Download Management of sexually transmitted diseases

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Sexually transmitted diseases (STDs) are the
venereal disorders that are caused by a
variety of pathogenic microorganisms.
In almost all the countries STDs are the most
common of all infectious diseases. Among
which Syphilis, Gonorrhea, and AIDS are
predominant
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INFECTIOUSDISEASE - CAUSATIVE ORGANISM
Bacterial
 Gonorrhea
 Syphilis
 Non
gonococcal
trachomatis
Chancroid
Viral
 Herpes Genitalis
 AIDS
 Hepatitis
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- Neisseria gonorrhoeae
- Treponema pallidum
urethritis
-Chlamydia
-Ureaplasma urealyticum
- Hemophilus ducreyi
- HSV 1 0r 2
- HIV
- Hepatitis A, B, and C
Parasites
 Trichomniasis -Trichomonas Vaginalis
 Giardiasis
- Giardia lamblia
 Scabies
- Sarcoptes scabiei
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The fundamental factor that contributes for
the spread of infection is sexual intercourse.
It spreads both by homosexism and
heterosexism.
To avoid the spread of the disease, it is
important to identify the group of
individuals who are more at risk.
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Men aged 18 – 34 years
Women aged 16 – 28 years
Commercial sex workers
Homosexual and Bisexual men with
multiple partners
Frequent travelers (truck drivers)
Control of STDs
Good clinical practice – which, includes:
 Accurate diagnosis,
 Effective treatment, and
 Intensive follow-up to ensure the cure of
disease.
It is an infection to the epithelium of the
urethra, cervix, rectum, or pharynx that is
caused by the organism called as Neisseria
gonorrhoeae.
Signs and symptoms:
 In men, the incubation period is 2 – 14days
 women it ranges from 7 – 21 days
 discomfort in urethra
 dysuria
 purulent discharge
 meatus may be red and swollen.
Diagnosis
In male:
 Signs and symptoms and
 Gram stain of urethral discharge showing
gram negative diplococci.
In female:
 Signs and symptoms and
 Culture of cervical discharge showing gram
negative diplococci
Disseminated gonococcal infection (DGI)
This is more common in women than in men
 Mild febrile illness
 Malaise
 Polyarthritis
 Skin lesions often on the periphery of the limbs
 Genital symptoms are often asymptomatic
Detected by culture
Gonococcal arthritis
 Similar to DGI
 Fever
 Severe joint pain and
 Limitation in movement of the joints
(swelling, redness, and warmth)
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Treatment for uncomplicated gonorrhea
Ceftriaxone 125 mg IM single dose
Or
Ciprofloxacin 500 mg PO single dose
Or
Cefixime 400 mg PO single dose
Or
Ofloxacin 400 mg PO single dose.
In pregnancy:
 Ceftriaxone 125 mg IM single dose.
Treatment for complicated gonorrhea:
 Ceftriaxone 1gm IV / IM once daily for 3 – 7
days.
Or
 Ampicillin / ammoxicillin 1 gm PO q. 6
hours for 3 – 7 days.
 NSAIDs preferred in gonococcal arthritis
along with antibiotics.
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It is a contagious systemic disease caused by
the spirochete Treponema Pallidum which is
characterized by sequential clinical stages.
Primary syphilis
Secondary syphilis
Latent syphilis
Tertiary syphilis
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Cardiovascular syphilis and neuro syphilis
Congenital syphilis
Primary syphilis:
Incubation period is 14 – 28 days
Characterized by –
 Skin lesions (painless)
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Regional lymph nodes are moderately
enlarged
Secondary syphilis:
Starts from 6-8 weeks after chancre (skin
lesions) appearance
Characterized by –
 Mild fever
 Malaise
 Headache
Dermatological manifestations like
 Facial macular rash and
 Genital ulcers may present
Generalized Lymphadenopathy
Diagnosis by signs & symptoms + +ve VDRL
Latent syphilis
The late stages of syphilis called as latent
syphilis (appears after 1 or 2 years of infection)
patients are asymptomatic with elevated VDRL
titer.
Diagnosis can be made by +ve serology and
prior history of syphilis.
Tertiary syphilis
May present with –
 Aortitis
 Irtis
 Gumma
Diagnosis by H/o syphilis + positive VDRL
It may cause end organ damage.
Cardiovascular syphilis and neuro syphilis
May present with –
 Ophthalmic / auditory symptoms
 Signs of meningitis
 psychosis
 Dementia
Diagnosis
CSF abnormalities
Positive VDRL .
Congenital syphilis
 In pregnant women with syphilis,
T. Pallidum can cross the placenta at any
time during pregnancy
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Transmission of syphilis during pregnancy
can result in fetal death, prematurity or
congenital syphilis
Symptoms can be seen during first month
of life (early congenital syphilis) or in later
stages of childhood or adolescence (late
congenital syphilis)
Clinical manifestations
 Early congenital syphilis resemble with
secondary syphilis
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Late congenital syphilis resembles with
latent syphilis.
Diagnosis:
Venereal disease research laboratory
(VDRL) test.
 Rapid plasma regin (RPR)
T.Pallidum hemagglutination assay (TPHA).
 ELISA.
Treatment of primary, secondary and latent
stages of syphilis:
 Procaine penicillin: 600 – 1200 mg IM OD for
12 days
Or
 Doxycycline: 100 mg orally q.8 hours for 15
days
Or
 Tetracycline: 500 mg orally q 6hours for 15
days.
Treatment of cardiovascular / neuro
syphilis
 Crystalline penicillin – 18 – 24 million units
IV q. 6 hours for 10 – 14 days
Congenital syphilis:
 Crystalline penicillin- 50,000 units/kg
IV q. 12 hours during first 7 days of life for 10
days.
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Organism : Herpes simplex virus
Signs and symptoms:
 Fever
 Headache
 Erythematous ulcers (chronic cases)
 Local itching
 Vaginal / urethral discharge
Diagnosis
Clinical presentations / culture
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STDs are common infectious diseases in
both developed and developing countries
especially in young adults.
Recent advances in technical medicine
assures 100% cure for most of the STDs.
The advancements in the diagnosis of STDs
help in early detection and management of
diseases, which minimizes complications
and healthcare cost.
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Applicable for STDs also
Avoiding sexual contact with infected
persons i.e. by avoiding multiple sex
partners
Using proper physical and chemical barriers
during intercourse.