Sexually transmitted diseases management

Introduction to Sexually transmitted diseases with a concentration on certain diseases like syphilis - herpes - chancroid- gonorrhoea - chamydia - bacteria vaginosis- trichomoniasis-candidiasis- human papilloma virus

1. Sexually Transmitted Diseases Dr. Sameh Ahmad Muhamad abdelghany Lecturer Of Clinical Pharmacology Mansura Faculty of medicine

2. Describe clinical characteristics of Sexually transmitted diseases Identify most likely etiologic organism(s) Review appropriate drug therapy Objectives

3. Sexually transmitted Diseases INTRODUCTION      Syphilis –Herpes- Chancroid Gonorrhea-Chlamydia Trichomoniasis-Bacterial vaginosis - candidiasis Human Papilloma virus CONTENTS

4. INTRODUCTION

5. Introduction The incidence of sexually transmitted disease(STD) is growing very fast not only in advancing countries but also in advanced countries. It was regarded as a main hazard to human health which can cause both serious worldwide social economic problems and public health problems.

6. Introduction STDs are a series of transmissible diseases which infected though sexual activity or indirect contact transmission. STDs can affect both genitourinary apparatus and many other organs though lymphatic system or hematogenous dissemination.

7. Major STDs Type of Agent Name Disease Viruses Human Papillomavirus Warts Herpes Simplex Herpes Hepatitis B Hepatitis HIV AIDS Bacteria Chlamydia Chlamydia Neisseria Gonorrheae Gonorrhea Treponema pallidum Syphilis Hemophilus ducreyi Chancroid Fungi Candida albicans Candidiasis Protozoa Trichomonas vaginalis Trichomoniasis Insects Sarcoptes scabii Scabies

8. Causes of Genital Ulcers Herpes Syphilis Chancroid

9. Causes of Urethral or Cervical Discharge Gonorrhea Chlamydia

10. Vaginitis Candidiasis Trichomoniasis Bacterial vaginosis

11. SYPHILIS

12. Syphilis Cause: Spirochete - Treponema pallidum

13. Clinical Manifestations Syphilis is a multi-stage disorder: Primary stage: Chancre is the main feature: Painless infectious Hard Single or multiple Several days - few months after infection Genitals, mouth, rectum, other areas Sometimes there is no chancre Ulcer heals; many may think there is no problem

14. Clinical Manifestations Syphilis is a multi-stage disorder: Secondary stage Infectious rash 3-6 weeks following infection Hands, soles of feet; other areas Fever and flu-like symptoms may also be apparent Rash typically heals after several weeks Condylomata Lata Wart-like lesions

15. Clinical Manifestations Syphilis is a multi-stage disorder: Latent Stage Infection hides in body, often central nervous system Infected person can remain in this stage for years There may be no symptoms for a long time Disease begins to attack organs Latent further divided into early, late, or unknown stages based on when infection occurred

16. Clinical Manifestations Syphilis is a multi-stage disorder: Late/Tertiary Stage Severe symptoms develop: paralysis/numbness blindness heart disease dementia

17. Syphilis

18. Complications Late syphilis Congenital syphilis HIV transmission

19. Investigation Dark Field exam : used to demonstrate the spirochete as shiny motile spiral structures with a dark background usually positive in the primary and secondary stages Serological test: Non specific : RPR(Rapid plasma reagin ), VDRL((venereal disease research laboratories) Specific: MHA-TP( Microhemagglutination Assay for Treponema pallidum Antibodies), IgG

20. Syphilis Treatment Early syphilis Benzathine penicillin G ( Bicillin L-A) 2.4 million units IM x 1 Late latent Benzathine penicillin G 2.4 million units IM per week x 3 Neurosyphilis and cardiovascular syphilis Intravenous penicillin G

21. HERPES

22. Herpes Herpes Simplex Virus (HSV) I and II

23. Symptoms Most common symptom is blisters First (primary) outbreak occurs within a few weeks of contact May continue for a couple weeks, longer for those with compromised immune system May feel painful, itchy, tingle/burn

24. Symptoms Flu-like symptoms (headache, fever, swollen lymph glands, muscle aches, etc ) Burning during urination

25. Symptoms

26. Complications are rare Spread to infants at delivery Severe infections in AIDS patients

27. Investigations Viral culture: This test involves taking a tissue sample or scraping of the sores for examination in the laboratory. Polymerase chain reaction (PCR) test. Blood test.

28. Treatment No cure Antivirals shorten duration, reduce frequency and severity of recurrences Acyclovir (Zovirax) Famcyclovir ( Famvir ) Valcyclovir (Valtrex) Different dosages for initial treatment vs. recurrent or suppressive treatment

29. CHANCROID

30. Chancroid Cause: Hemophilus ducreyi

31. Clinical Manifestations Painful sore (may be multiple) that looks like chancre with soft edges Male:female ratio 10:1

32. Symptoms

33. Investigation A definitive diagnosis of Chancroid requires the identification of H. ducreyi on special culture media

34. Treatment Azithromycin, Ceftriaxone

35. Causes of Genital Ulcers Herpes Painful , blister ulcer, shallow, multiple, recurrent Syphilis Painless single, not recurrent Chancroid Painful single or multiple, not recurrent

36. GONORRHEA

37. Gonorrhea Cause: Neisseria gonorrhea Gram negative diplococci

38. Clinical Manifestations Men: painful discharge from urethra Burning while urinating, Women: Pain when urinating. Vaginal discharge. Redness of the genital area often no symptoms

39. Complications Women: Pelvic Inflammatory Disease (PID) Infertility ectopic pregnancy Men epididymitis. Infertility Infants: Eye infection "ophthalmia neonatorum"

40. Investigation Gram Stain Culture Non-culture tests DNA Probe test ( GenProbe ) PCR/LCR test

41. Gonorrhea: Treatment Antibiotics for gonorrhea Cefixime ( Suprax ) 400 mg PO x 1 Ciprofloxacin (Cipro) 500 mg PO x 1 Azithromycin (Zithromax) 2 gm PO x 1 Ceftriaxone (Rocephin) 125 mg IM x 1 Always treat for chlamydia also

42. CHLAMYDIA

43. Chlamydia Cause: Chlamydia trachomatis

44. Symptoms Symptoms generally appear within three weeks of infection Men : scant clear discharge from urethra Women: cervical discharge Pain during urination Usually no symptoms for men or women

45. Complications Women: Pelvic Inflammatory Disease (PID), Infertility, ectopic pregnancy Infants :Pneumonia at 6 week age, eye infection

46. Investigation Culture Non-amplified tests Enzyme Immunoassay (EIA), e.g. Chlamydiazyme Nucleic Acid Hybridization (NA Probe), e.g. Gen-Probe Pace-2 NA amplification assays polymerase chain reaction (PCR) ligase chain reaction (LCR)s

47. Chlamydia: Treatment Antibiotics for Chlamydia Azithromycin 1 gm PO x 1 Doxycycline 100 mg PO BID x 7 days Communicate with sex partner Sexual intercourse should be avoided until treatment plan is finished Condoms can help prevent the spread of chlamydia

48. TRICHOMONIASIS

49. Trichomoniasis Cause: Trichomonas vaginalis (protozoan)

50. Clinical Manifestations Symptoms in women: Stinging in the vaginal area. Strong vaginal smell, outside of the ordinary. Vaginal discharge. Small ulcers on the vulva, etc. Symptoms in men: Stinging when urinating. Discharge from the penis. Stinging sensation in the urethra

51. Complications If the trichomoniasis is not treated or is treated incorrectly it can: Spread other sexually transmitted diseases and infections. Genital inflammation (the infection of HIV is easier).

52. Investigation Trich . on wet mount: looking at a sample of vaginal fluid for women or urine for men under a microscope. Culture: used to to diagnose trichomoniasis,

53. Treatment Metronidazole (Flagyl) 2 gm PO Very high recurrence rate after treatment

54. BACTERIAL VAGINOSIS

55. Bacterial Vaginosis Cause: Increase in Gardnerella vaginalis & others, decrease in lactobacilli

56. Clinical Manifestations Vaginal pain. Appearance of an abundant vaginal discharge. Burning sensation. An unpleasant smelly vaginal discharge ( like fish)

57. Complications: Increases the possibility of getting infected with HIV Offers more possibilities of catching other types of sexually transmitted diseases such as herpes, chlamydia or gonorrhoea . In a pregnant woman, increases the risk of having a premature birth.

58. Investigations Clue cells on wet mount: Clue cells=vaginal cells covered with bacteria that are a sign of bacterial vaginosis. Positive "whiff test“ Vaginal pH. A vaginal pH of 4.5 or higher is a sign of bacterial vaginosis.

59. Treatment Metronidazole ( Flagyl ) 500 mg BID x 7 days (oral tab). Clindamycin(cream) Tinidazole(oral tab) High recurrence rate after treatment

60. CANDIDIASIS

61. Candidiasis Cause: Candida albicans Not STD Symptoms: Cheesy white adherent discharge Treatment: Fluconazole (Diflucan) Terconazole ( Terazol )

62. Syndromic Treatment for STDs Genital ulcer - treat for syphilis Benzathine penicillin 2.4 million units IM Urethral discharge/cervical discharge - treat for gonorrhea and chlamydia Cefixime 400 mg or Cipro 500 mg AND Azithromycin 1.0 gm or Doxycycline 100 mg b.i.d . x 7 days Vaginal discharge in female - treat for trichomoniasis and bacterial vaginosis Metronidazole 2 gm

63. HUMAN PAPILLOMAVIRUS

64. HUMAN PAPILLOMAVIRUS Cause: Human Papilloma virus(HPV) Virus; therefore, incurable A group of many viruses 200+ strains 40+ HPV forms can be sexually transmitted

65. Clinical Manifestations Sometimes HPV provides no symptoms Most common symptom is genital warts Appearing days, weeks or longer after infection Less common among men

66. Clinical Manifestations

67. Complications Approximately 30 of the HPV strains are thought to cause cervical cancer HPV may also increase risk of vulvar, anal, penile,

68. Investigtion If genital warts aren't visible, you'll need one or more of the following tests: Vinegar (acetic acid) solution test: may help in identifying difficult-to-see flat lesions. Pap test: can reveal abnormalities that can lead to cancer. DNA test: can recognize the DNA of the high-risk varieties of HPV that have been linked to genital cancers.

69. Treatment Genital warts may disappear on their own Topical ointments/creams provided by physician Freezing/burning/laser treatments for smaller warts Communicate with all sex partners regarding HPV Refrain from sexual activity until warts are gone Condoms may help prevent HPV transmission (less definite than other conditions)

70. Prophylaxis HPV Vaccines: Vaccines for several HPV strains Example: Gardasil 3 injections across 6 months Protects against four high-risk HPV types (6, 11, 16, 18)

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