Nevirapine , Efavirenz , Delaviridine . (II)Retroviral Protease inhibitor (given orally): Saquinavir , Ritonavir , Indinavir , Nelefnavir , Amprenavir , Loprinavir , Adefovir . (III)Other drugs: Foscornet (given orally) Interferon α (given I.V)

10. Treatment recommended for AIDS patients: 1 st choice: 2 nucleoside reverse transcriptase inhibirors + one protease inhibitor. Eg : zidovudine + Lamivudine + Indinavir . 2 nd choice: 2 nucleoside + one non nucleoside reverse transcriptase inhibiror Eg : zidovudine + Lamivudine + nevirapine Chemoprophylaxis for transmission of HIV from: (A)Mother to neonate during labour : To mother: 28 weeks onward zidovudine and give nevirapine at the time of delivery. To baby: zidovudine . (B)Post exposure prophylaxis: Start treatment immediately . zidovudine + Lamivudine + Saquinavir + Ritonavir (daily for 28 days)

11. Prevention: Using condoms. Sexual contact with one partner. Use only disposable sterilized needles and syringes. Blood and blood products should be transfused after strict laboratory investigations. Infected females should not conceive