1. Sexual transmitted infections
Dr. Alia kareem

2. Sexual transmitted infections
Is an infection acquired primarily through sexual contact

3. Patient at high risk of STI
Sex workers
Multiple sexual partener
Homo sexual men
Drug abusers
Early sexual activity

4. General measures for management of patient with STIs
Screening for other STIs
Tracing & screening of all sexual partners
Protective intercourse or abstinence during disease
Follow up of patient

5. gynecological manifestations of STI
Genital Ulcer
Mass Lesions
abnormal vaginal discharge
Lower abdominal pain
Dysuria
Vulval itching

6. STD causing genital ulcer
Genital herpes
Syphilis
Chancroid
Lymph granuloma venerum
Granuloma inguinali

7. Genital Herpes Is caused by herpse simplex virus(HSV)
HSV is ds DNA virus, belong to herpse family
is a chronic viral infection with lifelong latency in dorsal root ganglion
Spontaneous reactivation by various events results in virus shedding, with or without lesion formation.

8. Genotype of HSV Two types of herpes simplex virus, HSV-1 and HSV-2.
Both types can cause genital herpes.
Type 2 HSV is found more typically with genital lesions,

9. herpseClinical manifestation of genital depends primarily on prescence of antibody from previous exposure
primary infection(no antibodies)
recurrent infection( with previous exposure)

10. Menifestation of primary infection incubation peroid 3-7 days
Systemic manifestation (fever,malaise,)
Local manifestation:
is usually widespread involvement of the vulva, and the vagina and cervix
Cluster of painful vesicles which coalesce into multiple superficial ulcers,then crusting and heal`
Peri-urethral involvement may cause urinary retention duto sever pain and due to involvement of the sacral nerve.
Firm, tender, often bilateral Regional LAP
lesion healing requires 2 to 3 weeks

11. Herpetic genital ulcer

12. Recurrent herpes Asymptomatic shedding of virus.
Heralding paresthesias are frequently described as pruritus or tingling in the area prior to lesion formation
Localized clusters of painful vesicles and ulcers over an area of 1-2 cm diameter.
recurrences are more limited, with only about a week of symptoms

13. Herpes Simplex in Women with AIDS
Speaker Notes:
The above picture shows Herpes simplex in woman with AIDS, CD4 cell count <50.
Again note the coalescence of the lesions and consequent ulcer formation, this particularly occurs in patients who are severely immunocompromised.
Credit: Jean R. Anderson, MD

14. diagnosis tissue culture Polymerase chain reaction
Serologic type-specific glycoprotein G– based assays are available to detect HSV-1 and HSV-2 antibodies

15. treatment
General measures
Antiviral drugs

16. General measures analgesics bathing in saltwater.
Lignocaine gel can be applied sore areas.
Protective intercourse during the prodrome symptome or lesions
screening for other STD

17. Antiviral treatment ( hasten healing and decrease severity of symptoms)
1.primary episode
Acyclovir 400 mg three times daily for 7 to 10 days   or   Acyclovir 200 mg five times daily for 7 to 10 days      
2.    recurrent episode Acyclovir 400 mg three times daily for 5 days   or   Acyclovir 800 mg twice daily for 5 days   
3.    daily suppression(>6 attacks/ y)  Acyclovir 400 mg twice daily

18. syphilis
is a chronic, complex systemic disease produced by the spirochete, Treponema pallidum.
Treponema pallidum, is a slender spiral-shaped organism with tapered ends, is anearobic bacteria.

19. Clinical manifestation
The natural history of syphilis in untreated patients can be divided into four stages:
1-Primary
2-Secondary
3-latent
4-tertiary

20. a chancre, at the site of inculation
primary syphilis .
a chancre, at the site of inculation
is an isolated nontender ulcer with raised smooth rounded borders and clean indurated base

21. Secondary syphilis
is associated with bacteremia develops 6 weeks to 6 months after a chancre appears. in30% of untreated primary syphilis

22. Maculopapular rash

23. Condylomata lata

24. The latent stage of syphilis
follows the secondary stage and varies in duration from 2 to 20 years .
a woman has a positive serology without symptoms or signs of her disease
early latent syphilis: a period less than 2 years after the initial infection.
Late latent syphilis : a period greater than 2 years after the initial infection.

25. The tertiary phase of syphilis
Tertiary syphilis develops in approximately 20% of patients who are not appropriately treated during the primary, secondary, or latent phases of the disease .
The manifestations are
optic atrophy,
tabes dorsalis,
generalized paresis of insane
aortic aneurysm,
gummas of the bone , skin

26. Diagnosis
Definitive diagnosis can be made by dark-field examination or direct fluorescent antibody testing of lesion exudate. .
Serologic tests are the principal means for diagnosis:
Nontreponemal test: VDRL, RPR
Treponemal tests: TPI, FTA-ABS, MHA-TP

27. Diagnosis Nontreponemal: VDRL, RPR
Quantitative results correlate with disease activity,
therefore helpful in screening and follow up after treatment.
Titers rise when disease is active, fall when
treatment is adequat
These tests become non- reactive
within a few months of adequate treatment.

28. Non-treponemal testing
Detects antibodies against a cardiolipin- cholestrol-
lecithin complex, not specific for syphilis.
False Positives:
Only in serum, not in CSF testing
:False negatives
certain viral infection: infectious mononucleosis,
hepatitis, varicella, measles
lymphoma, TB, malaria, endocarditis,
connective tissue disease
pregnancy
Very early or late diseases
HIVpostive
Reinfection

29. Confirmatory Testing Treponemal Tests: TPI, FTA-Abs, MHA-TP
Detect specific treponemal antibody
They become positive soon after initial infection and usually remain positive for life, even with adequate therapy.
They do not correlate with disease activity, and are not quantified.
Not 100% specific for syphilis: other spirochetal dz.

30. Treatment Recommended Treatment of Syphilis:
Primary, secondary, early latent (<1 year) syphilis
Recommended regimen:
  Benzathine penicillin G, 2.4 million units IM once
Alternative oral regimens (penicillin-allergic, nonpregnant women):
  Doxycycline 100 mg orally twice daily for 2 weeks or
  Tetracycline 500 mg orally four times daily for 2 weeks
Late latent, tertiary, and cardiovascular syphilis
  Benzathine penicillin G, 2.4 million units IM weekly times 3 doses
Alternative oral regimen (penicillin-allergic, nonpregnant women):
  Doxycycline 100 mg orally twice daily for 4 weeks

31. Follow up after treatment
Following treatment
of primary or secondary syphilis) the titre of
VDRL should fall twofold every 3 months, b coming
negative within 2 years.

32. Chancroid
is a sexually transmitted, acute, ulcerative disease of the vulva
It appears as local outbreaks predominantly in black and Hispanic males.
It is caused by a nonmotile, nonspore- forming, facultative, gram-negative bacillus, Haemophilus ducreyi.

33. an erythematous papule that becomes pustular and within 48 hours, ulcerates
Edges of these painful ulcers are usually irregular with erythematous nonindurated margins.
The ulcer bases are usually red and granular

34. half of patients will develop unilateral or bilateral tender inguinal lymphadenopathy.
If large and fluctuant, they are termed buboes.
These may occasionally suppurate and form fistulas, the drainage from which will result in other ulcer formation.
Definitive diagnosis requires growth of H ducreyi on special media

35. Recommended Treatment of Chancroid
Azithromycin 1 g orally or
Ceftriaxone 250 mg intramuscularly
Ciprofloxacin 500 mg orally twice daily for 3 days
Erythromycin base 500 mg orally three times daily for 7 days

36. Granuloma Inguinale is also known as donovanosis,
is caused by the intracellular gram- negative bacterium Calymmatobacterium (Klebsiella) granulomatis.

37. Granuloma inguinale presents as painless inflammatory nodules that progress to highly vascular, beefy red ulcers that bleed easily on contact.
If secondarily infected they may become painful.
These ulcers heal by fibrosis, which can result in scarring resembling keloids.

38. Diagnosis is confirmed by identification of Donovan bodies during microscopic evaluation of a specimen following Wright-Giemsa staining

39. Doxycycline 100 mg twice daily for a minimum of 3 weeks and until lesions have completely healed
Azithromycin 1 g orally once a week as above
Ciprofloxacin 750 mg orally twice daily as above
Erythromycin base 500 mg

40. Lymphogranuloma Venereum (LGV)
This ulcerative genital disease is caused by Chlamydia trachomatis, serotypes L1, L2, and L3.

41. This infection is commonly divided into three stages as follows:
stage 1—small vesicle or papule;
stage 2—inguinal or femoral lymphadenopathy; and
stage 3—anogenitorectal syndrome

42. A serologic titer that is greater than 1:64 can support the diagnosis.
lymph node specimens obtained by swab or aspiration may be tested by immunofluorescence or PCR.

43. doxycycline, 100 mg orally twice daily for 21 days
doxycycline, 100 mg orally twice daily for 21 days. Alternatively, one may use erythromycin base, 500 mg orally four times daily

44. STD causing mass lesions
Genital warts
Moll scum contagiusm

45. Genital warts are caused by HPV types 6 and 11
Genital warts display ranging from flat papules to the classic verrucous, exophytic lesions, termed condyloma acuminata
external genital warts may develop at sites in the lower reproductive tract, urethra, anus, or mouth.

46. Condylomata acuminata

47. Diagnosis by clinical inspection

48. Podofilox 0. 5% solution or gel
Podofilox 0.5% solution or gel. should not exceed 10 cm2, and the total volume of podofilox should be limited to 0.5 mL per day.
Imiquimod 5% cream.
Cryotherapy with liquid nitrogen or cryoprobe. Repeat applications every 1 to 2 weeks.
Podophyllin resin 10 to 25 percent .
Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80 to 90 percent. or
Surgical removal either by tangential scissor excision, tangential shave excision, curettage, or electrosurgery.
Intralesional interferon
Laser surgery

49. Mollescum contagiosum Flesh-colored, dome-shaped papules with central umbilication

50. It`s caused by DNA virus
It`s diagnosed by clinical inspection
Lesions may spontaneously regress over 6 to 12 months
It`s treated by:
cryotherapy,
electrosurgical needle coagulation,
sharp needle-tip curettage of a lesion's umbilicated center.
topical application of agents used in the treatment of genital warts