SEXUALLY TRANSMITTED INFECTIONS

SEXUALLY TRANSMITTED INFECTIONS

1. Sexually Transmitted Infections

2. Sexually transmitted infections (STIs) include those infections, which are predominantly transmitted through sexual contact from an infected partner

3. GONORRHEA

4. Causative organism Neisseria gonorrheae - Gram-negative diplococcus

5. Site of invasion Columnar Transitional epithelium of the genitourinary tract.

6. Primary Sites of infection endocervix, urethra, Skene’s gland Bartholin’s gland.

7. Other sites of infection Oropharynx anorectal region conjunctiva

8. Clinical Features in adult 50 percent of patients with gonorrhea are asymptomatic The clinical features are claasified as: Local. Distant or metastatic. PID

9. Local Urinary symptoms such as dysuria (25%) Excessive irritant vaginal discharge (50%) Acute unilateral pain and swelling over the labia due to involvement of Bartholin’s gland

10. There may be rectal discomfort due to associated proctitis from genital contamination Others: Pharyngeal infection, intermenstrual bleeding.

11. Distant or Metastatic Perihepatitis Septicemia

12. Perihepatitis results from spread of infection to the liver capsule. There is formation of adhesions with the abdominal wall.

13. Septicemia is characterized by low grade fever, polyarthralgia, tenosynovitis, septic arthritis, perihepatitis, meningitis, endocarditis, and skin rash.

14. COMPLICATIONS Infertility, ectopic pregnancy (due to tubal damage), dyspareunia, chronic pelvic pain, tubo -ovarian mass Bartholin’s gland abscess

15. DIAGNOSIS NAAT (Nucleic acid amplication testing) Thayer - Martin medium

16. TREATMENT PREVENTIVE CURATIVE

17. PREVENTIVE Adequate therapy for gonococcal infection and meticulous follow up are to be done till the patient is declared cured. To treat adequately the male sexual partner simultaneously. To avoid multiple sex partners. To use condom till both the sexual partners are free from disease.

18. FOLLOW UP Cultures should be made 7 days after the therapy. Repeat cultures are made at monthly intervals following menses for three months. If the reports are persistently negative, the patient is declared cured.

19. CHLAMYDIAL INFECTIONS

20. CAUSATIVE ORGANISM Chlamydia trachomatis

21. INCUBATION PERIOD 6-14 days

22. SITE OF INVASION Columnar and transitional epithelium of the genitourinary tract. SUPERFICIAL invasion

23. Site of infection Urethra Bartholin’s gland Cervix.

24. CLINICAL FEATURES 75% - non-specific and asymptomatic Dysuria, dyspareunia, postcoital bleeding intermenstrual bleeding

25. COMPLICATIONS Urethritis and bartholinitis Chlamydial cervicitis spreads upwards to produce endometritis and salpingitis. Chlamydial salpingitis  infertility and ectopic pregnancy

26. DIAGNOSIS Chlamydial nucleic acid amplification testing Polymerase chain reaction (PCR) is a very sensitive and specific test (95%) ELISA  sensitivity less compared to NAAT Chlamydia can be demonstrated in tissue culture  100% specific

27. SYPHILIS

28. CAUSATIVE ORGANISM Treponema pallidum

29. MODE OF SPREAD Syphilitic lesion of the genital tract is acquired by direct contact with another person who has open primary or secondary syphilitic lesion. Transmission occurs through the abraded skin or mucosal surface.

30. SITE OF INFECTION PRIMARY LESION  Labia (may be single/ multiple) Other sites:- Fourchette, Anus Cervix nipples

31. CLINICAL FEATURES Incubation period ranges between 9 and 90 days. PRIMARY  A small papule is formed, which is quickly eroded to form an ulcer. The margins are raised with smooth shiny floor. The ulcer is painless The inguinal glands are enlarged and painless. The primary chancre heals spontaneously in 1–8 weeks leaving behind a scar.

32. Secondary syphilis— Coarse, flat-topped, moist, necrotic lesions Systemic symptoms like fever, headache, and sore throat. Maculopapular skin rashes are seen on the palms and soles. Other features  generalized lymphadenopathy, mucosal ulcers, and alopecia.

33. LATENT SYPHILIS  dormant phase after secondary syphilis TERTIARY SYPHILIS when not treated. Damages CNS, CVS, MUSCULOSKELETAL SYSTEM. GUMMA D eep punched ulcer with rolled out margins. It is painless with a moist leather base

34. DIAGNOSIS History of exposure to an infected person. Identification of the organism— Treponema pallidum, an anaerobe. VDRL  + ve 6 weeks after initial infection

35. SPECIFIC TEST Treponemapallidum hemagglutination (TPHA) test, Treponema pallidum enzyme immunoassay (EIA), fluorescent treponemal antibody absorption (FTA-abs) test Treponema pallidum immobilization (TPI) test.

36. FOLLOW UP: Serological test is to be performed 1, 3, 6, and 12 months after treatment of early syphilis. In late symptomatic cases, surveillance is for life The serological test is to be done annually.

37. HIV & AIDS

38. INCIDENCE Spreading fast and has become a global problem.

39. MODE OF TRANSMISSION Sexual intercourse Intravenous drug abusers. Transfusion of contaminated blood or blood products. Use of contaminated needles, needlestick injuries. Breastfeeding

40. Perinatal transmission—The vertical transmission to the neonates of the infected mothers is about 25–35%. The baby may be affected in utero (30%) through transplacental transfer, During delivery (70–75%) by contaminated secretions and blood of the birth canal.

41. Gynecological symptomatology Infection of the genital tract Vaginitis – recurrent candidiasis PID with other STIs Neoplasms of the genital tract are increased Increased incidence of wound infection

42. Menstrual abnormality: Menorrhagia, amenorrhea, or abnormal uterine bleeding may be due to associated weight loss, thrombocytopenia or opportunistic infections or neoplasms.

43. DIAGNOSIS CD 4 cells Detection of IgG antibody to Gp 120 (envelope glycoprotein component) Viral P-24 antigen  Detected soon after the infection ELISA is extremely sensitive (99.5%) but less specific. Western blot or immunoblot—It is highly specific but complicated and time consuming HIV RNA by PCR is the gold standard for diagnosis of HIV.

44. TREATMENT Safer sex with barrier methods Male circumcision reduces transmission by 50%. Use of blunt tipped needles to avoid needle stick injury during surgery. HIV negative blood transfusion HIV negative frozen semen to use for artificial donor insemination. Termination of pregnancy in HIV positive women when requested.

45. Wide spread voluntary counseling and testing Mother needs to be counseled as regard the risks and benefits of breastfeeding. She is helped to make an informed choice.