Std Power Point Slide For Prof Bello Flashcards
A. Genital ulcer diseases
A. Genital ulcer diseases
1. Syphilis
2. Chancroid
3. LGV
4. Granuloma inguinale
5. Herpes genitalis
B. Genital discharge diseases
B. Genital discharge diseases
1. Gonorrhea
2. Chlamydia (NGU/NSU).
3. Trichomoniasis.
4. Candidiasis.
5. bacterial vaginosis.
C. Viral STDs
C. Viral STDs
1. Herpes genitalis
2. Molluscum contagiosum
3. Genital warts
4. Serum hepatitis
5. AIDS
D. Miscellaneous STDs
D. Miscellaneous STDs
1. Pediculosis Pubis
2. Tinea cruris
3. Tropical diseases affecting the genitalia.
4. Erythrasma (Corynebacterium minutissimum).
5. Emerging STDs.
Classification of syphillis
Congenital
a.Early congenital stage
(i.e. in the first 2 years of life)
b. Late congenital stage
(from 3rd year of life onward)
c. Stigmata
(sequellae of early & late lesions)
Acquired
Primary syphillis (chancre)
Secondary syphillis
Tertiary syphillis
Infectious syphillis
Early congenital stage
(i.e. in the first 2 years of life)
Primary syphilis (Chancre)
Secondary syphilis
Non infectious syphillis
b. Late congenital stage
(from 3rd year of life onward)
Tertiary syphilis
c. Stigmata
(sequellae of early & late lesions)
Two types of syphillis
Non-venereal (endemic) and venereal syphillis
non venereal syphillis
YAWS (T.PERTENUE)
PINTA (T.CARATEUM)
BEJEL (T. PALLIDUM SUBSPP)
Types of Serological tests for syphillis
SEROLOGICAL TESTS FOR SYPHILIS (STS)/reagin/ non specific
•A. SCREENING TESTS.
•1. VDRL
•2 RPR.
•B. CONFIRMATORY TESTS./ treponema/specific
•1. TPHA.
•2. TPI
•3. FTA-Abs.
•4. PCR.
Full meaning of VDRL
Venereal disease research laboratory
Full meaning of RPR
Rapid plasma reagin test
Full meaning of TPHA
Treponema haemagglutination test
Full meaning of TPI
Treponema pallidum immobilization test
Full meaning of FTA-abs
Fluorescent treponema antibody-absorbed
INTERPRETATION OF SEROLOGICAL RESULTS
Reagin test. Treponemal test
Option I. + +
Option II. + -
Option III. - +
Option IV. - -
INTERPRETATION OF SEROLOGICAL RESULTS
•OPTION I.
•Active syphilis. If untreated, treat; and if treated, surveillance.
•OPTION II.
•A}. BFP, follow up with repeat serology monthly x3months + clinical observation. If active un-treated syphilis, Reagin Ab titre rises and later Treponemal Abs appear. If serology is negative and no clinical signs, Discharge patient.
•B). Early active syphilis, follow-up serology and clinical signs will emerge, Treat patient.
Another name for GRANULOMA INGUINALE
DONOVANOSIS
Causative agent of granuloma inguinale
Agent: Calymatobacterium granulomatis.
Incubation period of granuloma inguinale
IP = 1week-6months(av. 2/12)
Characteristics of syphillis ulcer
Indurated
Clean
Painless
Characteristics of granuloma inguinale ulcer
Lesion appears beefy- red; and no lymph node involvement , instead there is pseudo -bubo.
Causative organism of genital yeast infection
The commonest fungus causing this disease is Candida albicans.
Characteristics appearance of granuloma inguinale ulcers
Lesion appears beefy- red; and no lymph node involvement , instead there is pseudo -bubo.
Complications of granuloma inguinale
Complications include: secondary bacterial infection, Mixed infection, and malignant change.
Diagnosis of granuloma inguinale
•Diagnosis: culturable in egg-enriched media, biopsy from the edge of the lesion and stained with Giemsa or Wright’s stain, showing Donovan bodies.
Granuloma inguinale has never been found in sexual contact of infected patients. True/false
True
NB: The disease has never been found in sexual contact of infected patients.
Treatment for granuloma inguinale
TREATMENT:
•Streptomycin is the drug of choice until Syphilis is excluded.
•Others are: Erythromycin, Tetracycline, Chloramphenicol. They are used for 2-3 weeks and if possible repeated.
SURVEILLANCE: Follow up for 3 months if streptomycin is used, but 6 months if other drugs are used.
There are similarities between HHV-2 and…..
HSV-1
Incubation period of HHV-2
IP 3-7 days (av 5days).
Characteristics appearance of HHV-2
Lesions, go through papules-vesicles-bullae- shallow ulcers.
•Sites, mainly on genitalia but no distinction.
primary attack with constitutional symptoms and recurrent attacks are common.
Complications involve eyes, urethra, lymphatics, secondary and carcinoma.
bacterial infection
Diagnosis of HHV-2
Diagnosis.
•1. clinical picture.
•2.Smear from the lesion , to be stained with IFT, Giemsa or Papanicolaou stain. (Shows multi nucleated giant cells, (Tzank cells)
•3. Virus isolation on tissue culture or CAM.
•4. Serologically using CFT method.
•5. Demonstration of virus particles using Electron Microscopy.
• DD: All causes of GUDs and cancer.
•Rx: Acyclovir (Zovrax).
•NB: Pregnant women with HHV-2 infection should deliver by C/S.
What causes HHV-2
Chemical characteristics of chancroid
Constitutional symptoms are rare. Multiple sites are affected due to autoinoculation.
Ulcers are dirty, ragged, shallow and take several forms. NOT INDURATED. Inguinal adenopathy, (above the ligament) soft, matted together and form unilocular sinus.
Causative agent of chancroid
Haemophilus ducreyi (G-ve bacilli).
Incubation period of chancroid
1-7days
Epidemiology of chancroid
•Epidemiology: Commonest GUD in the Nigeria. ‘Disease of the socially un-enlightened and economically unfortunate’ ! 50% of sexual contacts are infected.
Multiple sites are affected due to autoinoculation.
Complications of chancroid
Complication: Mixed chancre, secondary bacterial infections, fistulae, stricture, haemorrhages, gangrene, phimosis and para-phimosis.
HIV transmission is 2-9 times commoner in patients with chancroid.
Diagnosis of chancroid
Diagnosis:
1. Ito-reeisterna (or Dmelcos ) test.
2. Gram stain.
3. Culture. Requires X-factor. Incubation is at 28-32 degree for 2-5 days. Gram stain from cultures show G-ve bacilli in long chains (the so-called shoal of fish) pattern. NB: 99-1oo% of African isolates are beta-lactamase positive.
4. Biopsy from the edge of the ulcer.
5. Serology is Not reliable.
Causative organism of LYMPHOGRANULOMA VENEREUM (LGV).
•Aetiology. Chlamydia trachomatis, subgroup A, serotypes L1, L2 and L3.
Epidemiology of lymphogranuloma venerum
•Epidemiology: Found in tropical and subtropical countries. Commoner in Southern than Northern Nigeria. It is also commoner in males than females.
Clinical features of lymphogranuloma venerum
Clinical features: Primarily a disease of lymph nodes and the lymphatics. The ulcer is small and transient (haircut). Constitusional symptoms are common. Lymphadenitis occurs 1-8 weeks after the ulcer and both are usually moderately painful except if secondarily infected by bacteria. The lymphadenitis occurs above and below the inguinal ligament, giving rise to the sign of the grove.
Complications of lymphogranuloma venerum
Complications. Secondary bacterial infection, fistulae, sinuses, urethral and anal stricture, abscesses, lymphatic obstruction also called Esthiomene, and malignant changes.
Diagnosis of lymphogranuloma venerum
Diagnosis.
1. Frei test. Using Lygranum.;
2. CFT.
3. Biopsy.
4. Culture either in yolk-sac or in irradiated or chloheximide –treated McCoy cells /Hela 229 cells.
5. Micro IF test.
6. ELISA test.
7. PCR test.
8. Microscopy on pus mixed with Lugol’s Iodine.
9. ESR rises due to increased globulin. 10. Clinical diagnosis.
Treatment of lymphogranuloma venerum
Treatment: Doxycycline, Oxytetracycline, Erythromycin, Co-trimoxazole. NB: Bubo if present and ripe, MUST be aspirated and NOT incised!
Causative agent of gonorrhea
•Agent: Neisseria gonorrhoeae
Epidemiology of gonorrhea
Epidemiology: It is universal with short incubation period. (I.P. 1-5, average 2, days).PPNG strains complicate the story. Males and females are affected but asymptomatic infections are more in females due to their anatomy.
Clinical features of gonorrhea
Clinical features: Purulent discharge; associated organs are affected. Condom usage has diminished the magnitude of the problem while use of many orifices has escalated the matter.
Complications of gonorrhea
Complications. Genital stricture, metastatic complications like meningitis, skin lesions, arthritis, endocarditis and eye infections. Subfertility and infertility. Gonococcal ophthalmia neonatorum should be distinguished from that caused by Chlamydia.
Diagnosis of gonorrhea
Diagnosis of gonorrhea. From history, clinical, microscopic, cultural and biochemical modes.
READ TEXT BOOK
Treatment for gonorrhea
Treatment: Except for the PPNG strains, isolates are sensitive to several antibiotics.
Sub-groups of chlamydia
The genus Chlamydia is divided into two sub-groups:
•1. Chlamydia psittaci –primarily a pathogen of psittacine birds but also causes zoonotic infections in man.
•2. Chlamydia trachomatis. This is sub-divided into three sero-groups:
• i. Serotypes A,B,Ba,& C.-These cause Trachoma.
• ii. Serotypes D-K. These cause inclusion conjunctivitis & genital infections.
•Iii. Serotypes L1, L2, L3. These cause Lymphogranuloma venereum (LGV). Chlamydia does better, whatever Neisseria gonorrhoeae does.
Chlamydia is commoner and more dangerous than………..
Virtually all STDs can cause NGUjust as Chlamydia does.
Chlamydia is commoner and more dangerous than N. gonorrhoeae.
•(Cf. pp70-71.). Virtually all STDs can cause NGUjust as Chlamydia does.
HHV-2 is acquired by……..
Sexual contact
HHV-1 is acquired by…..
For mites and saliva
Incubation period of trichomoniasis
Incubation period (I.P.) is 2-28 days, average 10 days. Once established, infection tends to last long in females.
Causative agent of trichomoniasis
Flagellated protozoan, trichomonas vaginalis
Characteristics appearance of trichomoniasis
Strawberry appearance; Its typical discharge is greenish, watery and foamy (ie, it contains air bubbles); it smells badly and itches intensely and worse at night. When the urinary blader is involved, frequency and dysuria occur. Severe vaginitis results in dyspareunia and ‘scissors action’.
Complications of trichomoniasis in females
Complications: In females- Bartholinitis, adnexitis, pyosalpinx endometritis, infertility, low birth weight and cervical erosion.
Complications of trichomoniasis in males
males-NGU, prostatitis, balanoposthitis, epididymitis, urethral disease and infertility. In both sexes, TV facilitates HIV transmission by 2-9 times.
Diagnosis of trichomoniasis
Diagnosis: 1. Direct (wet-prep) microscopy. 2. Broth culture.
•3. Staining method.acridine orange, Leishman, PAS, Fontana, Papanicollau stains may be used.
•4.Antibody-based techniques.(using monoclonal antibodies, are being tried.) 5. DNA techniques. PCR & dot-blot hybridization, are techniques for the future.
Treatment of trichomoniasis
Treatment: Metronidazole (Flagyl), is the drug of choice; but about 5% strains are found to be resistant to it. Where they exist, increase the dose and treatment time.
•NB: Don’t use in pregnant women in first trimester and babies below 3 months.
•Alternate drugs include: Tinidazole (Fasygin), Nimorazole (Naxogin).
•Both patient and contact should be treated.
Control of trichomoniasis
•Control: Screening of both men and women is recommended. Those harboring the TV should be treated.
Diagnosis of BV
Diagnosis.
•1. Vaginal PH >4.5.
•2. Positive amine test.
•3. Presence of Clue cells. OR absence of Lactobacilli.(best shown on Gram stained slide).
Treatment of BV
Treatment. 1. Metronidazole 2. Povidone-iodine pessaries.
3. Intra-vaginal Clindamycin cream nocte x3days.
Clinical features of BV
•Clinical feature: I.P. is 1-4 weeks. Vaginal PH >4.5, Fish-like odour.
•Vulval (NOT) vaginal discomfort.
Causative agent of BV
AETIOLOGY: Gram negative , microaerophilic bacillus called Gardnerella vaginalis.
The discharge due to BV is:
•Malodourous, copious, milky-white/grayish, without vaginal inflammation, without itching/irritation. It is commoner following surgery, or pregnancy, or in women with an IUCD
The commonest cause of genital yeast infection is
Candida albicans
Clinical course of genital yeast infection
IP is a few days to 3months.These infections have increased in recent years. Principally, they affect the mucosal surfaces like the mouth, pharynx, vagina and glans penis. Also the inter-triginous surfaces like the peri-anal and infra-mammary regions; the nails(onichia) and adjascent tissues(paronychia) and less commonly, the skin. Very rarely they cause systemic infections especially in immuno-compromised patients, as in HIV/AIDS. Other predisposing factors include prolonged use of antibiotics, Cntaceptive pills, Steroid therapy, homonal imbalance, wearing of tight pants, malignant disease, iron-deficiency anaemia, severe stress very young and very old ages.
Epidemiology of genital yeast infection
Epidemiology: Candida sp and other yeasts are part of the normal flora of the mouth, and GIT and also in the vagina of over 50% of adult females. Candida is more than ten times commoner in females than males ! Candida genital infection is endogenous in females but exogenous in males and males invariably acquire it through sex . Babies born to infected mothers acquire it. (oral thrush).
Other candida and yeast species
Torulopsis species,
Saccharomyces species,
Geotrichum species,
Trichosporum species
Treatment of genital yeast infection
Treatment: 1. Nystatin tablet/cream/ pessaries .2. Fluconazole.
•3. Econazole. 4. itraconazole. 5. Amphotericin B
Diagnosis of genital yeast infection
Diagnosis:
Candida is di-morphic fungus, existing in both yeast and mycelial forms, the latter being predominant in the pathogenic state.
•The specimen is best obtained from the vaginal wall (introitus) because the fungus is microaerophilic. Mix it with a drop of normal saline on a glass slide and view it as direct microscopy or stain with Gram stain. For a greater yield, culture it on blood/chocolate agar or sabouraud agar medium.
Complications of genital yeast infection
•Complications. Very rare except in persons with debilitating illness or depressed immunity. In which systemic infection could be life-threatening.
Primary syphillis lesion is called
Chancre
Constitutional signs of primary syphillis
Malaise,low-grade fever, head ache, joint pains
Note:
Primary syphillis lesion (chancre) is one. May be two or three but not more
Development of chancre
Macule- maculopapular- papule- ulcer
Features of syphillis lesion (ulcer)
Clean
Indurated
Painless
Mixed chancre in secondary syphillis
Ulcer may be dirty
Non- indurated
Painful
Note:
All genital ulcers must be presumed to be due to syphillis unless proved otherwise by dark field microscopy done daily for 3 days and syphillis serology done weekly for four weeks without the patient taking any treponemicidal antibiotics
Note:
Syphillis ulcer heals within 3-8 wks
With or without treatment
Syphillis ulcer is usually accompanied with
Lymphadenopathy
In 25-50% cases features is secondary syphillis set in whilst…….had not healed
Chancre
By far the commonest and the most easily recognizable lesions of secondary syphillis are:
The skin rash
Mucous membrane lesion
Lymphadenopathy
The rash of secondary syphillis assumes several forms:
Macular/roseolar
Papular
Annular
Pustular
Squamous varieties
The rings that is formed below the hairline by papules is called
Crown of Venus or corona veneris
There are three varieties of tertiary syphillis:
Cardiovascular syphillis
Neuro syphillis
Gummata
Kassowitz law
The effects of untreated maternal syphillis on the foetus depends on the stage of the maternal disease and the stage of pregnancy when the infection is acquired
Treatment for syphillis
Acqueous procaine Penicillin
Benzathine penicillin G
Ceftriaxone or erythromycin
Immunity in syphillis
Wassermann and immobilizing antibodies
It is a gram negative carboxyphilic, kidney shaped cocci
Neisseria gonorrhea
Opthalmia neonatorum could be caused by
Neserria gonococcus
Chalmydia trachomatis
Tests for gonorrhea
Oxidase positive and gram negative cocci
Sugar fermentation test (the gonococci ferments glucose only)
Fluorescent antibody technique
Congo red
Co agglutination test manganous chloride disc test
Treatment for gonorrhea
Erythromycin
Azithromycin
Kanamycin
Spectinomycin
Ciprofloxacin
Cefuroxime
Cefoxitin
Cefoxime
Ceftriaxone
Prevention of opthalmia neonatorum
Erythromycin- eye ointment
1% silver nitrate solution
Treatment of opthalmia neonatorum
Ceftriaxone
Erythromycin syrup
Erythromycin ointment
Hemophilus ducreyi is a
Gram-negative bacillus
What std is christened the disease of the socially unelightened and economically unfortunate
Chancroid
Commonest form of genital ulcer disease
Chancroid
Clinical features of chancroid lesion
Lesion tends to be multiple because of auto-includability is the features of this infection.
Small, red papule develops; this becomes vesiculopustular and finally ulcerated.
Characteristics of chancroid ulcer
The ulcer is described as
dirty and ragged
Shallow
Non indurated
Under-mind edge and the base is grey
Surrounded by a large area of dull erythema
Very painful
Bleeds easily
LGV is a disease of
Lymph nodes and lymphatics
Gram negative bacillus
Calymatobacterium granulomatis
Hemophilus ducreyi
Neisseria gonorrheae
Trichomonas vaginalis is
A flagellated Protozoa
Worlds most commonly non viral std
Trichomoniasis
