Sexually Transmitted Diseases (STDs) Classification, Syndromic Management Complications & Prevention. Professor Jamal R Al-Rawi Prof. of Comm. Med. & Dermatovenereology Dept of Comm. Med. College of Med. Al-Mustansiriya University.

Terminology VD No more used. It include 5 classical diseases, Syphilis, Gonorrhea, Chancroid, Lymphogranuloma venereum, & granuloma inguinale. STD a- Social Stigma b- Emerging of new diseases c- affecting other organs extragenital e.g. Hepatitis. STI: Sexually transmitted infection STP: Sexually transmissible pathogen RTI: Reproductive tract infection STD patients examined by different specialty according to country. Newly identified STDs since 1980 are 18 types.

Etiological Classifications (>200) I- VIRAL A- Herpes virus groups, HSV1, HSV2, HHV4 (EB), HHV5 (CMV), HHV8. B- Hepatitis virus group; A, B, C, D, E, F, G, & non-A-G. C- HTLV1, HTLV2, D- HIV1 & 2 & subtype O. E- HPV 1->100 serotype, 16, 18, 33, 43, 52, & 87. F- Molliscum contagiosum virus. G- Ebola-Marburg virus H- Lassa virus

II- BACTERIAL A- Treponema pallidum B- Neisseria gonorrhea C- Chlamydia trachomitis D- Hemophilus ducreyi E- Calymmatobacterium granulomitis F- Group B streptococci G- Shigella Sp. H- Salmonella Sp. I- Corynebacerium diphtheria . J- Neisseria meningitides K- Mycoplasma homonis L- Gardnerella vaginalis M- Ureaplasma urealyticum N- Compylobacter species. O- Mobiluncus species P- Helicobacter fenneliae, cinaedi

STDs III- FUNGAL: IV- PROTOZOAL: V- ECTOPARASITE: Candida albican. A- Trichomonus vaginalis B- Giardia lamblia C- Entamoaba histoliytica D- Cryptosporidium parvum E- Balantidium coli V- ECTOPARASITE: A- Pthirus Pubis B- Sarcoptes scabiei

Syndromes A- MALES: Urethritis Epididmyitits Proctitis Proctocolitis Enterocolitis Enteritis Hepatitis AIDS Peritonitis Meningitis B- FEMALES: Urethritis Vulvitis Vaginitis Vaginosis Cervicitis Endometritis Chorioaminionitis Salpingitis Hepatitis Infertility PID AIDS Prematurity Ectopic gestation Peritonitis Meningitis

SYNDROMES-continued C- NEOPLASIM: Carcinomas; vulva, vagina, cervix, penis, & oral mucosa. Caused by HPV16,18, 33, 43, 52, 87, HSV1 & 2. HIV1 & 2, HHV4 (EB). Lymphoma; HTLV1 & 2, HIV 1 & 2 HHV4 (EB). Leukemia; Adult cell leukemia, & Hairy cell-leukemia (HTLV1 & 2). Kaposi’s Sarcoma; HHV8. Hepatocellular carcinoma; HBV, HDV, HCV, HHV5 (CMV).

STDs- Syndromes D- NEONATES & INFANTS: TORCHES Syndrome Conjunctivitis Pneumonia Otitis Media Sepsis, Meningitis Cognitive impairment, Deafness

Prevention 1- Public health & school sexual education 2- Use condom or limit the number of partners. 3- Control drug abuser 4- Proper medical, surgical, gynecological & instrumental sterilization 5- Use disposable syringes & instruments. 6- Screening of blood & its products for transfusion transmitted diseases. 7- Screening for HIV, HBV, HCV,...etc in antenatal care, during premarital counseling & organ transplantation 8- Vaccination of high risk group with the available vaccine( HBV, HAV, HSV1 & 2, HHV3 (VZ), HIV,)

As there are few nerve endings to the cervix, women may not feel pain associated with a cervical chlamydial infection. This is particularly significant in transmission of this STD. A woman may have no apparent symptoms. This indicates a need for constant safer sex practices by both men and women.

While the discharge associated with a gonococcal infection is likely to be purulent, a clear or white discharge is more likely associated with NGU

Oral sex is usually the cause of a gonococcal infection of the throat Oral sex is usually the cause of a gonococcal infection of the throat. This pharyngitis is often asymptomatic

Epididimytis is a complication resulting from the spread of a gonococcal infection to the posterior urethra that can lead to infertility if left untreated. Without prompt treatment, gonorrhea can also affect the prostate and can lead to scarring inside the urethra, making urination difficult. In women undiagnosed and untreated gonorrhea can lead to pelvic inflammatory disease (PID). Symptoms may or may not be present. PID can lead to internal abscesses, long lasting pelvic pain, and infertility. It may also damage the fallopian tubes enough to increase the risk of ectopic pregnancy, a life-threatening condition.

Gonorrhea in pregnant women can cause premature delivery or spontaneous abortion. As the baby passes through the birth canal during delivery, it can contract gonorrhea which may cause blindness, joint infection, or a life Proper prenatal care is important in pregnancy. It should include appropriate testing for STDs. 

The chancre is usually found at the place where the bacterium enters the body.

Condylomata may be highly infectious lesions They may also be found in non-genital sites, such as the mouth, groin, thigh and breasts.

In Negroid people this hair loss may take on the so-called "moth-eaten"scalp appearance.

Trichomoniasis is caused by the single-celled protozoan parasite, Trichomonas vaginalis. It affects both women and men, although symptoms are more common in women. Trichomoniasis is spread through penis-to-vagina intercourse or vulva-to-vulva contact with an infected partner. Women can acquire the disease from infected men or women, whereas men usually only contract it from women. Most men have no signs or symptoms. Men with symptoms may have an irritation inside the penis, mild discharge, or slight burning after urination or ejaculation.In women, trichomoniasis causes a frothy, yellow-green vaginal discharge with a strong odor. In infected pregnant women, a premature rupture of the membranes and premature delivery is possible.Trichomoniasis may increase a woman’s risk of acquiring HIV infection and transmitting it to her partner

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