STD Prevalence in World, USA and Iran, and Neisseria gonorrhoeae

1. Hidden Epidemics
Stigma
1

2.  Common bacterial infections
 Neisseria gonorrhoeae (causes
gonorrhoea or gonococcal
infection)
 Chlamydia trachomatis (causes
chlamydial infections)
 Treponema pallidum (causes
syphilis)
 Haemophilus ducreyi (causes
chancroid)
 Klebsiella granulomatis (causes
granuloma inguinale or
donovanosis).
 Common Fungal infections
 Candida albicans Vulvovaginitis,
penile candidiasis
http://www.who.int/mediacentre/factsheets/fs110/en/
 Common viral infections
 HIV (causes AIDS)
 HSV 1-2
 HPV (causes genital warts and certain
subtypes lead to cervical cancer in
women)
 HBV (causes hepatitis and chronic
cases may lead to cancer of the liver)
 Commom Parasitic infection
 Crab louse, colloquially known as
"crabs" or "pubic lice" (Pthirus pubis)
 Scabies (Sarcoptes scabiei)
 Trichomoniasis (Trichomonas
vaginalis), colloquially known as
"trich"
1

3. Unintended pregnancy, Potentiated HIV risk (three to six times the risk)
STDs Background
2
(PID)

4. 6 Ways STDs Impact Women Differently from Men
 A woman’s anatomy can place her at a unique risk for STD infection,
compared to a man.
 Women are less likely to have symptoms of common STDs — such as
chlamydia and gonorrhea — compared to men.
 Women are more likely to confuse symptoms of an STD for
something else.
 STDs can lead to serious health complications and affect a woman’s
future reproductive plans.
3

5. 6 Ways STDs Impact Women Differently from Men
 Women who are pregnant can pass STDs to their babies.
 Human papillomavirus (HPV) is the most common sexually
transmitted infection in women, and is the main cause of cervical
cancer.
 Women typically see their doctor more often than men.
 There is a vaccine to prevent HPV; and available treatments for
other STDs can prevent serious health consequences, such as
infertility, if diagnosed and treated early.
3

6. 2

7. In World

8. ESTIMATED
NEW CASES
OF
CURABLE
STI
AMONG
ADULTS,
1999
4

9. 4

14. GLOBAL PREVALENCE AND INCIDENCE OF SELECTED CURABLE
SEXUALLY TRANSMITTED INFECTIONS OVERVIEW AND ESTIMATES 1999-2001
NORTHAMERICA
LATINAMERICA
&THECARIBBEAN
NORTHAFRICA
&THEMIDDLE
EAST
SUB-SAHARAN
AFRICA
WESTERN
EUROPE
EASTERNEUROPE
&CENTRALASIA
EASTASIA&
PACIFIC
SOUTH&
SOUTHEASTASIA
AUSTRALIA&
NEWZEALAND
GLOBAL
TOTAL
CHLAMYDIAL
INFECTIONS 4 9.5 3 16 5 6 5 43 0.5 92
GONORRHOEA 1.5 7.5 1.5 17 1 3.5 3 27 0.1 62
SYPHILIS 0.1 3 0.3 4 0.1 0.1 0.2 4 0.01 12
NEW CASES OF
CURABLE STI
AMONG
ADULTS
14 38 10 69 17 22 18 151 1 340
Digits are in MILLION 4

15. Incidence conveys
information about the
risk of contracting the
disease, whereas
prevalence indicates how
widespread the disease
is.
3

16. http://globalgrind.com/2013/02/14/cdc-says-us-highest-rates-stds-stats-in-world-details/ 5
Most shockingly,
HPV,
compromising 71
percent of all the
current
infections, and 72
percent of new
infections.

17. 3

18. 3

19. Chlamydia
3

20. Gonorrhea
Sexually Transmitted Disease Surveillance 2011, Division of STD Prevention December 2012 3

21. Gonorrhea
Sexually Transmitted Disease Surveillance 2011, Division of STD Prevention December 2012 3

22. Syphilis
Sexually Transmitted Disease Surveillance 2011, Division of STD Prevention December 2012 3

23. In Iran

24. Prisons
tested for
HIV
6
injecting drug 62%
sexual contact 26%

25. Result
507
patients
Candida Trichomona
Neisseria
gonorrhoeae
Chlamydia
Men %47 %8 %9 %34
Women %53 %18 %4 %22
7
between May 2005 and May 2007

26. 9
• 100 women during
2009-2010
• HIV-Ab, Chlamydia
trachomatis-IgG and
syphilis infection
Result:
• The overall prevalence of C.trachomatis was 19%.
• No case with syphilis or HIV infection.

27.  358 parent were assessed for knowledge about HPV
 73% of parents had no information about HPV
 26% had obtained their information via internet
 Others from studying medical resources
 Average score of mothers information about HPV
infection was higher than that of fathers
 Parent knowledge about the hazards of HPV was higher
than their knowledge about modes of transmission
10
Most common sexually
transmitted diseases (STD)
Cervical cancer in women
resulting in 233,000 deaths
per year
HPV infection often clears
over without treatment
HPV types 16 and 18 can be
a hazard to change
precancerous lesions

28. Gonorrhea
The ticking time bomb
SEM TEM Methylene Blue Gram Stain

29. Clinical manifestations
23
Gonococcal pharyngitis Neonatal ophthalmia

30. Virulence FactorsCellsurfacecomponents
Capsule – antiphagocytic
Pili
• Composed of repeating peptide subunits of pilin.
• Mediate initial attachment of gonococci to epithelial cells.
• Specific cell receptor unidentified; high specificity of binding for genito-epithelial cells.
OuterMembrane
Proteins
Por (protein I)
• Most abundant outer membrane protein;
• Forms trimers through which some nutrients enter the cell.
• Role in virulence
Opa (protein II)
• When expressed, is a major component of the cell surface.
• Function in virulence
Rmp (protein III) - Reduction–modifiable protein
Tbp1, Tbp2 – two transferrin-binding proteins
Lpb – Lactoferrin-binding protein
LOS (Lipooligosaccharide)
xtracell
lar
roducts
Secretory IgA 1 protease
24

31. Common diagnostic tests (as of June 2012) for detection
of N. gonorrhoeae
23

32. • Azithromycin is safe and effective in pregnant women, but
doxycycline is contraindicated.
Treatment
• CDC: patients with uncomplicated genital or rectal infections be
treated with ceftriaxone (250 mg) given intramuscularly as a single
dose or 400 mg of oral cefixime as a single dose.
3
• azithromycin as a single 1-g oral dose or doxycycline 100 mg
orally twice daily for 7 days) is recommended for
administration with ceftriaxone.

34. Pic: Unemo M, Shafer WM. Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the future. Ann N Y Acad Sci. 2011;1230:E19-28
Merbromin
(Mercurochrome)
Gonococcal infections are usually treated with
single-dose therapy with an agent found to cure
>95 per cent of cases.
11

35. Antimicrobial susceptibility
and genetic characteristics Articles
Number of
Articles
Years Number of
Isolates
In Countries Techniques AMR
5 1990-2012 2047 ،‫بوتان‬،‫هند‬
‫و‬ ‫پاکستان‬
‫کشورهای‬
‫اروپایی‬
MIC
E Test
Nitrocefin
ST (ESC)
NG-MAST
Ciprofloxacin
Tetracycline
Penicillin G
Azithromycin
Ceftriaxone
Cefixime
Spectinomycin
Gentamicin
Ertapenem
12-165 Articles

36. Enzyme
base
Iodometric
Chromomeric
AcidometricGrowth
base
Dilution
Disk
Diffusion
Etest
Clover leaf
17
Detection of beta-lactamases

37. Clover leaf
17

38. Acidometric Method
17
Iodometric method
• Penicillin
solution
• several
colonies
• Starch
solution
• iodine
• Penicillin
phenol red
• Several
colonies

39. Nitrocefin
 Slide Surface Assay
 Direct Contact Assay
 Broth Suspension Assay
 Lysed Cell Assay
 Filter Paper Assay
(10.0 mg/mL)
in DMSO
(1.0 mg/mL)
diluted with PBS
25 units of beta-
lactamase
Vortexed mixture
Red color within 20-30 min 17
Detection of all known beta-lactamases Neisseria gonorrhoeae, Moraxella,
Staphylococcus, Haemophilus, Enterococcus spp., and some anaerobic bacteria
for the production of beta-lactamase.

40. Average Susceptibility
Antibiotic Average (%)
Ciprofloxacin 79
Tetracycline 68
Penicillin G 46
Azithromycin 12
Ceftriaxone 5
Cefixime 5
12-16

41. ESC resistance determinants
penA (encodes altered forms of PBP2)
ponA (encoding an altered form of PBP1)
penB (encodes mutations in the major outer membrane
porin (PorB1b))
mtrR (MtrR represses expression of the mtrCDE,
The mtrCDE-encoded efflux pump)
12-16

42. http://www.medscape.com/viewarticl
e/777317_6
ESC resistance
determinantsmtrR
penB
penA
ponA
Mtr120: C-to-T transition
mutation 120 bp
upstream of the mtrC
start codon: to be
stronger than the wild-
type promoter
12-16
18

43. NG-MAST
Porin PorB (porB) gene (908 bp)
Subunit B of the transferrin binding protein (tbpB) gene
(110 bp)
(ST 1407, ST 1901, ST 7363) in Europe and Japan is dominant and
relative with the recent reports of recommended third generation
cephalosporins resistance
(ST 225) associated with ciprofloxacin resistance
12-16

44.  Therapeutic dose 64 µg/ml (2grX1)
 High-level spectinomycin-resistant MIC >1,024 4g/ml
 Amino acids 19 to 33 in the N terminus of the ribosomal protein 5S
that form a loop structure (loop 2) which nonspecifically binds to
helix 34 of 16S rRNA and is within 50 nm of the spectinomycin-
binding site. Amino acid alterations at this loop can disrupt the
binding of spectinomycin to the ribosome, which results in
spectinomycin resistance. 19

45.  21 different nanomaterials
 1-120 nm in diameter
20

46. SEM
hollow and shrank 20

47. TEM
20

48. Cell wall depth of the control group: 152635 nm cell wall depth in bacteria exposed to Ag NPs
was reduced to 71625 nm
TEM
20

49. TEM
20

50. 20

51.  This study highlighted that the CDS disc diffusion technique yielded excellent
category agreement with their analogous Etest minimal inhibitory
concentrations in comparison to CLSI technique.
 Applicable microbiological method to detect antimicrobial susceptibilities of
N. gonorrhoeae in resource-poor countries.
 This technique will facilitate enhanced antimicrobial resistance surveillance
and direct and meaningful comparison of resistance data generated within
different national and international laboratories.
26
• CFU: 1 x 107
• Annular diameter oc 18mm was selected as the uniform cut-off point.
Calibrated Dichotomous
Sensitivity Test

52. Thank You