Download Sexually transmitted Infections

SEXUALLY TRANSMITTED
INFECTIONS
Dr Y P Beh
SpR GUM
25/10/2011
OVERVIEW
Definition of Sexual Health
2. Transmission factors
3. Epidemiology of STIs
1.
-
Worldwide
UK
Sexually transmitted Infections
5. Summary
4.
Definition of Sexual Health (WHO)
 Sexual health is a state of physical, emotional,
mental and social well-being related to sexuality;
 Not merely the absence of disease, dysfunction or
infirmity.
 Requires a positive and non judgemental
approach to sexuality and sexual relationships
 Sexual rights of all persons must be respected,
protected and fulfilled
Factors involved in Transmission
Prevention & control interventions
Individual factors
Socio-demographic factors
Health beliefs
Healthseeking
seeking behaviours
Health
behaviours
Highrisk
risk sexual
sexual behaviours
High
behaviours
Environmental Factors
STI/HIV
Epidemics
Socio-economic deprivation
Limitations to use of, and access to,
curative services
Infectious agents
Antimicrobial resistance
Prevalence, incidence and duration of infectivity
STIs
Around 30 different STIs
Common bacterial infections
 Chlamydia trachomatis
 Neisseria gonorrhoea




Treponema pallidum (causes syphilis)
Lymphogranuloma venereum ( caused by chlamydia)
Haemophilus ducreyi (causes chancroid)
Klebsiella granulomatis (previously known as
Calymmatobacterium granulomatis) causes granuloma
inguinale or donovanosis.
Common viral infections
 Human immunodeficiency virus (1&2)
 Herpes simplex virus type 1 & 2
 Human papillomavirus
 Hepatitis B virus
Protozoal infection
 Trichomonas vaginalis (causes vaginal trichomoniasis)
Fungal infections
 Candida albicans ( Thrush)
Global prevalence of STI
Estimated New Cases Of Curable STI Among Adults, 1999
•Source:WHO
Worldwide
 > 340 million new cases of STIs every year
 Untreated early syphilis in pregnancy


Stillbirth (25%), Neonatal deaths (14%)
40% Perinatal mortality
 Untreated gonococcal and chlamydial infections in women result in pelvic
inflammatory disease in up to 40% of cases. One in four of these will result
in infertility
 4000 newborn babies/yr become blind due to untreated maternal
gonococcal and chlamydial infections
 Herpes simplex virus type 2 infection - leading cause of genital ulcer
disease in developing countries
STIs in UK
Number of STIs based on sex
Number of STIs based on sex
Proportional increase in STIs
% change
2007
2006-2007
1998-2007
Chlamydia
121,986
7%
150%
Genital warts
89,838
7%
28%
Genital herpes
26,062
20%
51%
Gonorrhoea
18,710
-1%
42%
Syphilis
2,680
0%
1,828%
Routine GUM clinic returns
Sexually Transmitted Infections, HPA Centre for Infections
Sexually Transmitted
Infections (STIs)
Classification on the Basis of Presentation
STD
Urethritis
Ulcerative
Chlamydia
Gonorrhoea
Non-specific urethritis
Genital Herpes
Syphilis
Chancroid
LGV
Donovanosis
Bechet`s Disease
Vaginal
Discharge
Systemic
Miscellaneous
Chlamydia
Gonorrhoea
Trichomonal infection
Candidiasis
Bacterial vaginosis
HIV
Hepatitis A
Hepatitis B
Hepatitis C
SARA
PID
Epididymo-orchitis
Genital warts
Molluscum
Contagiosum
Scabies
Pubic lice
*Not Transmitted sexually
Chlamydia Trachomatis
 Most common sexually transmitted infection
 5 -10% of sexually active women under 24 yrs and men between 20-24 yrs
may be currently infected
 Incubation period up to 2 weeks
 Caused by serovars D-K
 Risk Factors




Age under 25yrs
New sexual partner/ >1 sexual partner in the past year
New sexual partner being more important than number of
partners
Lack of consistent use of condoms
Symptoms of chlamydial infection
Men
- 50% asymptomatic
- Discharge and dysuria
Women
- 70-80% asymptomatic
- Discharge and dysuria
- Intermenstrual/ postcoital
bleeding(cervicitis/endometritis)
- Abdominal pain
– 70% asymptomatic
Complications associated with Chlamydia
•
•
•
•
•
•
•
•
Endometritis/ Salpingitis/ PID
Ectopic pregnancy
Infertility
Chronic pelvic pain
Pregnancy complications
Reiter’s syndrome
Epididimo-Orchitis
Fitz-Hugh Curtis syndrome
Chlamydia
 Diagnosis
 Nucleic Acid Amplification Technique (NAAT)
 Specimen: urine (males), endocervical swab/self swab
(females)
 Sensitive 90-95%
 Specificity 99% ( 93 – 100%)
 Treatment
 Azithromycin 1gm stat
(or)

Doxycycline 100mg bd 7 days
National Chlamydia Screening Programme
 Established in 2002
 Opportunistic Screening in all health settings (Outside
GU medicine)
 Women & men ,16 –25 yrs
 Positives advised to attend GU clinic for treatment &
screening, especially those with symptoms
Gonorrhoea
 Second commonest bacterial STI in UK
 Neisseria gonorrhoea – intracellular, gram negative





diplococci
Incubation period 2-5 days but can be up to 2 weeks
Men symptomatic >80%, women asymptomatic 50%
Symptoms include dysuria, discharge, lower abdominal
pain
Extra-genital infection possible (pharyngeal)
Disseminated - skin lesions, arthralgia, arthritis and
tenosynovitis.
Gonorrhoea
Diagnosis
 Test: NAAT and Culture, microsopy
 Specimens : urine/urethral swab(males),endocervical swabs
Treatment
 First Line – Ceftriaxone with Azithromycin
 Increased resistance to Penicillins, Ciprofloxacin, Tetracyclines.
Non-specific urethritis
 Present in males
 Diagnosis depends on symptoms ie discharge and
dysuria and microscopy showing pus cells
 May be STI – usually chlamydia, less frequently
mycoplasma, ureaplasma sps.
 May be trauma, allergic reaction, dermatitis
 Treatment – similar to chlamydia treatment
(Azithromycin/Doxycycline)
SYPHILIS
•Classification
•Congenital
•Acquired
•Early
•(<2 years)
•Primary
•Late
•(> 2 years)
•Late latent
•Early
•<2years
•Tertiary
•Secondary
•Early latent
•<2years
Infectious Stage
•Late
•Stigmata
Primary Syphilis
 Spirochaete – Treponema Pallidum
 Primary chancre
 Appears 9 – 90 days post-infection at site of
inoculation
 Classically – solitary and painless BUT can
be multiple and painful and atypical
 Often ignored when atypical
 Resolves spontaneously within weeks
Primary Syphilis
Treponema pallidum
Primary Chancre
Secondary Syphilis
 Around 6 weeks later
 Alopecia, lymphadenopathy, snail track
ulcers, condylomata lata, maculopaular rash
(palms and soles), hepatitis……
Snail track Ulcers
Secondary Syphilis
Syphilis
Diagnosis
Direct: demonstration of Treponema pallidum
 Dark field microscopy
 Direct fluorescent antibody (DFA) test
 PCR
Indirect: different serological test
 VDRL
 TPPA
 EIA
Treatment: Penicillin
Genital Herpes
 Caused by herpes simplex virus
 Same virus that causes cold sores
 HSV-1 vs HSV-2
 Spread by skin to skin contact – condoms do reduce risk of
transmission
 Transmission occurs with or without lesions
Clinical features of Herpes
 60% of primary genital HSV infections
asymptomatic
 Multiple, painful ulcers
 Flu–like symptoms
 Can lead to urinary retention, especially in
women
 First outbreak almost always worst
 Recurrences decrease in frequency with time
Pathway of Herpes Infection
Genital Herpes
Diagnosis:
 Clinical
 HSV PCR, culture infrequently used
Treatment
 General advice
 Recommended regimens (all for five days):



Aciclovir 200 mg five times daily/ 400mg tds
Famciclovir 250 mg tds
Valaciclovir 500 mg bd
 Reduces severity and duration of outbreak
 No effect on recurrence rates
 Low doses can be used prophylactically
Trichomonas vaginalis
 A flagellated protozoan.
 Found in the vagina, urethra and paraurethral glands.
 Vulval itching, dysuria, offensive odour, strawberry cervix
 Associated with preterm delivery and low birth weight.
Trichomonas vaginalis
Diagnosis
 Clinical (strawberry cervix and discharge)
 Posterior fornix vaginal wet film
 TV culture
 TV PCR based tests
Treatment
 Metronidazole 2g orally in a single dose
 Metronidazole 400 – 500mg bd 5/7
 Partners need treatment
Molluscum Contagiosum
 Could be sexually transmitted
 Look like warts
 Caused by pox-virus
 Spread by skin to skin contact
 Common in children
 In adults, not commonly seen on face
Lymphogranuloma veneruem
 Caused by Chlamydia trachomatis serovars L1,2,3
 Seen in MSM in the UK
 Symptoms include rectal discomfort, rectal discharge and
bleeding.
 Test : NAAT testing sent to reference lab
 Needs longer course of antibiotics
Genital Warts
 Caused by human papilloma virus
 Over 100 strains
 Low risk types 6 and 11 causes visible lesions
 High risk types 16 and 18 – vaccine preventable
types in UK.
 HPV-16 and 18 contribute to over 70% of all cervical
cancer cases
 HPV prevalence in normal cytology – 8.9%
 Can be carried without symptoms
HPV
Genital Warts
Treatment usually topical – creams, cryotherapy, TCA, curettage
Other bumps
•Sebaceous
cyst
Summary
 Sexual health is a public health priority
 Young people aged less than 25 years experience the




highest rates of STIs
The number of diagnoses of STIs in MSM continues to rise
Almost half of chlamydia and gonorrhoea can be
asymptomatic
Effective treatment and cure available for most STIs
STIs increase the transmission risk of HIV
Questions?
 Thank you