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SEXUALLY TRANSMITTED
INFECTIONS
Dr B S Kumari
Associate Specialist
September 2015
OVERVIEW
Definition of Sexual Health
2. Epidemiology of STI’s
1.
-
Worldwide
UK
Sexually transmitted Infections
4. Physiological findings and Non STI’s in the
Genital Area
3.
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
What is the burden of STI’s?
Worldwide &UK
 World wide
More than 1 miilion people acquire STI’s every day
> 498 million new cases of curable STIs every
year(Chlamydia,Gonorrhoea,Trichomonas,Syphilis)
Most common is Trichomonal Vaginalis 276 million
Chlamydia 106 million
530 million have HSV2 genital herpes
290 million have Human papilloma virus
 UK
450,000 new STI diagnosis in 2013 in UK
Most common Chlamydia(208,755 out of which 139,000 were in the 1524 yrs age group)
Global prevalence of STI
Rates of new STI diagnoses by LA of residence: England,
2013
England
London
• Data from routine GUM service returns & chlamydia data from
community services
• Data type: residence data
24
Public Health England: 2013 STI Slide Set
Whats the trend in STI’s in
UK?
CASE
 75 yr old women
 Husband died 15 yrs ago
 No SI since last 15 yrs
 c/o feeling sore down below since 2 weeks
 No h/o similar symptoms in the past
 On examination multiple tender ulcers on the
labia
 Herpes antibody negative
STIs
Common bacterial infections
 Chlamydia trachomatis
 Neisseria gonorrhoea
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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)
Classification on the Basis of Presentation
STD
Urethritis
Ulcerative
Chlamydia
Gonorrhoea
Non-specific urethritis
Genital Herpes
Syphilis
Chancroid
LGV
Donovanosis
Behcet`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
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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
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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 taken
vulvovaginal swab (females)
 Sensitive 90-95%
 Specificity 99% ( 93 – 100%)
 Treatment
 Azithromycin 1gm stat
(or)

Doxycycline 100mg bd 7 days
Gonorrhoea
 Second commonest bacterial STI in UK
 Neisseria gonorrhoea – intracellular, gram negative


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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 , Culture and microscopy
 Specimens : urine/urethral swab(males),endocervical ,throat
rectal 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 10 – 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
 PCR
Serology:
Non Specific
 VDRL
 RPR
Specific
 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
 Recommended regimens (all for five days):
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Aciclovir 200 mg five times daily
Famciclovir 250 mg three times daily
Valaciclovir 500 mg twice daily
 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
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
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
Physiological findings
Pearly white papules
Fordyce Spots
Vulval Pappilomatosis
Epidermoid cyst
Non STI’s in genital area
Lichen planus
Lichen Sclerosis
Vulval Cancer
Fixed drug eruption
Systemic manifestations
of STI’s
Disseminated Gonococcal infection
Rash in secondary syphilis
Kaposi’s Sarcoma
Oral Candidiasis in HIV
CASE
 On further questioning pt said she had sex
with a casual male 2 weeks prior to
presenting with symptoms
 Herpes type 2 positive
Myth- older woman don’t have casual sex
Thank You