LOGO Sexually Transmitted Disease Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun
Sexually transmitted disease,STD STD is used to denote disorders spread principally by sexual intercourse or behavior similar to that. Forms of transmission: Sexual transmission Indirect contact transmission blood touch iatrogenic( 医源性 ) transmission
STD surveillance STD surveillance in China Syphilis Gonorrhea AIDS Nongonococcal urethritis (NGU, 非淋菌性尿道炎 ) Condyloma acuminata( 尖锐湿疣 ) Chancroid( 软下疳 ) Lymphogranuloma venereum ( 性病性淋巴肉芽肿 ) Genital herpes( 生殖器疱疹 ) Sexually transmitted disease,STD
Pathogens : Bacteria Virus Spirochete( 螺旋体 ) Mycoplasma Chlamydia Protozoa( 原虫 ) Fungi( 真菌 ) Ectoparasite( 寄生虫 )
Sexually transmitted disease,STD Gonorrhea Pathogen : Neisseria gonorrhoeae Transmission : primarily by sexual contact Invasion : columnar epithelium and transitional epithelium cervix, urethra →upper reproductive tract
Gonorrhea Clinical findings : Incubation period : 1-10 days 50%~70% patients are asymptomatic. 1. Lower genital tract infection: endocervicitis urethritis bartholinitis( 前庭大腺炎 ) 2.Upper genital tract infection: pelvic inflammatory disease (PID) 3.Disseminated gonococcal infection(DGI) pass by blood circulation
Gonorrhea
Diagnosis : According to bad sexual encounter, clinical findings and laboratory findings Gram- negative diplococci ( 双球菌 ) can be seen microscopically in secretions. Culture is the best standard. PCR Gonorrhea
Treatment : Principles: promptly 、 full dose 、 antibiotics available third generation cephalosporins quinolones Criterion of cure : Under the situation of no sexual life and 2 weeks after the whole therapy, the clinical symptoms and signs have gone. The 4-7d after cure, the smear testing and culture of secretion in cervical canals are negative. Gonorrhea
Sexually transmitted disease,STD Syphilis Pathogen : Treponema pallidum Transmission : sexually transmission indirect contact transmission blood touch from infected mother to fetus
Syphilis Clinical findings : 1.Primary syphilis : chancre ( 硬下疳 ) indurated, firm, painless papule or ulcer with raised borders on labia, vulva, vagina, cervix, anus, lips, or nipples 2.Secondary syphilis : diffuse bilaterally symmetric extragenital papulosquamous eruption ( 丘疹鳞屑性皮疹 ), condyloma latum ( 扁平湿疣 ) 3.Tertiary syphilis : cardiac , neurologic( 神经的 ), ophthalmic( 眼的 ), and auditory( 耳的 ) lesions
Syphilis secondary syphilis condyloma latum ( 扁平湿疣 ) secondary syphilis: papulosquamous ( 丘疹疹鳞屑性皮疹 )
Syphilis Tertiary syphilis
Syphilis Laboratory findings: 1.Identification of the organism Darkfield microscopy examination ( 暗视野显微镜检查 ) →Treponema pallidum ( 梅毒螺旋体 ) 2.Serologic examination a. Nontreponemal tests ( 非梅毒螺旋体抗原试验 ) VDRL, RPR ——syphilis screening( 筛查 ) b. Treponemal tests ( 梅毒螺旋体抗原试验 ) TPPA, TPHA ——syphilis confirmation( 确诊 ) 3.Examination of cerebrospinal fluid ( 脑脊液 )
Syphilis Treatment : penicillin Criterion of cure : Clinical cure Serologic cure
Sexually transmitted disease,STD Condyloma acuminata (尖锐湿疣) Pathogen: human papilloma virus (HPV) mainly Types 6 and 11 —— low-risk HPV Transmission : sexually transmission
Condyloma acuminata Clinical Findings Symptoms neoplasm : vulvae, cervix, vagina, perianal area ( 肛周 ) vulvar pruritus vulvar burning sensation postcoital bleeding Signs : Tiny, isolated or clustering pink papules ( 丘疹 ) are present at first, then get together just like comb shape ( 鸡 冠状 ).
Condyloma acuminata
Laboratory Findings Cytology : koilocytosis ( 挖空细胞 ) dyskeratosis ( 角化不良细胞 ) parakeratosis ( 角化不全细胞 ) Acetic acid test ( 醋酸试验 ) → white ( + ) Colposcope ( 阴道镜 ) Pathology : hyperplasia of squamous epithelium PCR:HPV detect
Condyloma acuminata Treatment There is no cure for HPV although lesions can be removed. External medicine – Podophyllin (0.5% 足叶草脂毒素酊, 鬼臼毒素 ). – Trichloroacetic acid (50% 三氯醋酸 ) Physical therapy – Microwave – Laser therapy – Cryotherapy Excision Interferon
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