Sti Doctor Arif Abid - PowerPoint Presentation

Slide1

Sti

Doctor

Arif

Abid

Slide2

SEXUALLY TRANSMITTED DISEASEPRESENTATIONS

Sexually transmitted diseases can present as follows

:

• Genital ulcers or sores

• Urethral discharge

• Vaginal discharge

• Cervical infection

• Lower abdominal pain

• Inguinal bubo

• Scrotal swelling

• Rectal or pharyngeal inflammation

Slide3

Syphilis

Description

Syphilis

is a

sexually transmitted infectious

disease caused by the spirochete

Treponema

pallidum.

The infection can affect

any organ

, and may mimic various other diseases, thus it has been called

the"great

imitator

".

If

left untreated

syphilis can infect and damage the heart, aorta, brain, eyes and bones, and can be fatal.

Syphilis passes through

three distinct stages

:

primary infectious

Secondary and latent

tertiary

stage.

Slide4

History

In

the past, syphilis was called

the"French

Disease

" but also known as the

Christian Disease

The

Great

Pox"Cupid's

disease

," "

The Black Lion

, and most well-known as

lues

or

lues

venereal or

venereal plague

"

It is believed the disease was

introduced to Europe by Columbus

after returning from the

West Indies

, and its spread within Europe was blamed on the frequent wars within the region at that time.

Slide5

Incidence

declined

after World War II because of

penicillin treatment

.

The Tuskegee study in 1932

is a dark part of medical and syphilis history, in which in therapy for black men who

penic

were infected with syphilis was withheld in order to study the short-term and long term effects of the disease.

syphilis has become

more common the last 3 decades

with the in

introduct

the acquired immune

deficie

syndrome

(

AIDS)

.

Slide6

Primary Syphilis

Initially

, syphilis appears as a cutaneous

ulcer or chancre

after

direct contact with

anothe

r infectious lesion.

The chancre appears

10-90 days

average

21 days after exposure. Chancres are usually solitary, but multiple lesions can occur. Untreated primary chancres resolve in 75% of cases, but the spirochete remains within the host.

Slide7

Secondary Syphilis

Secondary

syphilis results from

hematogenous

and

lymphatic spread

of the spirochete.

The secondary stage begins approximately

6 weeks after the chancre appears

and lasts for

2-10 weeks.

An influenza-like syndrome occurs with mucocutaneous lesions, hepatosplenomegaly, and generalized adenopathy.

Slide8

Secondary Syphilis

The distribution and morphologic characteristics of individual skin

lesions vary

Secondary

syphilis lesions most commonly manifest as

pink 1-2cm

scaly

atch

that

become

generalized

syphilis in this stage is easily confused with numerous other cutaneous and systemic diseases, and therefore it has been termed the “great imitator" In addition to the above cutaneous findings, secondary syphilis may manifest as fever pharyngitis, weight loss, headache

,

meningitis

,

hepatitis

, renal disease, gastritis, colitis, arthritis, keratitis s and uveitis.

Slide9

Latent Syphilis

Latent

syphilis is a state of

positive serologic tests

( false positive)

without evidence of active disease

.

It has an

early and late status

.

The early latent period begins 2 years from the onset of primary disease, without signs or symptoms of disease. Late latent syphilis is infection with the spirochete greater than 2 years, without clinical evidence of disease. Early latent syphilis can be treated with one intramuscular injection of long- acting penicillin.

Late latent syphilis requires 3 weekly. injections, but is not

as"infectious

" as early latent syphilis

.

Half of patients in early latent syphilis will progress to late stage syphilis

Slide10

Tertiary Syphilis

Tertiary

syphilis is characterized by a

small number of organisms eliciting

a

large

or brisk cellular immune

response with

many clinical manifestations

.

Systemic disease

develops in about 25% of untreated or inadequately treated cases. Tertiary syphilis typically develops 1-10 years after initial infection. Cardiovascular and central nervous system involvement, with systemic granulomas or

gummas

are the hallmarks of this stage.

Slide11

Congenital Syphilis

Treponema

pallidum can be transmitted from an

infected mother to her fetus

.

In untreated cases:

25% of neonates are stillborn,

25% die shortly after birth,

10% have no symptoms,

40% will

have late symptomatic congenital syphilis. In early congenital syphilis, rash, hepatosplenomegaly and bone and joint changes occur before age 2 years.

In late congenital syphilis,

bone and joint changes

,

neural deafness

and interstitial keratitis occur after age 5 years. Therapy before the 16th week of gestation usually prevents infection of the fetus. A fetus is at greatest risk

when the

mother has syphilis for less than 2 years

.

Slide12

Skin Findings

Primary

syphilis

The chancre begins as a

papule or nodule,

then

undergoes

ischemic necrosis

and

erodes and ulcerates

The chancre is usually

3 mm to 2.0cm, With firm raised sharply defined border These lesions may be asymptomatic and undetected on the cervix of women, allowing transmission to the

other

Painless, hard, discrete,

Nonsuppurative

regional lymphadenopathy develops in 1-2 weeks, The chancre heals with scarring

, typically in

3-6 weeks.

Slide13

Skin Findings

Secondary Syphilis

This stage of syphilis is characterized by

systemic

, cutaneous

and mucosal signs

Symptoms

. Fever, malaise, pharyngitis adenopathy, weight loss and meningeal signs

(

headache) are common. The most common sign is a non-pruritic generalized, pink, scaly papular eruption(80%), The patches develop slowly, appear in a variety of shapes, including

round, ellipsoid

,

oval or annular and last for weeks or months.

symmetric

hyperpigmented oval papules with a collarette of scale appear on the palms or the soles in most s patients.

Slide14

Skin

Findings

Secondary Syphilis

...

Alopecia

of the beard, scalp

, Irregular and eyelashes occurs which is sometimes referred to

as"moth

-eaten alopecia".

Whitish, moist, anal

condyloma lata lesions are highly infectious wart like papules that are characteristic of syphilis, and may be confused with condyloma(warts). Split papules appear at the angle or commissures of the mouth. All secondary lesions are highly infectious with direct contact or palpation.

Without treatment, lesions of this stage relapse in about 20% of patients within a year.

Slide15

Skin Findings

Latent Syphilis

very few if any clinical signs of syphilis in this stage.

Slide16

Skin Findings

Tertiary Syphilis

Cutaneous

gummas

or

granulomatous nodules

develop subcutaneously,

expand and ulcerate

These lesions

also occur in the liver, bones and other organs Gummas produce a chronic inflammatory state in the body and produce distortion and malfunction with mass effects. Untreated tertiary syphilis can also cause neuropathic joint discase and degeneration of bones.

Cardiovascular syphilis

includes

syphilitic

aortitis

, aortic aneurysm and cardiac valve problems. Neurosyphilis can manifest as a generalized

paresis,personality

and emotional changes and hyperactive reflexe

s.

Infection and inflammation of the

spinal cord

can cause the

characteristic shuffling gait

of syphilis or

tabes

dorsalis.

Slide17

Laboratory and Testing

Direct

detection of

treponemal

spirochete is diagnostic

Detection of the spirochete from skin lesions

can be achieved under

dark-field microscopy

, which

shows corkscrew rotation

motility of the small, spiral syphilis spirochete, but must not be confused with other spirochete infections There are two quick and inexpensive serologic screening tests: the Rapid Plasma Reagin(RPR test ) and the Venereal Disease Research Laboratory (VDRL test) .

These screening tests are reactive by

day 7 of

the chancre,

Slide18

Laboratory and Testing

Because of the

possibilty

of false positive results from the RPR and VDRL tests, positive results from the screening tests should be confirmed with a

fluorescent

treponemal

antibody absorption test

(FTA ABS) or the

Treponemal

pallidum

hemaglutination

assay (TPHA), which are more specific but more expensive.

Slide19

Treatment

In

early disease (primary, secondary, latent less than 1 year) the drug of choice is

benzathine

penicillin G 2.4 million units intramuscularly

given once

In late

disease (lasting

more than 1

year)

the drug of choice is benzathine penicillin G 2.4 million units intramuscularly once a week for 3 weeks consecutively. People who are allergic to penicillin and not pregnant can be given doxycycline 100 mg twice a day for 2 weeks, or tetracycline, 500 mg four times a day for 2 weeks.

Slide20

Treatment

successful

therapy is indicated by a

falling Rapid Plasma

Reagin

titer

.

Rapid

Plasma

Reagin

testing should repeated

3,6, and 12 months after be treatment is complete. Treatment is repeated when there is a sustained fourfold increase in the Rapid Plasma Reagin titer. Therapy is repeated when a high titer does not show a fourfold decrease within 1 year

.

In

most patients infected with the

human immunodeficiency virus, syphilis responds to standard treatment regimens

.

Slide21

Chancroid

Description

Chancroid

is a rare

sexualy

tnansmitted

disease

caused by the

Gram negative

streptobacillus. It is characterized by painful genital ulceration and inguinal lymphadenopathy. The infection is also known as soft chancre and ulcus molle

Slide22

Chancroid

History

The

male to

female ratio is 10 to 1

It is more common in

heterosexual men

, who obtain it from

asymptomatic carriers

, usually

prostitutes

It is more common in developing countries and in people who travel to those countries but is rare in the United States. The ulcer from chancroid is a risk factor for co-infection with human immunodeficiency virus.

Slide23

Skin Findings

It

has an

incubation period from l day to 2 weeks

from the time of initial infection

Most lesions

occur on the

genitalia

, especially the

coronal sulcus

of the

penis in men and fourchette and labia minora in women, but also includes the thighs, buttocks and perianal area Half of men have a single ulcerative lesion, while

women are more likely to have multiple lesions

, but less pain

A

painful red papule

first appears at the site of inoculation within a day or 2. followed by a pustule, which may rupture, forming an ulcer with a bright red base.

Slide24

Skin Findings

The

ulcer of

chancroid

is deep

,

bleeds easily

, is

covered by a yellow to gray

fibrinous

exudate

, and may spread laterally. The ulcer sizes are variable from 3mm to 5cm in diameter. Women are more likely to develop"kissing ulcers" or bilateral ulcers on opposing surfaces of the labia and perineal area. These ulcers are

highly infectious

and

may become

multiple

via autoinoculation. form of

Slide25

Non-skin Findings

Patients

may feel ill with fever and malaise

Unilateral or bilateral inguinal

suppurative

lymphadenopathy

in

50% about 1 week after infection

Lymph nodes may

suppurate and ulcerate

or resolve spontaneously

Women may carry the organism, but display no clinically detectable lesion and have no symptoms. Women, more than men, may also present with dysuria or dyspareunia Untreated cases either resolve spontaneously or become chronic and require a long time to heal

Slide26

Laboratory

Haemophilus

ducreyi

cannot be cultured on routine media,

Newly formulated transport

mcdia

can maintain the viability of the organism.

A cotton swab is used to obtain a specimen at the base of the ulcer which is then rolled over a glass slide.

Slide27

Laboratory

Gram-negative

clumped organisms

, resembling a school of fish can be

scen

and is diagnostic

There is a high rate of

coinfection

with human immunodeficiency virus among patients with

chancroid

, so a test for this virus is reasonable in these patients

Syphilis serologies should be considered Differential Diagnosis Herpes simplex Syphilis lymphogranuloma venereum Granuloma inguinale

Slide28

Treatment

Azithromycin

1g orally in a single dose

Ciprofloxacin 500mg twice daily for 3 days

Ceftriaxone 250 mg intramuscularly in single dose,

Erythromycin base 50omg orally four times daily for 7 days.