sexuallytransmittedinfections-130112235416-phpapp02 (1).pdf

Dr.T.V.Rao MD
1/12/2013 Dr.T.V.Rao MD 1

What is a Sexually Transmitted
Infection or STI?
• STI’s are infections that are spread
from person to person through
intimate sexual contact.
• STI’s are dangerous because they are
easily spread and it is hard to tell just
by looking who has an STI.
• 1 in 4 sexually active teens has an
STI ?.
1/12/2013 Dr.T.V.Rao MD 2

STDs
• STDs are diseases and infections
which are capable of being spread
from person to person through:
– sexual intercourse
–oral-genital contact or in non-sexual
ways.
–IV drugs
1/12/2013 Dr.T.V.Rao MD 3

Four Classes of STD’s
• Bacterial
• Fungus
• Parasites
• Viruses- NOT curable ?
1/12/2013 Dr.T.V.Rao MD 4

Common STI’s
• Chlamydia
• Gonorrhea
• Genital Herpes
(HSV-2)
• Genital Warts
(HPV)
• Hepatitis B
•HIV and
AIDS
•Pubic Lice
•Syphilis
• Trichomoniasis
1/12/2013 Dr.T.V.Rao MD 5

What are some common
Symptoms of STIs?
• The symptoms vary among the different types
of STIs. Some examples of common
symptoms include:
– Unusual discharge from the penis or vagina
– Sores or warts on the genital area
– Burning while urinating
– Itching and redness in the genital area
– Anal itching, soreness, or bleeding
• If having any of these symptoms or think you
might have an STI, talk to your health care
provider.
1/12/2013 Dr.T.V.Rao MD 6

STIs in Women
• Women are more
vulnerable
biologically,
culturally,
socioeconomically
• Most are
asymptomatic (no
symptoms)in
women
1/12/2013 Dr.T.V.Rao MD 7

8
STDs of Concern
• Actually, all of them
• “Sores” (ulcers)
–Syphilis
–Genital herpes (HSV-2, HSV-1)
–Others uncommon in the U.S.
• Lymph granuloma venereum
• Chancroid
• Granuloma inguinale
1/12/2013 Dr.T.V.Rao MD

9
STDs of Concern (continued)
• “Drips” (discharges)
– Gonorrhea
– Chlamydia
– Nongonococcal urethritis / mucopurulent cervicitis
– Trichomonas vaginitis / urethritis
– Candidiasis (vulvovaginal, less problems in men)
• Other major concerns
– Genital HPV (especially type 16, 18) and Cervical
Cancer
1/12/2013 Dr.T.V.Rao MD

Scientifically known as the
gonococcus, or Neisseria gonorrhea
1/12/2013 Dr.T.V.Rao MD 10

Signs & Symptoms
• Most infected
women have no
symptoms
• Include a painful or
burning sensation
when urinating,
increased vaginal
discharge, or vaginal
bleeding between
periods
1/12/2013 Dr.T.V.Rao MD 11

NEISSERIA GONORRHOEAE
• 3rd most common STD i
• It is a G-ve diplococci
• Infects the endocervix  mucopurulent cervicitis
• Majority of infections are asymptomatic
• It is a leading cause of PID
• Dx  endocervical culture
• N gonorrhea & chlamydia coexist in 50% of patients
• Rx  ceftriaxone 125 mg IM
cefixime 400 mg PO
• Followed by Rx for chlamydia
• Husband should be treated
• Can cause purulent conjunctivitis of the newborn
1/12/2013 Dr.T.V.Rao MD 12

13
Gonorrhea - Clinical
Manifestations
• Urethritis - male
– Incubation: 1-14 d (usually 2-5 d)
– Sx: Dysuria and urethral discharge (5% asymptomatic)
– Dx: Gram stain urethral smear (+) > 98% culture
– Complications
• Urogenital infection - female
– Endocervical canal primary site
– 70-90% also colonize urethra
– Incubation: unclear; sx usually in l0 d
– Sx: majority asymptomatic; may have vaginal discharge, dysuria,
urination, labial pain/swelling, abd. pain
– Dx: Gram stain smear (+) 50-70% culture
– Complications
1/12/2013 Dr.T.V.Rao MD

14
Gonorrhea
Source: Florida STD/HIV Prevention Training Center
1/12/2013 Dr.T.V.Rao MD

Gonorrhea
1/12/2013 Dr.T.V.Rao MD 15

16
Gonorrhea Gram Stain
Source: Cincinnati STD/HIV Prevention Training Center
1/12/2013 Dr.T.V.Rao MD

Effects on Pregnancy
• Can also be spread from mother
to child during birth
• Can cause fertility problems, birth
defects, skin problems, arthritis,
blood poisoning, and heart and
brain infections
1/12/2013 Dr.T.V.Rao MD 17

18
Nongonococcal Urethritis
• Etiology:
– 20-40% C. trachomatis
– 20-30% genital mycoplasmas (Urea plasma urealyticum,
Mycoplasma genitalium)
– Occasional Trichomonas vaginalis, HSV
– Unknown in ~50% cases
• Sx: Mild dysuria, mucoid discharge
• Dx: Urethral smear 5 PMNs (usually 15)/OI field
Urine microscopic 10 PMNs/HPF
Leukocyte esterase (+)
1/12/2013 Dr.T.V.Rao MD

Treatment
• Several antibiotics can successfully cure
gonorrhea
• Because of drug-resistance the successful
treatment o single shot of ceftriaxone 125 mg
or a single dose of cefixime 400 mg taken by
mouth are currently the recommended
antibiotic treatment
• Azithromycin (Zithromax) 2g in a single dose may be used for
people who have severe allergic reactions to ceftriaxone,
cefixime, or penicillin.f gonorrhea is becoming more difficult
1/12/2013 Dr.T.V.Rao MD 19

20
Bacterial Vaginitis
• Controversy: STD - yes or no
• Need for treatment
– 1980: only if patient complains
– 2002: increased risk of:
• Preterm birth / premature rupture of membranes
• Amniotic fluid infection
• Chorioamnionitis / Postpartum endometritis
• Pelvic inflammatory disease
• Postsurgical infection
• Cervical intraepithelial neoplasia
• Mucopurulent cervicitis
• Acquisition of HIV infection
1/12/2013 Dr.T.V.Rao MD

SYPHILIS
1/12/2013 Dr.T.V.Rao MD 21

About Syphilis
• Researchers tracing origins(CBC, 5:03)
• Incidence
 US: 13,997 in 2009
• Top 13 states = 75% of cases per CDC
• Data by sex (males on the increase, females on the
decrease)
 King County: 289 early syphilis cases in 2010
• 285 - men, 4 - women
 Over 90% among men (MSM)
• Source: 2009 King County STD Epidemiology Report
• Caused by bacteria, therefore curable
• Transmission via vaginal, oral, anal sex
1/12/2013 Dr.T.V.Rao MD 22

Syphilis Symptoms
• Syphilis is a multi-stage disorder:
 Primary stage - painless, infectious chancre
• 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
• Illustration: male (MayoClinic)
• Photos: oral male, female, mix (CDC, Univ. of South Carolina
Integrated Biomedical Sciences; University of Quebec; Cincinnati STD/HIV
Prevention Training Center; istdpictures.com)
1/12/2013 Dr.T.V.Rao MD 23

24
Primary Syphilis -
Clinical Manifestations
• Incubation: 10-90 days (average 3
weeks)
• Chancre
–Early: macule/papule erodes
–Late: clean based, painless, indurated
ulcer with smooth firm borders
–Unnoticed in 15-30% of patients
–Resolves in 1-5 weeks
–HIGHLY INFECTIOUS
Sores
1/12/2013 Dr.T.V.Rao MD

25
Primary Syphilis Chancre
1/12/2013 Dr.T.V.Rao MD

26
Primary Syphilis
Source: Centers for Disease Control and Prevention
1/12/2013 Dr.T.V.Rao MD

Syphilis Symptoms
 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 (on female, male, CDC)
1/12/2013 Dr.T.V.Rao MD 27

28
Secondary Syphilis -
• Represents haematogenous dissemination
of spirochetes
• Usually 2-8 weeks after chancre appears
• Findings:
– rash - whole body (includes palms/soles)
– mucous patches
– Condylomata lata - HIGHLY INFECTIOUS
– constitutional symptoms
• Sn/Sx resolve in 2-10 weeks
1/12/2013 Dr.T.V.Rao MD

29
Secondary Syphilis Rash
1/12/2013 Dr.T.V.Rao MD

30
Secondary Syphilis: Generalized Body
Rash
Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
1/12/2013 Dr.T.V.Rao MD

31
Secondary Syphilis Rash
1/12/2013 Dr.T.V.Rao MD

Syphilis
1/12/2013 Dr.T.V.Rao MD 32

Syphilis Symptoms
• 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
• Late/Tertiary Stage
 Severe symptoms develop: paralysis/numbness; blindness;
heart disease; dementia
1/12/2013 Dr.T.V.Rao MD 33

34
Secondary Syphilis
Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas
1/12/2013 Dr.T.V.Rao MD

Syphilis Treatment
• Penicillin or other antibiotics
• Communicate with all sex partners
regarding syphilis
• Refrain from sexual activity until
infection is gone
• Condoms may help prevent syphilis
transmission
1/12/2013 Dr.T.V.Rao MD 35

Chancroid
• A sexually transmitted disease caused by a bacterium.
More commonly seen in men than women, particularly uncircumcised
males
• Chancroid is spread by having unprotected anal, vaginal or oral sex.
• Some symptoms include:
– sores or raised bumps on the genitals which eventually if untreated,
becomes filled with pus and eventually ruptures leaving a painful
sore/ulcer.
– The bacterial may also infect the lymph glands in the groin. These
glands may become enlarged, hard and painful.
– In Women, ulcers appear on the genitals, painful urination and
painful intercourse
• Chancroids are contagious as long as the person as open sores. The open
sores contain bacteria and any contact with these sores can result in
infection.
• Chancroids may be treated with certain antibiotics. The ulcers generally
heal within 2 to 3 weeks.
1/12/2013 Dr.T.V.Rao MD 36

Chancroid ulcers
CDC / Center for Disease Control and Prevention/ Division of STD Prevention
1/12/2013 Dr.T.V.Rao MD 37

Regional adenopathy
CDC / Center for Disease Control and
Prevention/ Division of STD Prevention
1/12/2013 Dr.T.V.Rao MD 38

Chlamydia
• Bacterial Infection
• Spread During
unprotected anal,
vaginal, or oral sex.
• Symptoms: Occur within
7-21 days of infection.
• Men: Clear thick
discharge from Penis,
burning during urination
• Women: Painful
Urination, itching,
burning or bleeding from
vagina.
1/12/2013 Dr.T.V.Rao MD 39

40
Chlamydia trachomatis
• More than three million new cases annually
• Responsible for causing cervicitis, urethritis,
proctitis, lymphogranuloma venereum, and
pelvic inflammatory disease
• Direct and indirect cost of chlamydial
infections run into billions of dollars
• Potential to transmit to newborn during
delivery
– Conjunctivitis, pneumonia
1/12/2013 Dr.T.V.Rao MD

Chlamydia
• Chlamydia is one of the most common STIs, infecting an
estimated 1 in 6 teens.
• An infected person with no symptoms can still pass the
disease to others, or have serious complications.
• Symptoms in a male may include: a slight discharge (drip)
from the penis, and a tingling sensation or pain with
urination.
• A female may experience irregular bleeding, pain during
intercourse, a vaginal discharge, belly pain, or pain with
urination.
• Untreated chlamydia can lead to fertility problems. This
disease can also be passed to babies during birth.
• Chlamydia is treated with antibiotics
• To prevent chlamydia use latex or plastic condoms each time
you have sex.
1/12/2013 Dr.T.V.Rao MD 41

Chlamydia
• Four million new cases occur each year
• SYMPTOMS: fever, weight loss for no reason, swollen glands, fatigue,
diarrhea, white spots on the mouth.
FEMALE SYMPTOMS:
Vaginal discharge (white or grey) or burning with
urination
Lower abdominal pain
Bleeding between menstrual periods.
Low-grade fever (later symptom)
MALE SYMPTOMS:
Discharge from the penis and/or burning when
urinating
Burning and itching around the opening of the penis
Pain and swelling in the testicles
Low –grade fever (associated with epididymitis –
inflammation of the testicles)
1/12/2013 Dr.T.V.Rao MD 42

Chlamydia
1/12/2013 Dr.T.V.Rao MD 43

Chlamydia Cervicitis
Source: St. Louis STD/HIV Prevention Training Center
1/12/2013 Dr.T.V.Rao MD 44

Chlamydia Complications
• Conjunctivitis in newborn (eye drops given)
• Reiter’s Disease (sensitive photos)
• Pelvic Inflammatory Disease (“PID” Illustration)
– Infection
– Disease-causing organisms migrate to uterus, fallopian
tubes, ovaries
– Untreated, PID leads to scarring, pelvic pain, tubal
pregnancy, infertility
– Treatment includes antibiotics
– Approximately 1 million women affected each year
– Approximately 100,000 women become infertile each year
– )
1/12/2013 Dr.T.V.Rao MD 45

Chlamydia Complications
• Epididymitis
 600,000 cases a year
 Inflammation of epididymis
• Tube located in back of testicle
• Holds maturing sperm
 Disease-causing microbe enters urethra, travels
 Symptoms include fever, pain, discharge, swelling
 Treatment includes antibiotics, STD treatment if
applicable
 Chronic epididymitis does not threaten fertility
1/12/2013 Dr.T.V.Rao MD 46

Lymphogranuloma venereum
• From different chlamydia
bacteria
• More prevalent in Asia,
Africa, South America, but
increasing in North
America; now required to
be reported in WA
• Per DOH, six cases in 2008-
2009
• Painless pimple or lesion
on genitals
• Infection spreads to lymph
tissue
1/12/2013 Dr.T.V.Rao MD 47

Lymphogranuloma
Venerum (LGV)
CDC / Center for Disease Control and Prevention/ Division of STD Prevention
Complication of Chlamydia
1/12/2013 Dr.T.V.Rao MD 48

 Herpes Simplex Virus (HSV-2), which
is related to the viruses that belongs to
the same family of viruses that cause
chicken pox and shingles
1/12/2013 Dr.T.V.Rao MD 49

About Herpes
• Transmission via vaginal, oral, anal sex
• Transmission of virus can also occur through fingers
(touching a sore, then touching a membrane)
• Transmission of virus possible when no sores present
• Transmission to fetus possible, but not typically if
herpes was contracted before pregnancy
 If pregnant woman contracts herpes toward end of
pregnancy, transmission to fetus more likely
 If pregnant woman has active herpes, Cesarean performed
• Transmission may occur outside body contact, but no
proof
1/12/2013 Dr.T.V.Rao MD 50

HERPES GENITALIS
• It is a recurrent sexually transmitted disease
• Caused by Herpes simplex virus
HSV-1  10% of genital lesions
HSV-2  90% of genital lesions
• HSV-1 & 2 also infect the orofacial skin in reversed %
• The virus causes prolonged lifelong infection of the
nerve cells of the affected area
1-PRIMARY (FIRST) INFECTION  multiple vesicles
which will ulcerate forming shallow superficial ulcers
over the external genitalia
• There is often simultaneous involvement of the
vagina & cx
1/12/2013 Dr.T.V.Rao MD 51

Herpes 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
1/12/2013 Dr.T.V.Rao MD 52

HERPES GENITALIS
• It causes severe pain, itching, vaginal discharge &
painful urination  urine retention that may require
catheterization
• Associated with fever, general malaise & headache
• It takes 2-4 weeks to heal
2-SECONDARY (RECURRENT ) HERPES
• The viruses that are already present in the nerve
cells will be reactivated by various stresses such as
generalized illness, menses, emotional stress or
trauma
• It is less painful, circumscribed, not associated with
generalized symptoms & lasts an average of 7 days
1/12/2013 Dr.T.V.Rao MD 53

Herpes
1/12/2013 Dr.T.V.Rao MD 54

Source: CDC/NCHSTP/Division of STD, STD
Clinical Slides
Oral Herpes
1/12/2013 Dr.T.V.Rao MD 55

Oral Herpes
1/12/2013 Dr.T.V.Rao MD 56

Herpes Simplex Oralis
patient age: 15 years, patient sex: male
1/12/2013 Dr.T.V.Rao MD 57

Herpes Simplex 1 & 2
• 45 million people in
the United States
ages 12 and older
have herpes
• 1 out of 5 of the
total adolescent and
adult population, are
infected with Herpes
Simplex
1/12/2013 Dr.T.V.Rao MD 58

Primary Herpes,
vulva
CDC / Center for Disease Control and
Prevention/ Division of STD Prevention
1/12/2013 Dr.T.V.Rao MD 59

60
Genital Herpes Simplex -
• Direct contact – may be with asymptomatic shedding
• Primary infection commonly asymptomatic; symptomatic
cases sometimes severe, prolonged, systemic
manifestations
• Vesicles painful ulcerations crusting
• Recurrence a potential
• Diagnosis:
– Culture
– Serology (Western blot)
– PCR
1/12/2013 Dr.T.V.Rao MD

HERPES GENITALIS
• There may be an association between the Herpes
virus & precancerous & cancerous conditions of
the genital tract . The virus has been detected in
in squamous cell carcinoma of the cx vagina &
vulva
• It was not proven to a causative factor for these
cancer
• Transmission of AIDS virus is increased in the
presence of genital ulcers caused by infections
such as Herpes or Syphilis
1/12/2013 Dr.T.V.Rao MD 61

Herpes Type 2 (HSV-2)
• Cause lesions around
and on the genital
areas
• Bumps form on the
lips and sometimes in
the mouth, tongue,
and throat
• Blisters crust over and
heal within 10-16 days
1/12/2013 Dr.T.V.Rao MD 62

63
Epidemiology of Genital Herpes
• One of the 3 most common STDs, increased 30% from
late 70s to early 90s
• 25% of US population by age 35
• HSV-2: 80-90%, HSV-1: 10-20% (majority of infections
in some regions)
• Most cases subclinical
• Transmission primarily from subclinical infection
• Complications: neonatal transmission, enhanced HIV
transmission, psychosocial issues
Sores
1/12/2013 Dr.T.V.Rao MD

64
Genital Herpes Simplex
Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas
1/12/2013 Dr.T.V.Rao MD

65
Source: CDC/NCHSTP/Division of STD, STD Clinical Slides
1/12/2013 Dr.T.V.Rao MD

66
1/12/2013 Dr.T.V.Rao MD

Effects on Pregnancy
•Type 2 Viral shedding from
cervix, vagina, vulva plays the
primary role in transmitting the
disease from mother to infant
•About 60% of newborns infected
and not treated will die or be
severely damaged
1/12/2013 Dr.T.V.Rao MD 67

HERPES GENITALIS
• Dx Viral culture of a suspicious lesion
Blood test for detection of antibodies  helpful
to
Dx asymptomatic individuals or to confirm a past
infection
• Rx Acyclovir 200mg orally 5 times /day for 10 days
  duration of ulcerative lesions
Improve the symptoms
Used for 1ry infection
-2ry infection  no Rx
-Supportive care  keeping the area clean & dry
xylocaine jelly
Applying compresses
Tylenol
1/12/2013 Dr.T.V.Rao MD 68

HERPES GENITALIS
• Patients with recurrence ≥ 6 years  prophylactic
Acyclovir 400 mg twice a day
• To reduce sexual transmission  couples should avoid direct
sexual contact (by abstinence or using condom) when the
infected individual has a lesion or experiencing a prodrome
“tingling, itching, or pain felt before the recurrent lesion
appear”
• 1ry infection in pregnancy close to delivery  risk of
transmission to the newborn  50%
• If the mother have active lesions  elective CS should be
performed
• Infection to the newborn is devastating  disseminated
infection with CNS involvement & 50% mortality
1/12/2013 Dr.T.V.Rao MD 69

LYMPHGRANULOMA VENEREUM
“A disease of Tropical Countries”
• Caused by Chlamydia trachomatis, serotype L1,2,3
• A chronic infection of the lymphatic tissue
• ♂ : ♀ 5 : 1
• Incubation period 4-21 days
• Involves : Vulva  most frequent site
Cx, urethra, rectum
• 3 phases of the disease
-Primary phase
Shallow , painless ulcer of the vestibule, labia or perirectal
Heals without Rx
-Secondary phase
1-4 wk after 1ry
Painful lymphadenopathy in the inguinal or perirectal areas
1/12/2013 Dr.T.V.Rao MD 70

LYMPHGRANULOMA VENEREUM
2/3 unilateral adenopathy
½ Systemic symptoms “malaise & fever
• Tertiary phase
-The nodes enlarged, tender , matted together & adherent
to the overlaying skin “bubos”
-7-15 days the bubo  rupture spontaneously  multiple
draining sinuses & fistulas
-Extensive tissue destruction of the genitalia & anorectal
region  elephantiasis, multiple fistulas & stricture
• Treatment
-Doxycycline 100 mg bd for 21 days
1/12/2013 Dr.T.V.Rao MD 71

GRANULOMA INGUINALE (DONOVANOSIS)
“A disease of Tropical Countries”
• Caused by G-ve , nonmotile , encapsulated rod 
Calymmatobacterium granulomatous
• Transmitted sexually & by close nonsexual contact
• Incubation period 1-12 wk
• Dx Donovan bodies in specimen taken from the ulcers
 dark staining bacteria with safety pin appearance
in the cytoplasm of mononuclear cells
• Painless red ulcer with fresh granulation tissue
• Multiple ulcers of the vulva  destroy normal vulvar
architecture  scarring & lymphatic obstruction  marked
enlargement of the vulva
• Rx  Tatracycline 500 mg qid for 3 wk
1/12/2013 Dr.T.V.Rao MD 72

Known as “Human Papillomavirus”
1/12/2013 Dr.T.V.Rao MD 73

Human Papillomavirus
(HPV)
• 20 million people
are currently
infected with HPV
• Very common
amongst sexually
active college
students
1/12/2013 Dr.T.V.Rao MD 74

Human Papilloma Virus
• Known as Genital Warts.
• NOT Curable!!!
• It causes growths of tiny, skin-
colored, cauliflower-like warts to
appear on the penis, vulva, vagina,
and the cervix, in or around the
anus or the throat.
• Spread by sexual or skin to skin
contact with someone who has HPV.
• Symptoms: Irritation or itching in
both men and women. HPV is
extremely dangerous for women
because it can lead to cervical
cancer.
• Warts caused by HPV are treated
with an ointment, laser surgery,
burning it with acid or freezing it
with liquid nitrogen!
1/12/2013 Dr.T.V.Rao MD 75

Signs & Symptoms
• Most common
manifestation of
HPV is warts
• Includes warts on
skin such as
plantar warts or in
the genital area,
known as genital
warts
1/12/2013 Dr.T.V.Rao MD 76

HPV Penile Warts
1/12/2013 Dr.T.V.Rao MD 77

Condylomata acuminata, anal
1/12/2013 Dr.T.V.Rao MD 78

Signs & Symptoms
• May be associated with
discomfort such as itching,
burning, or tenderness in the
genital area
• Most women with HPV do not
have any symptoms at all
1/12/2013 Dr.T.V.Rao MD 79

Signs & Symptoms
• Include fever,
general muscle
aches, swollen
lymph nodes in the
neck, flu-like
symptoms
• Increased salivation
and sometimes
bleeding in the
mouth
1/12/2013 Dr.T.V.Rao MD 80

Treatment
• No effective treatment
• Warts may be treated with agents
designed to reduce or remove the
warts, including creams, oral
medications, or surgery
• The infection usually goes away
without treatment, but for high risk
HPV
1/12/2013 Dr.T.V.Rao MD 81

82
HPV and Cervical
Cancer
1/12/2013 Dr.T.V.Rao MD

83
HPV and Cervical Cancer
• Infection is generally indicated by the detection of
HPV DNA
• HPV infection is causally associated with cervical
cancer and probably other anogenital squamous
cell cancers (e.g. anal, penile, vulvar, vaginal)
• Over 99% of cervical cancers have HPV DNA
detected within the tumor
• Routine Pap smear screening ensures early
detection (and treatment) of pre-cancerous
lesions
HPV and Cervical Cancer
1/12/2013 Dr.T.V.Rao MD

 HIV-Human Immunodeficiency
Virus
 AIDS-Acquired Immune Deficiency
Syndrome
1/12/2013 Dr.T.V.Rao MD 84

HIV/AIDS
• HIV is the virus that causes AIDS
• The definition of AIDS relates to
CD4+ T-cells Count
• Healthy adults usually have CD4+
T-cell counts of 1,000 or more
• Aids and some HIV sufferers have
less than 200 CD4+ T-cells
1/12/2013 Dr.T.V.Rao MD 85

Modes of Transmission
• blood
• blood products
• sexual fluids
• People can be
infected and NOT
look sick or even
have AIDS but can
still transmit HIV
1/12/2013 Dr.T.V.Rao MD 86

Signs & Symptoms
• rapid weight loss
• dry cough
• recurring fever or profuse night sweats
• profound and unexplained fatigue
• swollen lymph glands diarrhea
• white spots or unusual blemishes on the
tongue, in the mouth, or in the throat
1/12/2013 Dr.T.V.Rao MD 87

Effects of Pregnancy
• 70% transmission
occurs at the time of
delivery 30% amount
occurs antenatally
(before delivery)
• A significant
contributor to
transmission is
breastfeeding
1/12/2013 Dr.T.V.Rao MD 88

TREATMENT IN PREGNANCY
• Zidovudine monotherapy  vertical transmission
25% 8%
• Standard triple therapy should be offered
• Zidovudine should be included in the Rx to prevent
perinatal transmission
• Zidovudine IV intrapartum
to the neonate for the first 6 wk of life
• Elective CS recommended if
-Women did not receive antiretroviral therapy
-Monotherapy
-Detectable viral load > 500 RNA copies /ml
-Viral load determination not done
-No prenatal care
1/12/2013 Dr.T.V.Rao MD 89

AIDS-related
Opportunistic Infections
• Kaposi’s Sarcoma Yeast Infections
1/12/2013 Dr.T.V.Rao MD 90

Treatment
• Antiviral drugs drug’s
that boost the
immune system have
allowed many people
with HIV to resist
infections, stay
healthy, and prolong
their lives, but these
medications are not a
cure
1/12/2013 Dr.T.V.Rao MD 91

STD increases HIV susceptibility
• STD causes infection and
desquamation of squamous or
columnar cells producing an
inflammatory response
• Results in increased number of
HIV target cells (lymphocytes) on
mucous membrane surfaces and
a portal of entry for HIV
STD/HIV Inter-Relationships
1/12/2013 Dr.T.V.Rao MD 92

STD increases HIV transmission
For a person with HIV, having an
STD:
• Brings inflammatory cells loaded
with HIV to the genital tract
• Increases HIV viral shedding from
mucous membranes
1/12/2013 Dr.T.V.Rao MD 93

HEPATITIS
• Hepatitis A, B, and C all can be transmitted sexually
• Hepatitis B is the most common & its sexual transmission is
the most efficient
• Hepatitis A & B  can be prevented by vaccination
• Sexual transmission accounts for 45% of new cases
• Hepatitis B immunoglobulin's  post exposure prophylaxis
within 14 days
• Pregnant mothers with Hepatitis B  transmit the infection to
their infants during or after birth
Newborn infant should receive Immunoglobulin's +
Vaccination within 12 hrs of birth
1/12/2013 Dr.T.V.Rao MD 94

• Parasitic Infection of the vagina in women and urethra
in men.
• Mostly passed through sexual contact. It is also spread
through damp towels, bathing suits or wash clothes
shared with an infected person.
• There are frequently no symptoms.
– Men: discharge from penis, mild discomfort in penis and swelling in
genitalia.
– Women: green to yellow discharge with bad odor, vaginal itching, painful
urination, inflammation in genitals. Sometimes in lower abdomen.
• Trichomoniasis can usually be cured with the
prescription drug, metronidazole, given by mouth in a
single dose
1/12/2013 Dr.T.V.Rao MD 95

TRICHOMONIASIS
• Caused by a protozoan Trichomonas vaginalis
• Symptoms  diffuse malodorous yellowish green
discharge
vulvar irritation
• Dx  microscopy of vaginal secretion sensitivity 60-70%
culture  more sensitive
• Rx  Metronidazole 2 gm orally single dose
• Husband  should be treated & they should avoid intercourse
until they are cured
• Vaginal Trichomoniasis has been associated with adverse
pregnancy outcome  PROM, preterm delivery & low BWt.
• Metronidazole is safe in pregnancy
1/12/2013 Dr.T.V.Rao MD 96

PID(Pelvic Inflammatory Disease)
• Caused by a complication of
bacterial vaginosis and/or
gonorrhea/chlamydia.
• Sexually active women aged 15-
25 are at highest risk for
developing PID.
• A woman’s genital tract becomes
inflamed and infected causing
swelling, scarring, fever and
pain.
• PID is a major cause for
infertility.
• Symptoms: Abdominal and
pelvic pain, vaginal bleeding,
discharge and pain during sex.
1/12/2013 Dr.T.V.Rao MD 97

Candidiasis
•The 2nd most common cause of vaginal irritation or vaginitis and can also
occur on male genitals. It can also appear in the mouth and throat as white
sores.
• Contrary to popular belief, Candidiasis is rarely transmitted by sexual
contact. It is generally passes by
• Everyone has this fungus on and inside their bodies. Most of the time it is
harmless and keeps the bacterial levels in your body in check, but if there is
an overgrowth of this fungus it can lead to a variety of problems
• Some symptoms include:
•In Women: A thick white discharge that looks like cottage cheese,
itching and burning as well as a rash on the outer lips of the vagina.
•In Men: Soreness, itching and redness of the head of the penis,
scrotum and foreskin. (Uncircumcised men are more likely to develop
yeast because it thrives in moist areas)
•
An
1/12/2013 Dr.T.V.Rao MD 98

Infections with Trichomoniasis
and Candia
1/12/2013 Dr.T.V.Rao MD 99

SCABIES
• Scabies is a fairly common infectious disease of the skin caused by a mite.
Scabies mites burrow into the skin producing pimple-like irritations or
burrows.
• Scabies mites are transferred by direct skin-to-skin contact. Indirect
transfer from undergarments or bedclothes can occur only if these have
been contaminated by infected people immediately beforehand. Scabies
can also be transmitted during sexual contact.
• The most prominent symptom of scabies is intense itching particularly at
night. The areas of the skin most affected by scabies include the webs and
sides of the fingers, around the wrists, elbows and armpits, waist, thighs,
genitalia, nipples, breasts and lower buttocks.
• Skin lotions are available through a physician's prescription for the
treatment of scabies.
1/12/2013 Dr.T.V.Rao MD 102

ECTOPARASITIC INFESTATION
PEDICULOSIS PUBIS
• Humans are the only reservoir for pubic lice
• Can be transmitted by sexual & close
nonsexual contact
• Pruritus is the most common symptom
• Rx  Washing the area with pediculicide
formulations
Washing the clothes & linens with very
hot water
1/12/2013 Dr.T.V.Rao MD 103

Scabies (under the skin crabs)
1/12/2013 Dr.T.V.Rao MD 104

Scabies (under the skin crabs)
1/12/2013 Dr.T.V.Rao MD 105

What STD screening tests would
you order?
1 2 3 4
17%
39%
39%
6%
1. Urine for GC and CT and
syphilis serology
2. Urine for GC and CT and
syphilis and HSV-2
serology
3. Urine and rectal GC and
CT tests, pharyngeal GC,
and syphilis serology
4. Urine, rectal and
pharyngeal GC and CT, and
syphilis and HSV-2
serology

STI Prevention
• Abstain from sexual
intercourse—
vaginal, oral, or
anal
• Be in a
monogamous
relationship with an
uninfected partner
1/12/2013 Dr.T.V.Rao MD 107

• Reduce Number of Partners
• Get to know the Person
• Get tested together
• Try celibacy
• Learn about HIV/STDs together
• Talk to your partner about what you
know
• How many can you think of…?
1/12/2013 Dr.T.V.Rao MD 108

• Programme Created by Dr.T.V.Rao MD for
Medical and Paramedical Students in the
Developing World from Various WEB
RESSOURCES
• Email
• doctortvrao@gmail.com
1/12/2013 Dr.T.V.Rao MD 110

sexuallytransmittedinfections-130112235416-phpapp02 (1).pdf

More Related Content

Similar to sexuallytransmittedinfections-130112235416-phpapp02 (1).pdf

Recently uploaded

sexuallytransmittedinfections-130112235416-phpapp02 (1).pdf