sexually trasmitted infection, dermatology, Medicine,

1. Sexually Transmitted Infections
DR SUBODH KUMAR SHAH

4. Syphilis
Causative agent:
 Treponema pallidum, a spirochete
Transmission
Acquired:
 Sexual: through unprotected sexual contact,
 Blood: through contaminated blood and blood products.
 Accidental: in health care workers, e.g.,through needle prick injury.
Congenital: Vertical transmission occurs in utero (transplacentally) or at the
time of delivery.

5. Classification
 Early syphilis:Infection <24 months old.
 Late syphilis:Infection >24 months old.
 Incubation period: 9–90 days.

6. Age: Affects sexually active age
group.
Congenital syphilis in newborn.
Gender: Women are infected
more
easily than men,

7. Morphology
 Primary syphilis: Hunterian chancre characterized by:
 Being single, painless, regular, indurated, described as button-like
reddish or brownish plaque which frequently ulcerates ,The ulcer has a
clean floor and oozes clear serum on pressure.
 Heals spontaneously (4–6 weeks) or
on treatment, usually with a slightly
atrophic scar.

8. Location of ulcers
 Males: Coronal sulcus, glans, prepuce, and shaft of penis. Perianal area in
homosexual males.
 Females: Labia minora, labia majora, and mons pubis. Sometimes in cervix or
vagina,
 Extragenital lesions: Also seen on lips, nipples and fingers.

9. Secondary stage:
 SS is a systemic disease with cutaneous as well as extracutaneous manifestations.
Cutaneous lesions:
 Generalized rash (maculopapular, psoriasiform, even nodular but never vesiculobullous).
 Mucosal lesions (mucous patches and snail track ulcers), intertriginous condyloma lata and shotty,
generalized lymphadenopathy.

10. Palm and sole lesions: Hyperpigmented, coppery red, scaly lesions. Or hyperkeratotic papules.
Condyloma lata: In intertriginous area, the papules may erode superficially.

12. Secondary syphilis:
A:characterized by discrete dull red papules,
which coalesce to form annular lesions
which may be lichenoid or psoriasiform.
B: coppery red, scaly papules on palms.

14. condyloma lata present as
eroded papules in vulva.
healing lesions in
perianal
area.

15. Mucosal lesions:
 Several types of mucosal lesions seen:
 Mucous patches: Dull erythematous plaques with grayish slough.
 Snail-track ulcers: Mucous patches with serpiginous erosions.
Lymphadenopathy:
 Generalized, symmetrical, and rubbery lymphadenopathy.
 Axillary, cervical, and inguinal groups invariably enlarged

16. split papules at the angle of mouth. mucous patch which
appears as an erythematous
plaque with grayish slough.

17. lesions on
the tongue.

18. Systemic involvement:
---is a systemic disease with involvement of many organ systems:
 Musculoskeletal system: Periostitis and arthritis.
 Ocular: Iridocyclitis, uveitis, and choroidoretinitis.
 Renal: Nephrotic syndrome due to an immune complex
glomerulonephritis.
 Central nervous system: Cerebrospinal fluid abnormalities.

19. Latent syphilis
Latent syphilis is the stage of syphilis where there is
persistent seroreactivity in the absence of any clinical
evidence of syphilis.
No signs or symptoms of active disease

20. Tertiary syphilis
Several manifestations of tertiary syphilis are
recognized:

21.  A gumma (plural gummata or g
ummas) is a soft, non-
cancerous growth resulting from
the tertiary stage of syphilis.
 It is a form of granuloma.

22. Congenital syphilis
Syphilitic infection in pregnancy is highly deleterious to the fetus and can result in:
 Abortion of fetus.
 Stillbirth.
 Congenital syphilis.

23. Investigations
Specimen: Serum exuding from lesions of early syphilis(primary and secondary).
Methods used:
 Dark ground (DG) microscopy: T. pallidum appears as a corkscrew-
shaped organism

24. T. pallidum:
A: under dark field microscope.
B: with fluorescent staining.

25. Serological tests for syphilis (STS)

26. Treatment
GENERAL MEASURES:
 Counseling: Very important component of treatment.
 Advice on safe sex including use of condoms and encouraging single partner relationship.
 Avoidance of sex till healing of lesions.
 Partner management.
 Follow up testing for HIV, hepatitis B virus, and VDRL at 3 months and further if necessary.

27. TREATMENT:

29. Chancroid:
Etiology: Haemophilus ducreyi, a Gram-negative bacillus.
 Incubation period: 3–5 days.
Morphology:
 Multiple, superficial, tender, nonindurated ulcers (hence
called soft sore).Undermined, friable ragged edge with an
erythematous halo.
 Floor is covered with an exudate which on removal reveals
a bleeding surface

30. Chancroid: multiple,
dirty looking, tender
ulcers.

31. Location of ulcers:
 Males: Prepuce, frenulum, and coronal sulcus.
 Females: Fourchette, vestibule, and labia minora.
 Lymphadenopathy: Tender, inflammatory inguinal nodes (buboes) which may
suppurate to form chancroid-like ulcers

32. Investigations: Diagnosis based on clinical features
Treatment:
 Azithromycin, 1 g single dose. Or ceftriaxone,250 mg intramuscular,
single dose.
 Or ciprofloxacin, 1 gdaily × 3 days; erythromycin base, 1.5 g daily × 7
days.

33. Gonococcal Infection:
Etiology: Neisseria gonorrhoeae,
Transmitted:
 sexually
 vertically (from mother to child) causing ocular infection in neonates.
Incubation period: 1–5 days.
 Males: Urethritis manifesting as profuse urethral dischargeand dysuria.
 Females: Usually asymptomatic carriers; may have vaginal discharge.

34. Clinical Features
Manifestations:
Asymptomatic infection:
 Rectal and pharyngeal infections, Endocervical infection, Urethral infection may be
asymptomatic.
Symptomatic infection :
In males : is anterior urethritis which manifests as:
 Painful micturition.
 Urethral discharge which is purulent, profuse,thick, and creamy.
 Redness and edema of urethral meatus.

35. Symptomatic infection:
in females : the endocervical canal and concomitant urethral infection
 When symptomatic, female patients present with:
 Genital discharge which may be scanty or profuse.
 Dysuria and frequency and urgency of micturition.

36. Gonococcal urethritis: A: thick creamy discharge.
Gram stain of urethral discharge showing
Gram-negative intracellular and extracellular diplococci.

37. Investigations
Smear examination: Specimens used are:
 Urethral and endocervical discharge, and rectal swabs.
 What is seen?
---On Gram-stained slides, in gonococcal infection ,the following are
seen:
 Gram-negative kidney-shaped extracellular and intracellular
diplococci

38. Culture:
Media used: Two types of media are used.
 Nonselective media: Chocolate agar.
 Selective media: Modified Thayer-Martin
medium and Chacko-Nair medium

39. Treatment
General measures:
 Sexual abstinence.
 Treatment of sexual partners.
 Avoidance of heavy work.
 Avoidance of alcohol intake.

40. Specific treatment:

41. Chlamydial Genital Tract Infection
 Etiology: Chlamydia trachomatis, serotypes are D—K.
 Incubation period:1–5 weeks
 Clinical features:
 Symptoms: Almost 50% of patients may be asymptomatic. Dysuria, frequency, and urgency of
micturition.
 Signs: Urethral discharge which is mucoid or mucopurulent, the discharge is thick and creamy.
Vaginal discharge, but generally asymptomatic.

42.  Investigations
Smear examination
 Presence of five or more polymorphs cells in high power field with no
demonstrable organisms on Gram stain is confirmatory for non gonococcal
urethritis.
Treatment: Azithromycin 1 g SOD. Or doxycycline 200 mg daily × 7 days.