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

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

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

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

6. 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.

8. 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.

9. Complications: Pregnancy complications Newborn complications Infertility Urethral stricture Malignancy

10. The Causative Agents: Bacterial Fungal Viral Parasitic Protozoal

11. Clinical Presentation

12. 1- Discharge. 2- Ulcer.

13. 3- Pruritus: Scabies Pediculosis pubis Vaginitis

14. 4- Mass (papules and/or nodules): Genital warts Syphilis MC

15. 5- Systemic manifestations:  Syphilis: generalized rash, lymphadenopathy, neurological or cardiac manifestations.  AIDS: exanthem, xeroderma, folliculitis, diarrhea, pneumonia, and kaposi sarcoma.

16. 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

17. GENITAL
DISCHARGE
VAGINAL
ST CAUSES
NON
URETHRAL

18. Gonococcal Urethritis (Gonorrhea) (GC)

19. 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.

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

23.  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).

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

25. 2- Infertility 3- Ectopic pregnancy.

26. 4- Bartholin gland infection and abscess. 5- Skene glands infection
4- Bartholin gland infection and abscess. 5- Skene glands infection. 6- Periurethral abscess.

27. 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

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

31. 2- Conjunctivitis. 3- Rectal infection. 4- Pharyngeal infection.

34. 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.

35. Non GC Urethritis  

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

37. 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

38. URETHRITIS
NGU
INFECTIOUS
NON GC
IDIOPATHIC

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

40. 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.

41. 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.

42. 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

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

44. THANK YOU