1. LOGO Sexually Transmitted Disease Women’s Hospital, School of Medicine Zhejiang University Prof. Lin Jun

2. 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

3. 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

4. Pathogens ：  Bacteria  Virus  Spirochete( 螺旋体 )  Mycoplasma  Chlamydia  Protozoa( 原虫 )  Fungi( 真菌 )  Ectoparasite( 寄生虫 )

5. Sexually transmitted disease,STD Gonorrhea  Pathogen ： Neisseria gonorrhoeae  Transmission ： primarily by sexual contact  Invasion ： columnar epithelium and transitional epithelium cervix, urethra →upper reproductive tract

6. 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

7. Gonorrhea

8. 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

9. 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

10. Sexually transmitted disease,STD Syphilis  Pathogen ： Treponema pallidum  Transmission ： sexually transmission indirect contact transmission blood touch from infected mother to fetus

11. 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

12. Syphilis secondary syphilis  condyloma latum ( 扁平湿疣 ) secondary syphilis:   papulosquamous ( 丘疹疹鳞屑性皮疹 )

13. Syphilis Tertiary syphilis

14. 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 )

15. Syphilis Treatment ：  penicillin Criterion of cure ：  Clinical cure  Serologic cure

16. 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

17. 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 ).

18. Condyloma acuminata

19. 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

20. 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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