1. Sexually Transmitted Diseases (STDs)
Dr.MOHAMED NASR Lecturer Of Dermatology & Venereology Zagazig University
Sexually Transmitted Diseases (STDs)

2. Introduction
Communicable disease transmitted mainly by sexual activity including genital-genital contact, anal-genital contact & oral-genital contact.
May also be transmitted by blood & during birth.

3. Spectrum of STDs: Viral: Bacterial: HIV infection Syphilis
Genital wart
Herpes genitalis
Hepatitis B
Cytomegalovirus
Bacterial:
Syphilis
Gonorrhoea
Non-gonococcal urethritis
Chancroid
Lymphogranuloma venereum
Donovanosis (Granuloma inguinale) 3

4. Parasitic: Fungal: Protozoa: . Candidiasis (Moniliasis)
. Trichomonas vaginalis
Parasitic:
Pediculosis pubis
Scabies 4

5. Urethritis
Painful urethral discharge & testicular swelling are the most common presentations of symptomatic STDs in ♂.

7. Classification of urethritis
Gonococcal urethritis.
Non gonococcal urethritis.
Non-gonococcal urethritis (NGCU) is > common than gonococcal urethritis.

8. Urethritis (Clinical Features)
Urethral discharge often worse in morning, dysuria, urethral itching.
GC urethritis
NGCU
Organism(s)
Gram (-)ve intracellular diplococci.
Chlamydia trachomatis.
Ureaplasma urealyticum.
Trichomonas vaginalis.
HSV: rare.
Incubation period
< 1 week
2-3 weeks
Discharge
Amount
Color
+++
Yellowish-green (purulent)
Often slight
Gray, white, mucoid

9. Gonorrhoea
About 62 million cases of gonorrhoea are diagnosed each year worldwide.
The causative organism, Neisseria gonorrhoeae, is a Gram negative diplococci.
Infects non-cornified epithelium
Cervix
Urethra
Rectum
Pharynx
Conjunctiva

10. Transmission Gonorrhoea is always sexually transmitted in adults.
Transmission is more efficient from males to females.
The risk of acquisition from a single act of sexual intercourse with an infected partner is estimated at %.
Vertical transmission also occurs. About 30% of babies born to infected mothers develop ophthalmia neonatorum, typically presenting in the first week after birth.

11. Gonococcal Infections in Women
Cervicitis
Urethritis
Proctitis
Accessory gland infection (Skene, Bartholin)
Pelvic inflammatory disease (PID)
Peri-hepatitis (Fitz-Hugh-Curtis)
Pregnancy morbidity
Conjunctivitis
Many infections asymptomatic
Pharyngitis
DGI

14. Gonococcal Cervicitis
Incubation 3-7 days
Symptoms:
Vaginal discharge
Dysuria
Vaginal bleeding
Cervical signs :
Erythema
Friability
Purulent exudate

15. Pelvic Inflammatory Disease
Symp.: bilateral lower abdominal pain.
Signs: uterine/ adnexal tenderness, +/- fever.
Laparoscopy may show hydrosalpinx, inflammation, abscess, adhesions.
Adhesions
Tube
PID often silent

16. Bartholin’s Abscess
Tender swelling in the lower 3rd of the labia with difficulty in walking & sitting.
Treatment: antibiotic, analgesic, drainage followed by marsupialization.

17. Gonococcal Infections in Men
Urethritis
Epididymitis
Proctitis
Conjunctivitis
Abscess of Cowper’s/Tyson’s glands
Seminal vesiculitis
Prostatitis
Many infections asymptomatic
Pharyngitis
DGI
Urethral stricture
Penile edema

18. Gonococcal Urethritis
Incubation 2-5 days.
Abrupt onset of severe dysuria.
Yellowish-green purulent urethral discharge.

19. Epididymitis Swollen painful epididymis usually unilateral.
Epididymal tenderness or mass on exam.

20. Extra-genital gonococcal infection
1. Ano-rectal gonorhoea:
* It results from rectal sex with an infected partner.
* It is often asymptomatic but there may be a burning pain, tenesmus, pain on defaecation & bloody or mucopurulent stools.

21. 2. Gonococcal pharyngitis
* It always results from oro-genital coitus.
* There is sore throat & pain on swallowing.

22. 3. Gonorrhoea in children
a. Ophthalmia neonatorum:
* gonococcal eye infection of the newborn during passage through the birth canal.
* it develops within 7 days of birth, always bilateral.
* Lid edema, erythema and marked purulent discharge.

23. b. Gonococcal vulvo-vaginitis
* before puberty, the vulval and vaginal epithelium is immature stratified squamous epithelium, this allows gonococcal infection to occur.
* discharge on child’s underclothing.
* vulva is red & oedematous.

24. 4. Disseminated gonorrhoea (DGI)
“Dermatitis-arthritis syndrome”
Arthritis: 90%
Characterized by fever, chills, skin lesions, arthralgia, tenosynovitis
Less commonly, hepatitis, myocarditis, endocarditis, meningitis
Rash characterized as macular or papular, pustular, hemorrhagic or necrotic, mostly on distal extremities.

25. Complications of gonorrhoea

26. Local complications in men
Para-urethral duct infection
Tysonitis (infection of sebaceous glands)
Periurethral abscess
Epididymitis
Penile oedema
Prostatitis.
Seminal vesiculitis.

27. Local complications in women
Bartholinitis
Skenitis (para-urethral gland infection)
Endometritis
Salpingitis, which may lead to peritonitis and tubo-ovarian abscesses
Perihepatitis

28. Less commonly, disseminated infection occurs by haematogenous spread:
Septicaemia
Arthritis
Dermatitis
Endocarditis
Meningitis

29. GC Diagnostic Methods Gram stain smear Culture:
- Enriched media e.g. Mcleod’s chocolate agar.
- Selective media e.g. Thayer-Martin media.
Antigen Detection Tests: EIA & DFA
Nucleic Acid Detection Tests:
Probe Hybridization
Nucleic Acid Amplification Tests (NAATs)
Hybrid Capture

30. Gonorrhea Treatment Genital & Rectal Infections in Adults
Recommended regimens:
Cefixime 400 mg PO x 1 or
Ceftriaxone 125 mg IM x 1 or
Ciprofloxicin 500 mg PO x 1 or
Ofloxacin 400 mg PO x 1 or
Levofloxacin 250 mg PO x 1
PLUS if chlamydia is not ruled out:
Azithromycin 1 g PO x 1 or
Doxycycline 100 mg PO BID x 7 d
All sex partners within past 60 days need evaluation and treatment

31. Gonorrhea Treatment Genital & Rectal Infections in Adults
Alternative regimens:
Ceftizoxime 500 mg IM x 1
Cefotaxime 500 mg IM x 1
Cefoxitin 2 g IM x 1 plus probenecid 1 g PO x 1
Gatifloxacin 400 mg PO x 1
Lomefloxacin 400 mg PO x 1
Norfloxacin 800 mg PO x 1
Spectinomycin 2 g IM x 1

32. Gonorrhea Treatment Pregnancy
Must avoid quinolones & tetracycline
Recommended regimens:
Cefixime 400 mg PO x 1
Ceftriaxone 125 mg IM x 1
PLUS if chlamydia is not ruled out:
Azithromycin 1 g PO x 1
Other appropriate chlamydial regimen
Test of cure in 3-4 weeks

33. Gonorrhea Treatment Neonates
Ophthalmia neonatorum prophylaxis:
Silver nitrate 1% aqueous solution topical x 1
Erythromycin 0.5% ointment topical x 1
Tetracycline 1% ointment topical x 1
Ophthalmia neonatorum treatment:
Ceftriaxone mg/kg IV or IM x 1 NTE 125 mg
NTE = not to exceed

34. Gonococcal conjunctivitis:
Ceftriaxone 1 gm single IM once

35. Disseminated Gonococcal Infection (DGI)
Ceftriaxone 1 g IM or IV every 24 hours
Alternative Regimens Cefotaxime 1 g IV every 8 hours OR Ceftizoxime 1 g IV every 8 hours OR Ciprofloxacin 400 mg IV every 12 hours OR Ofloxacin 400 mg IV every 12 hours OR Levofloxacin 250 mg IV daily OR Spectinomycin 2 g IM every 12 hours
All of the preceding regimens should be continued for 24–48 hours after improvement begins.

36. Gonorrhea Treatment Children
Uncomplicated genital infection:
> 45 kg: same as adults
< 45 kg: ceftriaxone 125 mg IM x 1 (alternative spectinomycin 40 mg/kg IM x 1)
Disseminated Gonococcal Infection:
Ceftriaxone mg/kg/d x 7 d
Treat for 10-14d if child weights > 45 kg

37. Thank You 37