21-04-05 ד"ר סרוגו יצחק- בית חולים בני ציון חיפה איבחון וטיפול מחלות המועברות במגע מיני - האם יש הצדקה למרפאת STD?

Slides:



Advertisements
Similar presentations
Sexually Transmitted Diseases
Advertisements

SEXUALLY TRANSMITTED DISEASES
Kingdom of Bahrain Ministry of Health ( Syndromic Mangement ) Adopted from : IPPF MEDICAL AND SERVICE DELIVERY GUIDELINES FOR SEXUAL AND REPRODUCTIVE HEALTH.
Chapter Fifteen Sexually Transmitted Diseases Copyright, Corey E. Miller, 2002.
Sexually Transmitted Diseases
Pelvic inflammatory disease
Pelvic Inflammatory Disease. Does LEEP increase the risk of PTB before 37 weeks? Compared women with history of LEEP to Compared women with history of.
Antimicrobial Resistance in N. gonorrhoeae: In Brief 2014 INTRODUCTION Increased action is needed to help prevent and control gonorrhea. Worldwide antimicrobial.
Microbial Diseases of the Urinary and Reproductive Systems
Medical Technology Department, Faculty of Science, Islamic University-Gaza MB M ICRO B IOLOGY Dr. Abdelraouf A. Elmanama Ph. D Microbiology 2008 Chapter.
Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings PowerPoint ® Lecture Slide Presentation prepared by Christine L. Case Microbiology.
Fahey/Insel/Roth, Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness, Chapter 14 ©2007 McGraw-Hill Higher Education. All rights reserved.
Gonococcal Isolate Surveillance Project (GISP)
California STD/HIV Prevention Training Center STD Clinical Series
Common Sexually Transmitted Diseases
Overview of Sexually Transmitted Diseases
Batterjee Medical College. Dr. Manal El Said Head of Microbiology Department Aerobic Gram-Negative Cocci.
Neisseria gonorrhoeae (Gonococcus)  N. gonorrhoeae causes the sexually transmitted disease gonorrhoea.  The gonococcus was first described by Neisser.
Sexually Transmitted Diseases
Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 94 Drug Therapy of Sexually Transmitted Diseases.
CHLAMYDIA.
Sexually Transmitted Diseases (STDs)
Gonorrhea, trichomoniasis, chlamidiosis, candidal and mycotic affection of the skin. Lector: Shkilna M.
Chlamydial and Gonococcal Infections. An STD About to Happen!
Epididymitis Niki J Kritikos, MS, RN, MPH
Sexual Transmitted Infections
Copyright © 2007 Pearson Education Canada14-1 Sexually Transmitted Infections Chapter 14 This multimedia product and its contents are protected under copyright.
DRUGS USED FOR THE TREATMENT OF SYPHILIS & GONORRHEA.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Sexually Transmitted Diseases (STDs ); ch.16  Gonorrhea  Chlamydia  Syphilis.
Alice Beckholt RN, MS, CNS
Sexually Transmitted Diseases/Infections
Neisseria Gonorrhoeae
Sexually transmissible infections Dr Ursula Nusgen SpR in Microbiology St. James’s Hospital.
Sexually Transmitted Diseases
Hepatitis B - Sexually Transmitted Infection - Infects the liver and causes inflammation - About 1/3 people in the world have Hepatitis B - Can lead to.
HIV /AIDS.
Chapter 30 “Don’t eat chocolate agar!”
Sexually Transmitted Infections
Epidemiology Lab. Cup #____--Data Table 1-My partners 123 INFECTED PERSONS123 Data table 2- Classmate’s partners Bellringer- Copy these tables on page14.
Copyright © 2004 Pearson Education, Inc., publishing as Benjamin Cummings PowerPoint ® Lecture Slide Presentation prepared by Christine L. Case Microbiology.
Rebecca Love. What is Gonorrhea? Gonorrhea is a sexually transmitted disease (STD) Gonorrhea is caused by Neisseria gonorrhoeae Neisseria gonorrhoeae.
Outline What are STIs/STDs? Causes Mode of transmission Signs, symptoms and syndrome Prevention.
UTIs (Cystitis) Fluoroquinolones, TMP/SMX, nitrofurantoin, amoxicillin- clavulanate, cephalosporins, tetracyclines, and fosfomycin. Most women: 3 days.
بسم الله الرحمن الرحيم FAMILY: NEISSERIACEAE Prof. Khalifa Sifaw Ghenghesh.
FIGURE 1. URETHRAL DISCHARGE. Treatment of Urethral Discharge GonorrheaChlamydia Ciprofloxacin 500mg orally x 1 doseAzithromycin 1g orally x 1 dose Cefixime.
FEMALE GENITAL INFLAMMATORY DISEASE By O.Y. Stelmakh.
Sexually Transmitted Diseases David W. Haas, M.D. Division of Infectious Diseases Vanderbilt University School of Medicine Nashville, Tennessee.
Sexually transmitted diseases. Sexually transmitted infections (STIs) are a group of contagious conditions whose principal mode of transmission is by.
OVERVIEW OF SEXUALLY TRANSMITTED DISEASES Assist Prof Dr. Syed Yousaf Kazmi.
Sexually Transmitted Infections Jeannie Harper, PhD, RN.
Drug Therapy of Sexually Transmitted Diseases. Sexually Transmitted Diseases  Sexually transmitted diseases (STDs)  Infections or parasitic diseases.
 Sexually transmitted diseases (STDs) are the venereal disorders that are caused by a variety of pathogenic microorganisms.  In almost all the countries.
Reduce Your Risk of STD’s Chapter 13. True / False / It Depends 1.Young people rarely get STIs. False 2. People know when they are infected with an.
Gonorrhea Testing, Diagnosis and Treatment
Sexually Transmitted Infection Tutoring
STD AND RTI.
Topic Gonorrhea Diseases
Gonorrhoea & PID PHCP 402 By K S Labaran.
Gonococcal Isolate Surveillance Project (GISP)
Urethritis in males.
Chlamydial and Gonococcal Infections
Gonorrhea California STD/HIV Prevention Training Center STD Clinical Series.
Sexually Transmitted Infections (STIs) Dr
Sexually Transmitted Diseases
A decade of multi-drug resistant N. gonorrhoea in Coventry, UK
Sexually Transmitted Diseases Overview (STDs)
Sexually Transmitted Infections
Presentation transcript:

ד"ר סרוגו יצחק- בית חולים בני ציון חיפה איבחון וטיפול מחלות המועברות במגע מיני - האם יש הצדקה למרפאת STD?

STD מחלות המועברות במגע מיני STD הן מהמחלות הזיהומיות השכיחות ביותר בעולם. מעל 20 פתוגנים שונים אחראיים ל STD. רק בארה"ב מעל 13 מיליון מודבקים מידי שנה. עלויות גבוהות.

TABLE 1 -- SELECTED SEXUALLY TRANSMITTED DISEASES AND COMPLICATIONS DiseasesComplications ChlamydiaPelvic inflammatory disease GonorrheaSquamous intraepithelial lesion SyphilisCervical cancer TrichomoniasisDisseminated gonorrhea infection HerpesChronic active hepatitis, liver cancer Hepatitis BAcquired immunodeficiency syndrome Human papillomavirusPerihepatitis Human immunodeficiency virus Chancroid Donovanosis Lymphogranuloma venereum Mycoplasmas Enteric bacterial pathogens Intestinal protozoa Lice Scabies Molluscum contagiosum

STD פוגעות בכל האוכלוסיה, ללא הבדלי מין ורקע סוציואקונומי. שכיחות ביותר בגיל צעיר - כ 2/3 מתחת לגיל 25.

קיימת עלייה בשכיחות STD כי: קיימת עלייה בשכיחות STD כי: –פעילות מינית מתחילה בגיל צעיר יותר. –עלייה במספר הגרושים. –עלייה במספר הפרטנרים למגע מיני.

STD בדרך כלל לא נותן סימנים קליניים. הכלל הוא: –גבר- מתלונן אישה- לא מתלוננת אם מתפתחים סימנים קליניים בדרך כלל הרופא לא חושד ב STD גם ללא סימנים קליניים –יש הדבקה.

סיבוכים של STD יותר בנשים: –PID –בעיות פוריות –הריון מחוץ לרחם –סרטן צוואר הרחם –פגיעה בילוד

ועוד סיבות לעלייה בשכיחות של STD רוב הנדבקים עם הפרשה או נגע באבר המין, יפסיקו פעילות מינית ויבקשו טיפול. רוב הנדבקים במחלות מין הם מבני זוג אסימפטומטיים. הטיפול ברוב המקרים בארץ ניתן ללא אבחון מעבדתי, על פי הסינדרום הקליני ולכן לא ידווח למשרד הבריאות. בדרך כלל קיים כשלון טיפולי כי: –החולה מטופל בן/בת הזוג- לא מטופל המשך ההדבקה…..

ועוד סיבות…… בדרך כלל STD נגרמים על ידי פתוגנים מפונקים וקשה לבודד אותם בשיטות הרגילות. המיקרואוגניזמים הנ"ל עלולים למות בדרך מהחולה למעבדה. לקיחת הדגימה הנכונה היא שלב מכריע באיבחון. ולכן: מעבדה מקצועית –שיטות רגישות, מהימנות עם בקרת איכות

The Laboratory Cycle Bartlett ‘80 The Patient Report Creation Report Transmission Report Interpretation Collection Transport Accession Analysis Test Selection PreAnalytIcPreAnalytIc PostAnalytIcPostAnalytIc

Laboratory methods and source of specimen for each microorganism Infectious AgentSource of Specimen Diagnostic test N. gonorrhoeaeUrethra First catch urine Stained smear, Selective culture PCR (Amplicor, Roche Diagnostic Systems) C. trachomatisFirst catch urine PCR (Amplicor, Roche Diagnostic Systems) U. UrealyticumSemenSelective culture (Mycofast, France) M. hominisSemenSelective culture (Mycofast, France) T. VaginalisUrethra Semen Saline wet mount Selective culture (Hylabs, Rechovot, Israel) H. SimplexSerology Urethra Semen HSV-1&2 IgG ELISA (Gull Laboratories, USA) Viral Culture, Nested PCR 16 Other sexually transmitted pathogens tested for: T. PallidumSerologyVDRL TPHA (Biokit, SA. Spain) HBVSerologyAnti-HBc Ag (Abbott Labs, Abbott park,IL,USA) HIVSerologyELISA (Abbott Labs, Abbott park, IL, USA)

14 years old boy- massive urethral discharge, 2 days 5 days before had his first protected vaginal sex but unprotected oral sex. PE:yellow creamy urethral discharge Cx – positive for GO resistant to penicillin and ciprofloxacin I.M. Ceftriaxone and PO doxyxycline

Gonorrhea number of cases and rate per 100,

Urethritis Acute tenosynovitis Neonatal Conjunctivitis P.I.D. Urethral Strictures Chronic Arthritis Infertility Gonorrhea F.H.C.-Hepatitis Sepsis

Disseminated gonococcal infections 1-3% of cases manifestations include: Low grade fever Migratory polyarthralgias involving the large joints septic arthritis Tenosynovitis Skin rashes

Adolescent with septic arthritis of left ankle with petechial and necrotic skin lesions on feet and extremities. Blood cultures were positive for Neisseria gonorrhoeae.

Gonorrhea in children and infants During childbirth, gonococci infect the conjunctivitis, pharynx, respiratory tract and gastrointestinal tract of the body. Routine prophylaxis with 1% AgNO4 or 0.5% erythromycin or 1% tetracycline applied directly to the eye following birth prevents ophthalmia neonatorum.

GO Diagnosis IN Gram stain Culture. PCR. Out Clinical Diagnosis

Emerging inf Dis 2003

GO Resistance Plasmid-directed penicillinase- producing N. gonorrhoeae strains (PPNG) is a way of penicillin resistance. Increased resistance to quinolones, macrolides was noted lately.

DrugDose Uncomplicated infection of cervix, urethra, rectum Cefixime400 mg PO Ceftriaxone125 mg IM Ciprofloxacin500 mg PO Ofloxacin400 mg PO Uncomplicated infection of pharynx Ceftriaxone125 mg IM Ciprofloxacin500 mg PO Ofloxacin400 mg PO Conjunctivitis Ceftriaxone1 g IM Disseminated gonococcal infection Ceftriaxone1 g IM/IV q 24 h for h Then oral regimen to finish 1 week with one of following: Cefixime400 mg PO bid Ciprofloxacin500 mg PO bid Ofloxacin400 mg PO bid PO = Orally; IM = intramuscularly; IV = intravenously; q = every; bid = twice a day. Adapted from Centers for Disease Control: 1998 Guidelines for the treatment of sexually transmitted diseases. MMWR Morb Mortal Wkly Rep 47:1-118, TABLE 3 -- TREATMENT GUIDELINES FOR NEISSERIA GONORRHOEAE

14 years old boy-solid mass in the scrotum Denied urinary symptoms and sexual activity PE:swelling of right hemiscrotum with slight tenderness U/s 16x16 mm extratesticular mass Biopsy-massive inflammatory reaction in the epididymis-chronic inflammatory reaction-no organism in gram and gimesa stain. FVU- PCR positive for C.trachomatis Doxycycline 100mg bid for 5 wks-with resolution of mass.