SEXUALLY TRANSMITTED DISEASE PRESENTATIONS Sexually transmitted diseases can present as follows Genital ulcers or sores Urethral discharge Vaginal discharge Cervical infection ID: 929839
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Slide1
Sti
Doctor
Arif
Abid
Slide2SEXUALLY 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
Slide3Syphilis
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.
Slide4History
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.
Slide5Incidence
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)
.
Slide6Primary 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.
Slide7Secondary 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.
Slide8Secondary 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.
Slide9Latent 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
Slide10Tertiary 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.
Slide11Congenital 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
.
Slide12Skin 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.
Slide13Skin 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.
Slide14Skin
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.
Slide15Skin Findings
Latent Syphilis
very few if any clinical signs of syphilis in this stage.
Slide16Skin 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.
Slide17Laboratory 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,
Slide18Laboratory 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.
Slide19Treatment
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.
Slide20Treatment
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
.
Slide21Chancroid
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
Slide22Chancroid
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.
Slide23Skin 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.
Slide24Skin 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
Slide25Non-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
Slide26Laboratory
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.
Slide27Laboratory
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
Slide28Treatment
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.