Sexually Transmitted Diseases.......pptx

Hearing the word “tumor” may naturally cause fear or panic. But a tumor is simply an abnormal buildup of tissue that occurs when cells divide too quickly or don’t die off as they normally should. A lung tumor is a tumor that occurs in the lung tissue itself or in the airways that lead to the lungs. Your airways include your:

Nose.
The inside of your nose (nasal cavity).
Throat (pharynx).
Voice box (larynx).
Windpipe (trachea).
The large tubes that carry air from your windpipe to your lungs (bronchi).
Lungs.
Lung tumors can either be cancerous (malignant) or noncancerous (benign).

If a healthcare provider tells you that you have a lung tumor and it “looks like it’s benign,” what does that mean? Should you have concerns?

When compared to malignant tumors, benign lung tumors:

Aren’t cancerous, so they won’t spread to other parts of your body.
Grow slowly or might even stop growing or shrink.
Aren’t usually life-threatening.
Usually don’t require removal.
Can expand and push against nearby tissues but won’t invade, destroy or replace other tissues.

1. Sexually Transmitted Diseases UNIVERSITY OF EAST SARAJEVO Faculty of Medicine in Foča Clinical microbiology

2. Sexually Transmitted Diseases (STD) broad but relatively well-defined group of infectious diseases , generally with acute manifestations that often progress to a chronic clinical picture . STDs rank among the most important of all infectious diseases with regard to the physical, psychological, and economic damage they cause to humans.

3. Sexually Transmitted Diseases – Causative agents The agents of STDs are highly varied pyogenic cocci ( gonococci ) spirochetes ( Treponema pallidum of syphilis) strict intracellular bacteria ( Chlamydia trachomatis ) viruses ( herpes simplex viruses 1 and 2 , human papillomaviruses [ HPVs ], and HIV ) protozoa ( Trichomonas vaginalis ) arthropods ( scabies, pubic lice ).

4. Epidemiology Worldwide, nearly a million people acquire an STD, including the human immunodeficiency virus (HIV), every day highest frequency among marginalized populations who have difficulty accessing health care services The United States has among the highest rates of STDs of any developed country in the world.

5. Movement of an STD throughout the population A large number of biological and social forces are also involved in the dynamics of STD transmission. rate of movement of an STD throughout the population depends on: the transmissibility of the infectious agent partners ’ sexual history the duration of infectiousness.

6. Groups at Risk The multiple, long-term, devastating consequences of STDs disproportionately affect women and infants STDs are especially prevalent among the young. In the United States, almost 50% of all STD cases occur in persons less than 25 years

7. ENCOUNTER AND ENTRY Most of the STD-causing agents enter the body at local sites mucosal or squamous epithelial layers of the cervix, urethra, rectum, oral pharynx or, to a lesser extent, the vagina An exception is HIV . Although HIV is transmitted primarily by sexual contact , contaminated blood products or hypodermic needles are also a source of infection.

8. SPREAD AND MULTIPLICATION All the agents that cause STDs are able to resist the host’s nonspecific defense mechanisms and are infectious, that is , they are able to attach to and enter tissue with relative ease. The fact that chronic manifestations of STDs are relatively frequent indicates that the agents often cause asymptomatic disease and are not easily eliminated by specific immune responses

9. DAMAGE The acute manifestations of the most frequent STDs fall into two groups: mucopurulent cervicitis and urethritis , as in gonorrhea and chlamydial infection genital ulcer disease, as in syphilis and genital herpes .

10. DAMAGE With the exception of HIV, the STD-causing agents tend to cause primary lesions at or near the site of entry It is not uncommon for these lesions to be so indolent as to go unnoticed or to be located at an anatomical site as to be invisible. As a consequence, diagnosis and treatment are often delayed , enabling the transmission and progression of the disease to continue.

11. Damage The most serious consequences of STDs relate to their progression to chronic infections . These include Pelvic infl ammatory disease (PID), an ascending infection of the uterus and fallopian tubes most commonly caused by gonococci and chlamydia Anogenital cancer, including cervical cancer, caused by some HPV types Secondary and tertiary syphilis Recurrent herpes infection

12. Damage Many of these chronic infections cause additional adverse sequelae : Fallopian tube scarring and adhesions of surrounding tissues , resulting in ectopi pregnancy , infertility, and chronic pelvic pain Congenital diseases such as in syphilis, herpes, papillomatosis and chlamydial infection Increased risk of acquiring HIV , due to genital ulcers (found in syphilis, chancroid , and herpes) or altered genital mucosa (found in gonorrhea and chlamydial infection) Adverse outcomes of pregnancy including premature termination, fetal wastage, low birth weight, and premature rupture of membranes

13. Pelvic Inflammatory Disease or female upper reproductive tract infection ascending infection of the uterus, fallopian tubes, ovaries, and adjacent peritoneal linings Frequently results in severe, irreversible sequelae such as infertility, ectopic pregnancy, and chronic pelvic pain

14. Pelvic Inflammatory Disease approximately 60% of cases are subclinical, during which women experience no or only mild symptoms and do not seek medical care until late sequelae such as infertility or an ectopic pregnancy occurs

15. Pathobiology of PID The events that lead to PID are not well understood. It is likely that almost all cases involve the ascending spread of infection from the lower to the upper genital tract. A proportion of cases progress to develop chronic sequelae .

16. Causative agents of PID Most cases of PID are caused by the sexually transmitted organisms N. gonorrhoeae or C. trachomatis and follow cervicitis and urethritis . Other organisms implicated in the etiology of PID include Mycoplasma hominis , Mycoplasma genitalium , Ureaplasma urealyticum , and numerous aerobic and anaerobic bacteria such as Escherichia coli and Prevotella species.

17. HIV and STDs two obvious relationships between HIV infection and other STDs are: increased transmission of HIV due to other STDs alteration in the natural history, diagnosis, or response to therapy of other STDs in the presence of HIV infection.

18. HIV and STDs The risk of HIV transmission is increased three- to five fold in the presence of both the genital ulcer diseases (e.g., genital herpes and syphilis) and nonulcerative diseases such as gonorrhea and chlamydial infections and trichomonal vaginitis . The compromised immune system of patients with AIDS may result in more severe manifestations of other STDs.

19. Clinical case

20. Questions and answers What was the second antibiotic taken by Mr. C. and Ms. N., and why was it given? The second antibiotic was azithromycin . Mr. C. was probably infected with both gonorrhea and chlamydiae at the time of his visit to the physician. Since more than 55% of men with gonorrhea have coexisting chlamydial infection, the Centers for Disease Control and Prevention recommends that every treatment for uncomplicated gonorrhea (a single intramuscular injection of ceftriaxone ) be accompanied by a single dose of azithromycin for chlamydiae (since chlamydiae are not susceptible to ceftriaxone ). Azithromycin is an attractive drug for chlamydial treatment for two reasons: (1) its long half-life provides sustained killing concentrations over the length of the slow chlamydial developmental cycle and (2) patient adherence is not an issue because the treatment requires only a single oral treatment of two 500-mg capsules rather than multiple pills over several days.

21. Questions and answers Why were nucleic acid amplifi cation assays performed instead of culture on Ms. N.’s endocervical specimen? Nucleic acid amplification tests are more sensitive and faster than culture, especially for chlamydiae . By amplifying the Chlamydia trachomatis plasmid DNA, the assays can detect as few as one to three elementary bodies (EBs). Chlamydial EBs, which are only 0.25 μm in diameter, cannot be recognized on Gram stain. They would appear as tiny, featureless red dots. Moreover, because they are obligate intracellular bacteria, chlamydiae cannot be cultured on agar media. Culture of chlamydiae is done in epithelial cells, and cultivation takes at least 48 hours for growth. In addition, culture is expensive and is performed in only a few sophisticated hospital diagnostic laboratories that have tissue culture facilities (usually in clinical virology laboratories).

22. Questions and answers If Ms. N. had not heeded Mr. C.’s advice and sought medical attention, what might have been the consequences for her? What are the pathophysiological mechanisms of such sequelae ? Like most women with chlamydial cervicitis , Ms. N. was asymptomatic. Without appropriate azithromycin therapy, Ms. N. might have developed ascending infection and eventually pelvic infl ammatory disease (PID)— endometritis and salpingitis . The pathophysiological mechanisms are likely immune mediated. Direct inoculation of a cultured Fallopian tube in vitro with C. trachomatis produces only mild salpingitis that heals with minimal scarring. However, in both patients and monkey models in vivo, the infection produces severe salpingitis , adhesions, scarring, and tubal occlusions. These observations support the belief that the immune response is an important component underlying the pathophysiology of the disease.