STD
STD
STD
Dycoco
Objectives:
Definition of STIs: What are they?
Transmission: How are they spread?
Types of infection:
Bacterial (Chlamydia, LGV, Gonorrhea, Syphilis)
Viral (HSV, HIV, HPV)
Parasitic (trichomoniasis)
STI vs STD
STI Infections acquired through sexual
intercourse (may be symptomatic or
asymptomatic)
STD Symptomatic disease acquired
through sexual intercourse
STI is most commonly used because it
applies to both symptomatic and
asymptomatic infections
Syphilis
Treponema Pallidum
Incubation period: 3-90 days
Syphilis: Clinical
6
Primary Phase
Presentation
Primary chancre
Begins as papule and erodes into
painless ulcer with a hard edge
and clean base
Usually in the genital area
Appears 9-90 days after
exposure
Can be solitary or multiple (eg.
kissing lesions)
Heals with scarring in 3-6 weeks
and 75% of patients show no
further symptoms
Syphilitic Rash
Condyloma lata
Condyloma
lata
Credit: CDC
10
11
Syphilis: Clinical
Presentation (continued)
Tertiary Stage:
Cardiovascular: Aortic valve
disease, aneurysms
Neurological: Meningitis,
encephalitis, tabes dorsalis,
dementia
Gumma formation: Deep
cutaneous granulomatous
pockets
Orthopedic: Charcots joints,
osteomyelitis
Renal: Membranous
Glomerulonephritis
Maternal Syphilis
May cause:
Fetal death
Fetal growth restriction
Neonatal infection
Syphilis: Diagnosis
Non-Specific Treponemal Tests:
1. Venereal Disease Research
Laboratory
(VDRL)
2. Rapid Plasma Reagin (RPR)
13
16
Gonorrhe
a
17
N. gonorrhoeae-gram negative
diplococci
18
Risk factors
Age <25
Prior gonococcal infection
Multiple sexual partners
Drug use
Areas of Infection
Urethra
Endocervix
Vaginal discharge
Abnormal uterine
bleeding
Dysuria
Upper genital
tract
Pharynx
Rectum
Mucopurulent cervicitis
Lower abdominal pain
20
Effects on pregnancy
Gonorrhea: Diagnosis
Clinical exam
Cervical culture
Polymerase chain reaction (PCR) or ligase chain
reaction (LCR)
Gram stainpolymorphonucleocytes with gram
negative intracellular diplococci
22
Chlamydia
Chlamydia trachomatis
24
Risk factors
<25 years old
Multiple sexual partners
New sexual partner within 3 months
Presence or history of other STD(s)
Key Considerations:
50% of females are asymptomatic
Sterile pyuria with urinary tract symptoms should
trigger you to think chlamydia
26
Effects on Pregnancy
Preterm Labor
PROM
Amnionitis
Fever
SGA
Neonatal septicemia
Fetal effects
Inclusion conjunctivitis
Neonatal pneumonia
Cervicitis
29
Chlamydia: Diagnosis
Chlamydia culture
New tests include:
Lymphogranuloma Venereum
Caused by Chlamydia trachomatis.
Develops inguinal adenitis and leads to
suppuration
Treatment
Erythromycin 500mg orally 4x daily for
21 days.
33
Primary Infection
Prodrome phase:
Tingling/itching of skin
Appearance of painful
vesicles in clusters on an
erythematous base
Recurrent Disease
36
Neonatal routes
Intrauterine(5%)
Peripartum (85%)
Postnatal (10%)
HSV: Diagnosis
Clinical presentation
Viral culture
Tzanck smear/Giemsa smear
Skin biopsy
38
Human Papillomavirus
One of the most common sexually transmitted
infections.
Oncogenic HPV types 16 and 18 are associated with
dysplasia
External Genital Warts Condyloma Acuminata
-increase in number and size during pregnancy
Treatment: Trichloroacetic or bichloracetic, 80-90%
solution applied topically once a week.
Bacterial Vaginosis
Maldistribution of normal vaginal flora
Decreased lactobacilli and overrepresented species
are anaerobic bacteria that include Gardnerella
Vaginalis, Mobiluncus, and some Bacteroides species.
Treatment: Metronidazole 500mg twice daily for 7
days.
Trichomoniasis
Trichomonas vaginalis
43
Strawberry Cervix
45
Trichomoniasis: Diagnosis
Flagellated, motile trichomonads on wet
mount
Vaginal pH > 4.5
Diagnosis confirmed by microscopy
46
HIV
49
What Is HIV/AIDS?
Acquired immunodeficiency syndrome (AIDS)
is caused by the human immunodeficiency
virus (HIV).
HIV attacks and destroys white blood cells,
causing a defect in the bodys immune
system.
Etiopathogenesis
Causative agents of AIDS are RNA
retroviruses
Most cases worldwide are caused by
HIV-1 infection.
Clinical manifestations
Incubation: 3-6 weeks
Common symptoms
Fever, rash, headache, lymphadenopathy,
pharyngitis, myalgias, arthralgias, nausea,
vomiting and diarrhea.
Antenatal
In utero by transplacental passage
Intranatal
Exposure to maternal blood and vaginal
secretions during labor and delivery
Postnatal
Postpartum through breastfeeding
54
55
56
57
Antenatal Care
Primary prevention during pregnancy
Education about safer sex with use of
condoms for mother and father
Early treatment of STIs
Safer sex during pregnancy and
lactation
59
Initial Examination
All pregnant women
Syphilis test
Hgb
HIV counseling and consent
HIV test (rapid, if available)
Rule out active TB
If HIV positive:
Baseline TLC
CD4 and CD8 counts
CD4/CD8 ratio and all other baseline tests (CBC, LFT, etc.)
Viral load screening
60
62
64
66
Family Planning
Discuss family planning BEFORE discharge
Assess risk behaviors and counsel on suitable
and effective methods
Review birth control and infection control
Dual protection to prevent and reduce further HIV
infection, STIs and pregnancy
END
Thank you