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Sexually Transmitted Infections
DR SUBODH KUMAR SHAH
Sexually transmitted infections
Sexually transmitted infections
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.
Classification
 Early syphilis:Infection <24 months old.
 Late syphilis:Infection >24 months old.
 Incubation period: 9–90 days.
Age: Affects sexually active age
group.
Congenital syphilis in newborn.
Gender: Women are infected
more
easily than men,
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.
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.
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.
Palm and sole lesions: Hyperpigmented, coppery red, scaly lesions. Or hyperkeratotic papules.
Condyloma lata: In intertriginous area, the papules may erode superficially.
Sexually transmitted infections
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.
Sexually transmitted infections
condyloma lata present as
eroded papules in vulva.
healing lesions in
perianal
area.
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
split papules at the angle of mouth. mucous patch which
appears as an erythematous
plaque with grayish slough.
lesions on
the tongue.
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.
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
Tertiary syphilis
Several manifestations of tertiary syphilis are
recognized:
 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.
Congenital syphilis
Syphilitic infection in pregnancy is highly deleterious to the fetus and can result in:
 Abortion of fetus.
 Stillbirth.
 Congenital syphilis.
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
T. pallidum:
A: under dark field microscope.
B: with fluorescent staining.
Serological tests for syphilis (STS)
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.
TREATMENT:
Sexually transmitted infections
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
Chancroid: multiple,
dirty looking, tender
ulcers.
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
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.
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.
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.
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.
Gonococcal urethritis: A: thick creamy discharge.
Gram stain of urethral discharge showing
Gram-negative intracellular and extracellular diplococci.
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
Culture:
Media used: Two types of media are used.
 Nonselective media: Chocolate agar.
 Selective media: Modified Thayer-Martin
medium and Chacko-Nair medium
Treatment
General measures:
 Sexual abstinence.
 Treatment of sexual partners.
 Avoidance of heavy work.
 Avoidance of alcohol intake.
Specific treatment:
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.
 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.

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Sexually transmitted infections

  • 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.
  • 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.
  • 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
  • 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.
  • 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.