Bacterial Sexually Transmitted Diseases Syphilis

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Bacterial Sexually Transmitted Diseases-- Syphilis

• Syphilis -caused by the spirochete Treponema
  pallidum
• motile bacteria with fastidious growth
  requirements
• Incidence has, on average, been on the rise since
  1960
• declining steadily since 1990
• Diagnosis from examining fluid of chancre and
  blood tests
• Treatment Penicillin, erythromycin and
  tetracycline
• No vaccine and no acquired immunity

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Progressive Stages of Syphilis

• Incubation StageOver a period of 2 to 6 weeks
  after entering the body
• Primary StageAn inflammatory response occurring
  three weeks after infection causes formation of a
  chancre
• Primary latent periodAll external signs of the
  disease disappears,but blood tests diagnostic for
  syphilis are positive
• Secondary StageAll symptoms can appear,
  disappear and reappear for a period up to 5 years
  during which time a patient is highly contagious

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The Primary Stage of Syphilis---A Genital Site
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The Primary Stage of Syphilis---A Non-Genital Site
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Progressive Stages of Syphilis

• Secondary latent periodOnce again all symptoms
  can disappear and blood tests can be negative.
  This stage can persist for life or for a highly
  variable t period of time
• Tertiary StagePermanent damage occurs throughout
  various systems of the body.
• A wide assortment of symptoms can appear
  syphilis has been called the great imitator
  because its symptoms can mimic those of so many
  other diseases

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A Papular RashSecondary Stage of Syphilis
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Tertiary Stage of Syphilis
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Congenital Syphilis

• Congenital syphilis occurs when microbes cross
  the placenta from mother to baby
• At birth or shortly thereafter, the infant may
  show such signs as notched incisors (Hutchinsons
  teeth), perforated palate, saber shins (in which
  the shin bone projects sharply on the front of
  the leg), an aged-looking face with saddle-nose
  (a flat, saddle-shaped nose) and a nasal discharge

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Congenital Syphilis--Hutchinsons teeth
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Congenital Syphilis--Saber Shin
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Congenital Syphilis Saddle-nose
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Chancroid

• Called soft chancre to distinguish it from the
  hard, painless chancre of syphilis, is caused by
  Haemophilus ducreyi
• small Gram negative rods occurring in strands
• Chancroid begins with the appearance of soft,
  painful lesions called chancres, which bleed
  easily, on the genitals, tongue and lips 3 to 5
  days after sexual exposure
• Often leaves deep scars
• The only symptom is a burning sensation after
  urination

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Chancroid Diagnosis and Treatment

• US cases usually in immigrants
• Diagnosed by identifying organisms from scraping
  lesions
• Treatment tetracycline, erythromycin sulfa drugs
• No acquired immunity
• Patients with chancroid also often have syphilis
  and other STDs

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A draining bubo caused by Haemophilus ducreyi
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Non-Gonococcal Urethritis (NGU)Chlamydial
Infections

• Chlamydia trachomatis is a tiny spherical
  bacterium with a complex intracellular life cycle
• A gonorrhea-like STD caused by organisms other
  than gonococci
• Most cases are caused by Chlamydia trachomatis,
  but some are caused by mycoplasmas

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• Causes a wide range of disorders including
  conjunctivitis
• The most prevalent sexually transmitted disease
  in the United States
• Roughly four million US cases annually
• Symptoms are similar to but milder than gonorrhea
• Many people are asymptomatic but risk of PID can
  lead to sterility and entopic pregnancy
• difficult to control may be congenital

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Lymphogranuloma venereum

• STD caused by Chlamydia trachomatis
• Symptoms Genital lesions, fever, malaise, skin
  rash and pus filled lymph nodes
• Diagnosis by cervical smear or penile swab, or
  lymph fluid
• Treatment Silver nitrate in newborns eyes and
  Doxycycline
• Enlarged lymph nodes can take 4 to 6 weeks to
  subside even after successful antibiotic therapy

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Early development of bilateral buboes of
lymphogranulomavenereum, caused by Chlamydia
trachomatis
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Viral Sexually Transmitted DiseasesHerpes Virus
Infections

• Two closely related herpes viruses cause disease
  in humans
• Herpes simplex virus type (HSV-1) typically
  causes fever blisters (cold sores), and herpes
  simplex virus type 2 (HSV-2), sometimes called
  herpes hominis virus, typically causes genital
  herpes
• Both have incubation period of 4 to 10 days,
  cause the same kind of lesions, and have been
  isolated from skin and mucous membranes of oral
  and genital lesions
• Among oral infections, 90 are caused by HSV-1
  and 10 by HSV-2. Among genital infections, 85
  are caused by HSV-2 and 15 by HSV-1

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• Herpes simplex viruses are permanent
  houseguests once acquired
• After an occurrence of a lesion, they migrate to
  ganglia, from which they travel back to the site
  of the original lesion at the time of the next
  outbreak
• While the virus is in a neuron, neither humoral
  nor cellular immunity can combat it

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Genital Herpes Infections

• Genital herpes infections usually are acquired
  after the onset of sexual activity because the
  virus is transmitted mainly by sexual contact
• However, the virus can survive for short periods
  of time in moist areas such as hot tubs
• More than 20 million Americans now have genital
  herpes, and half a million new cases are seen
  each year
• Persons may be contagious even when lesions are
  not present
• No vaccine treatments only reduce number of and
  shorten outbreaks (acyclovir)

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Penile Herpes Lesions
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Neonatal Herpes

• Neonatal herpes can appear at birth or up to 3
  weeks after birth
• Babies most often become infected by delivery
  through a birth canal contaminated with HSV-2,
  but they can also become infected through
  contaminated equipment and hospital procedures
• In rare instances, infants are infected in utero
• Because neonates are highly susceptible to HSV
  infections, they should not be cared for by
  individuals with such infections

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Neonatal Herpes
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Genital Warts (Condylomas)

• Etiological agent Human papillomaviruses
• Results in warts on genitals, vagina and cervix
• Typically not dangerous themselves
• Linked to 99 of cervical cancers
• Externally visible strains usually do not result
  in cancer
• Pap smears do not detect HPV virus only abnormal
  cells (effective about 70 of the time)
• A new DNA test is available that detects all 13
  strains that cause cancer
• Treatment removal of warts by freezing, laser or
  acid
• Typically reoccur
• No vaccine currently available