SEXUALLY TRANSMITTED DISEASES

1
SEXUALLY TRANSMITTED DISEASES

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

2
SEXUALLY TRANSMITTED DISEASES

• Chlamydia
• Gonorrhea
• Syphilis

3
LEARNING OBJECTIVES

• Pathophysiology of infection
• Clinical manifestations
• Diagnosis
• Treatment

4
CHLAMYDIA

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

5
CHLAMYDIA TRACHOMATIS
6
CHLAMYDIAMICROBIOLOGY

• Reticular body
• Elementary body infectious form

7
CHLAMYDIA MECHANISMS OF TRANSMISSION

• Sexual contact
• Perinatal

8
CHLAMYDIAFrequency

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

9
CHLAMYDIAMANIFESTATIONS IN MEN

• Urethritis
• Proctitis
• Epididymitis

10
CHLAMYDIAMANIFESTATIONS IN WOMEN

• Urethritis
• Endocervicitis
• Proctitis
• PID
• Perihepatitis

11
FITZ-HUGH-CURTIS SYNDROME
12
CHLAMYDIADIAGNOSIS

• Clinical examination
• Culture
• Nucleic acid probes - PCR

13
CHLAMYDIADIAGNOSIS
14
CHLAMYDIATREATMENT

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

15
CHLAMYDIASEQUELAE

• Infertility
• Ectopic pregnancy
• Chronic pelvic pain

16
CHLAMYDIAUNUSUAL PRESENTATIONS

• Trachoma
• Inclusion conjunctivitis
• Lymphogranuloma venereum

17
TRACHOMA
18
INCLUSION CONJUNCTIVITS
19
LGVCLINICAL MANIFESTATIONS
20
GONORRHEAMICROBIOLOGY

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

21
GONORRHEAMECHANISMS OF TRANSMISSION

• Sexual contact
• Perinatal

22
GONORRHEAFREQUENCY

• Less common than chlamydia
• Prevalence varies with population

23
GONORRHEAMANIFESTATIONS IN MEN

• Urethritis
• Epididymitis
• Proctitis
• Pharyngitis

24
GONORRHEACLINICAL PRESENTATION
25
GONORRHEAMANIFESTATIONS IN WOMEN

• Urethritis
• Endocervicitis
• Proctitis
• PID
• Pharyngitis

26
GONORRHEADISSEMINATED INFECTION

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

27
DISSEMINATED GONORRHEACLINICAL PRESENTATION
28
GONORRHEADIAGNOSIS

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

29
GONORRHEAGRAM STAIN
30
GONORRHEATREATMENT

• Patient and partner should be treated
• Drugs of choice
• Ceftriaxone
• Quinolone

31
GONORRHEASEQUELAE

• Infertility
• Ectopic pregnancy
• Chronic pelvic pain

32
GONORRHEASEQUELAE
33
GONORRHEASEQUELAE
34
SYPHILISMICROBIOLOGY

• Pathogen - Treponema pallidum
• Cannot be cultivated in vitro

35
SYPHILISFREQUENCY

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

36
SYPHILISMECHANISMS OF TRANSMISSION

• Sexual contact
• Perinatal

37
SYPHILISCLASSIFICATION

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

38
CONGENITAL SYPHILISRISK OF PERINATAL TRANSMISSION

39
SYPHILISDIAGNOSIS

• Clinical examination
• Darkfield microscopy
• Serology
• VDRL or RPR screening test
• MHA or FTA confirmatory test

40
PRIMARY SYPHILISPRINCIPAL CLINICAL FINDING
41
SECONDARY SYPHILISPRINCIPAL CLINICAL FINDINGS
42
SECONDARY SYPHILISPRINCIPAL CLINICAL FINDINGS
43
LATE STAGE SYPHILISPRINCIPAL CLINICAL
MANIFESTATIONS

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

44
ARGYLL-ROBERTSON PUPIL
Accommodates but does not react
45
LATE STAGE SYPHYLISGUMMAS
46
CONGENITAL SYPHILISCLINICAL MANIFESTATIONS

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

47
CONGENITAL SYPHILISABNORMAL DENTITION
48
CONGENITAL SYPHILISSABER SHINS
49
SYPHILISTREATMENT

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

50
STDsCONCLUSIONS
51
SUGGESTED READING

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