Sexually Transmitted Infections (STIs) Dr Sexually Transmitted Infections (STIs) Dr. Ahmed Abdulhussein AL-Huchami

Definition: Diverse group of infections Caused by biologically dissimilar microbial agents Transmitted by sexual contact (usually illegal).

Terminology: Sexually Transmitted Infections(STIs) Sexually Transmitted Diseases(STDs) Venereal Diseases (VD)

Epidemiology:  Young, sexually active people.  Common with underreporting. More common in male. More serious in females.

Control and Prevention: Early and accurate diagnosis. Early and effective treatment. Ix to establish cure before sexual activity. Counseling around safer sexual practice. Screening for all risk groups. Screening for co-prevalence. Condoms. Vaccines: (Gardasil® and Cervarix®) Nonoxynol-9.

Prevention of STIs in Islam: (1) Proper selection of future wife & husband (2) Circumcision. (3) Inhibition of sexual excitement. (4) Bathing after coitus. (5) No intercourse in menses & purpereum. (6) Prohibition of extra-marital relations. (7) Prohibition of anal sex. (8) Prohibition of homosexual relations.

Complications: Pregnancy complications Newborn complications Infertility Urethral stricture Malignancy

The Causative Agents: Bacterial Fungal Viral Parasitic Protozoal

Clinical Presentation

1- Discharge. 2- Ulcer.

3- Pruritus: Scabies Pediculosis pubis Vaginitis

4- Mass (papules and/or nodules): Genital warts Syphilis MC

5- Systemic manifestations:  Syphilis: generalized rash, lymphadenopathy, neurological or cardiac manifestations.  AIDS: exanthem, xeroderma, folliculitis, diarrhea, pneumonia, and kaposi sarcoma.

Genital Discharge: A- Urethral discharge (Urethritis) Genital Discharge: A- Urethral discharge (Urethritis). Gonococcal and non Gonococcal. B- Vaginal discharge . ST causes: Candidal, &Trichomonal. Non ST causes: Physiological (ovulation) Cervical erosions Tumors

GENITAL DISCHARGE VAGINAL ST CAUSES NON URETHRAL

Gonococcal Urethritis (Gonorrhea) (GC)

Microbiology: Niesseria gonorrhoeae Intracellular, gram negative, kidney shape, diplococci. Short IP (2-5 days).  Pathogenesis: Columnar epithelium Urethra, and cervix in mature women. Vagina in girls. Pharynx, conjunctiva and rectum. Pilli or fimbriae & Outer membrane proteins.

Epidemiology: Gonorrhea is the commonest cause of genital discharge and urethritis in Iraq and other developing countries, followed by Chlamydia infection.  

 Clinical Features: Male (usually symptomatic): Purulent (yellowish) discharge Burning urination. Erythema of the meatus. Female (usually asymptomatic): Vaginal discharge, dysuria. Edema and easily induced bleeding (friability).

Complications: A- Genital: Female: 1- Pelvic inflammatory disease (PID).

2- Infertility 3- Ectopic pregnancy.

4- Bartholin gland infection and abscess. 5- Skene glands infection 4- Bartholin gland infection and abscess. 5- Skene glands infection. 6- Periurethral abscess.

Male: 1- Prostatitis, epididymitis, and cystitis Male: 1- Prostatitis, epididymitis, and cystitis. 2- Periurethral abscess and urethral stricture. 3- Infertility (very rare). 4- Infection of the Tyson's glands. 5- Infection of the Litter's glands. 6- Infection of the Cowper's glands

B- Extragenital: Dermatitis Septic arthritis 1- Disseminated gonococcal infection (DGI). Polyarticular tenosynovitis Dermatitis Septic arthritis

2- Conjunctivitis. 3- Rectal infection. 4- Pharyngeal infection.

Diagnosis: Suspected clinically, confirmed by smear, and made definitely by culture or PCR. 1- Smear. 2- Culture 3- PCR.  Two glass urine test. Two catch urine test.

Non GC Urethritis  

negative,intracellular, diplococci organisms (N negative,intracellular, diplococci organisms (N. gonorrhoeae) not detected on microscopic examination (Dx by exclusion of GC urethritis)

Causes: A- Infectious: I- Chlamydial: (25%-55%) Causes: A- Infectious: I- Chlamydial: (25%-55%). II- Non chlamydial: Bacterial, viral, fungal. B- Noninfectious: Drug allergy. Food (spicy food). Chemical (overuse of detergent). C- Idiopathic (true) urethritis

URETHRITIS NGU INFECTIOUS NON GC IDIOPATHIC

Chlamydial Urethritis Diagnosis: Serological tests Chlamydial Urethritis    Diagnosis: Serological tests. PCR: have largely replaced culture (cellular cultures).  

Clinical features: NGU versus GC urethritis 1- Longer incubation period (7-28 days). 2- More gradual presentations. 3- The discharge is fewer and thicker, mucoid or purulent, whitish in color, and may cause sticky urethral meatus.

Management of Urethritis (Urethral Discharge) Diagnosis: History: symptoms, sexual history, type of contraception, and drug and food history. Examination: type of discharge, meatal erythema. Investigation: GUE, smear, culture and PCR.

Treatment: GC urethritis Ciprofloxacin. Cefixime, Ceftriaxone, Chlamydial urethritis Azithromycin, 1g as a single oral dose, doxycycline, 100 mg twice a day for 7 d. The sexual partner(s) Co-infection

Recurrent and persistent urethritis: Metronidazole, 2g as a single oral dose , plus erythromycin, 500mg orally 4 times a day for 7 days. Complications: higher doses and longer courses.

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