SEXUALLY TRANSMITTED DISEASES

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SEXUALLY TRANSMITTED DISEASES

• PATRICK DUFF, M.D.
• UNIVERSITY OF FLORIDA

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SEXUALLY TRANSMITTED DISEASES

• Chlamydia
• Gonorrhea
• Syphilis

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LEARNING OBJECTIVES

• Pathophysiology of infection
• Clinical manifestations
• Diagnosis
• Treatment

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KEY QUESTIONS

• Most practical, clinically useful diagnostic test
  for gonorrhea and Chlamydia
• Most appropriate antibiotic for treatment of
  chlamydia endocervicitis
• Characteristic lesions of each stage of syphilis

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SEXUALLY TRANSMITTED DISEASESOVERVIEW
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SEXUALLY TRANSMITTED DISEASESOVERVIEW
Esoterica
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CHLAMYDIA

• Pathogen - Chlamydia trachomatis
• Obligate intracellular parasite
• Can be grown in tissue culture

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CHLAMYDIA TRACHOMATIS
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CHLAMYDIAMICROBIOLOGY

• Reticular body
• Elementary body infectious form

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CHLAMYDIA MECHANISMS OF TRANSMISSION

• Sexual contact
• Perinatal

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CHLAMYDIADISPELLING AN URBAN MYTH
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CHLAMYDIAFrequency

• Most common STD in Western countries
• 3 - 5 x as common as gonorrhea
• Prevalence varies with the population

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CHLAMYDIAMANIFESTATIONS IN MEN

• Urethritis
• Proctitis
• Epididymitis

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CHLAMYDIAMANIFESTATIONS IN WOMEN

• Urethritis
• Endocervicitis
• Proctitis
• PID
• Perihepatitis

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FITZ-HUGH-CURTIS SYNDROME
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CHLAMYDIADIAGNOSIS

• Clinical examination
• Culture
• Nucleic acid probes - PCR

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CHLAMYDIADIAGNOSIS
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CHLAMYDIATREATMENT

• Patient and partner should be treated
• Drugs of choice
• Doxycycline
• Erythromycin
• AZITHROMYCIN

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CHLAMYDIASEQUELAE

• Infertility
• Ectopic pregnancy
• Chronic pelvic pain

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CHLAMYDIAUNUSUAL PRESENTATIONS

• Trachoma
• Inclusion conjunctivitis
• Lymphogranuloma venereum

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TRACHOMA
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INCLUSION CONJUNCTIVITS
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LGVCLINICAL MANIFESTATIONS
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GONORRHEAMICROBIOLOGY

• Pathogen Neissseria gonorrhoea
• Gram-negative diploccus
• Can be cultured in selective media

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GONORRHEAMECHANISMS OF TRANSMISSION

• Sexual contact
• Perinatal

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GONORRHEAFREQUENCY

• Less common than chlamydia
• Prevalence varies with population

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GONORRHEAMANIFESTATIONS IN MEN

• Urethritis
• Epididymitis
• Proctitis
• Pharyngitis

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GONORRHEACLINICAL PRESENTATION
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GONORRHEAMANIFESTATIONS IN WOMEN

• Urethritis
• Endocervicitis
• Proctitis
• PID
• Pharyngitis

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GONORRHEADISSEMINATED INFECTION

• Arthritis
• Dermatitis
• Pericarditis and endocarditis
• Meningitis
• Perihepatitis

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DISSEMINATED GONORRHEACLINICAL PRESENTATION
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GONORRHEADIAGNOSIS

• Clinical examination
• Gram stain
• Culture
• Nucleic acid probes

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GONORRHEAGRAM STAIN
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GONORRHEATREATMENT

• Patient and partner should be treated
• Drugs of choice
• Ceftriaxone 125 mg i.m.
• Quinolone concern with increasing resistance

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GONORRHEASEQUELAE

• Infertility
• Ectopic pregnancy
• Chronic pelvic pain

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GONORRHEASEQUELAE
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GONORRHEASEQUELAE
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SYPHILISMICROBIOLOGY

• Pathogen - Treponema pallidum
• Cannot be cultivated in vitro

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SYPHILISFREQUENCY

• Incidence has increased , especially in females
  aged 15-24 years
• Highest prevalence - urban blacks and hispanics

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SYPHILISMECHANISMS OF TRANSMISSION

• Sexual contact
• Perinatal

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SYPHILISCLASSIFICATION

• Primary
• Secondary
• Latent
• Early
• Late
• Tertiary

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CONGENITAL SYPHILISRISK OF PERINATAL TRANSMISSION

Stage of Disease
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SYPHILISDIAGNOSIS

• Clinical examination
• Darkfield microscopy rarely used
• Serology mainstay of diagnosis
• VDRL or RPR screening test
• MHA or FTA confirmatory test

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PRIMARY SYPHILISPRINCIPAL CLINICAL FINDING
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SECONDARY SYPHILISPRINCIPAL CLINICAL FINDINGS
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SECONDARY SYPHILISPRINCIPAL CLINICAL FINDINGS
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LATE STAGE SYPHILISPRINCIPAL CLINICAL
MANIFESTATIONS

• Destructive gummas
• Aortic valve injury
• CNS manifestations
• Dementia
• Tabes dorsalis
• Pupillary abnormalities

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ARGYLL-ROBERTSON PUPIL
Accommodates but does not react
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LATE STAGE SYPHYLISGUMMAS
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CONGENITAL SYPHILISCLINICAL MANIFESTATIONS

• Fetal death
• Growth restriction
• Multiple anomalies
• Immediately apparent at birth
• Delayed appearance

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CONGENITAL SYPHILISABNORMAL DENTITION
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CONGENITAL SYPHILISSABER SHINS
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SYPHILISTREATMENT

• Patient and sexual partner(s) should be treated
• Antibiotic therapy
• Penicillin preferred in pregnancy
• Doxycycline
• Tetracycline

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STDsCONCLUSIONS
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KEY QUESTIONS

• Most clinically useful diagnostic test for
  gonorrhea and Chlamydia
• Most appropriate antibiotic for treatment of
  Chlamydia endocervicitis
• Characteristic lesion of each stage of syphilis

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SUGGESTED READING

• CDC. 2006 guidelines for treatment of sexually
  transmitted diseases. MMWR