STD

1. Sexually Transmitted
Diseases

2. What is a Sexually Transmitted
Infection or STI?
 STI’s are infections that are spread
from person to person through
intimate sexual contact.
 STI’s are dangerous because they are
easily spread and it is hard to tell just
by looking who has an STI.
 1 in 4 sexually active teens has an
STI.

3. STDs and Pregnancy
 It is important for pregnant women to be checked
for STDs.
 They can cause women to go into labor too early
and may complicate delivery.
 Many STDs can be passed from mother to baby
during pregnancy, childbirth, or after the baby is
born.
 STDs effects on babies can include stillbirth, low
birth weight, neurologic problems, blindness, liver
disease, and serious infection.
 But there are treatments to minimize these risks.
Treatment during pregnancy can cure some
STDs and lower the risk of passing the infection
to your baby.

4. Maternal-Fetal Transmission
Maternal-Infant Transmission
 HIV
 Herpes
 Gonorrhea
 Chlamydia
 Syphilis

5. 5
STDs of Concern
 Actually, all of them
 “Sores” (ulcers)
◦ Syphilis
◦ Genital herpes (HSV-2, HSV-1)
◦ Others uncommon in the U.S.
 Lymphogranuloma venereum
 Chancroid
 Granuloma inguinale
Background

6. 6
STDs of Concern (continued)
 “Drips” (discharges)
◦ Gonorrhea
◦ Chlamydia
◦ Nongonococcal urethritis / mucopurulent
cervicitis
◦ Trichomonas vaginitis / urethritis
◦ Candidiasis (vulvovaginal, less problems in men)
 Other major concerns
◦ Genital HPV (especially type 16, 18) and
Cervical Cancer
Background

7. 7
Genital Ulcer Diseases
 Painful
◦ Chancroid
◦ Genital herpes simplex
 Painless
◦ Syphilis
◦ Lymphogranuloma venereum
◦ Granuloma inguinale
Sores

8. SYPHILIS

9. 9
Primary Syphilis - Clinical
Manifestations
 Incubation: 10-90 days (average 3 weeks)
 Chancre
◦ Early: macule/papule  erodes
◦ Late: clean based, painless, indurated ulcer with
smooth firm borders
◦ Unnoticed in 15-30% of patients
◦ Resolves in 1-5 weeks
◦ HIGHLY INFECTIOUS
Sores

10. 10
Secondary Syphilis - Clinical
Manifestations
 Represents hematogenous dissemination of
spirochetes
 Usually 2-8 weeks after chancre appears
 Findings:
◦ rash - whole body (includes palms/soles)
◦ mucous patches
◦ condylomata lata - HIGHLY INFECTIOUS
◦ constitutional symptoms
 Sn/Sx resolve in 2-10 weeks
Sores

11. 11
Secondary Syphilis Rash
Sores
Source: Florida STD/HIV Prevention Training Center

12. 12
Secondary Syphilis Rash
Sores
Source: Florida STD/HIV Prevention Training Center

13. 13
Secondary Syphilis
Sores
Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas

14. Congenital Syphilis
 About 400-500 cases a year
 Cause of stillbirth, neonatal death,
deafness, retardation, bony
deformities, seizures
 Rate down >50% by targeting specific
areas (e.g. prenatal care for uninsured
women in the South)
 The bacteria can be cleared, but the
damage is permanent

17. Diagnosis
• Venereal Disease Research Laboratory (VDRL)
and Rapid Plasminogen Reagent (RPR) tests.
•Dark field microscope
•Microhemagglutination assay for T.
pallidum (MHA-TP) and the fluorescent treponemal
antibody absorbed test (FTA-ABS)
Treatment
Long-acting penicillin injections have been very
effective in treating both early and late stage
syphilis. The treatment of neurosyphilis requires the
intravenous administration of penicillin. Alternative
treatments include oral doxycycline (Vibramycin,
Oracea, Adoxa, Atridox and others)
or tetracycline(Achromycin).

18. Chlamydia

20. Obligatory intracellular.
 ocular, respiratory, and reproductive tract infections.
 via sexual contact, although vertical transmission from a
mother to a newborn is also seen.
 infects the columnar epithelium of the endocervix, urethra,
endometrium, fallopian tubes, and the rectum.
Clinical symptoms
1. mucopurulent cervicitis : yellow discharge coming from a
swollen, red, friable cervix that bleeds easily .
2. acute urethritis and dysuria with minimal
frequency/urgency and a negative urine culture

22. Fetal and neonatal infection
 preterm labor.
 Chorioamnionitis.
 postpartum
endometritis.
 Intrapartum
transmission to the
infant >> neonatal
conjunctivitis and/or
pneumonia.

23. Screening
>>Selective screening :
 at least annually on sexually active females <25
years old.
 risk factors (unmarried, multiple partners,
inconsistent use of barrier contraceptive
methods, previous history of any STI)
 all pregnant women
>30% of untreated chlamydial cervicitis will
progress to PID.
> Aggressive screening and appropriate early
treatment has been shown to decrease the
incidence of PID.

24. Diagonosis
 Antigen tests : chlamydiazyme test
 DNA hybridization tests and nucleic acid
amplification tests (PCR and ligase chain reaction)
 Urine culture or cervical swab
Treatment
 appropriate antibiotics ( azithromycin 1 g orally in
a single dose or doxycycline 100 mg twice a day for
7 days).
 (2) treatment of all sexual contacts within the
past 60 days prior to diagnosis.
 (3) testing for other STIs, including gonorrhea,
syphilis, hepatitis B, and HIV.
 (4) abstinence from sexual contact for 7 days
after last partner has started antibiotic therapy.
 (5) rescreening in 3 to 4 months to check for
reinfection is recommended.

25. Gonorrhea

26. ◦ Neisseria gonorrhea, Gram negative diplococci
: male-to-female transmission estimated at 80% to 90% compared
to an estimated 20% to 25% female-to-male transmission rate
after a single sexual encounter
Symptoms
primary site is endocervix :vaginal dischargefrequencydysuriaabdominal
painmenstrual abnormalities.
2)other local infections:
xx rectal→dischargetenesmusbleeding.
xx Oral-genital→pharyngeal gonorrhea(asymptomatic)sore
throatcervical adenitis.
xx Bartholin glands→abscess.
3)PID:
→ by spread to fallopian(salpingitis) then to pelvic cavity(peritonitis).
→complications:infertility and ectopic pregnancy.
4)DGI:
→bacteremia :fever,skin rashes,arthralgia,non-purulent
arthritis(hypersensitivity).
→then;endocarditis,meningitis,purulent arthritis.

28. Gonorrheal cervicitis

29. Ophthalmia Neonatorum

30. 30
Diagnostic Methods
 Culture tests
 Non-culture tests
◦ Amplified tests (NAATs)
 Polymerase chain reaction (PCR) (Roche Amplicor)
 Transcription-mediated amplification (TMA) (Gen-Probe
Aptima)
 Strand displacement amplification (SDA) (Becton-Dickinson
BD ProbeTec ET)
◦ Non-amplified tests
 DNA probe (Gen-Probe PACE 2, Digene Hybrid Capture II)
◦ Gram stain
Diagnosis

31. 31
Treatment
 Pregnant women should NOT be
treated with quinolones or
tetracyclines
 Treat with alternate cephalosporin
 If cephalosporin is not tolerated, treat
with spectinomycin 2 g IM once
Management

32. Herpes

33. 33
Genital Herpes Simplex - Clinical
Manifestations
 Direct contact – may be with asymptomatic shedding
 Primary infection commonly asymptomatic;
symptomatic cases sometimes severe, prolonged,
systemic manifestations
 Vesicles  painful ulcerations  crusting
 Recurrence a potential
 Diagnosis:
◦ Culture
◦ Serology (Western blot)
◦ PCR
Sores

35. 35
Genital Herpes Simplex
Sores
Source: Florida STD/HIV Prevention Training Center

39. Neonatal Herpes
Courtesy of Dr. Félix Omeñaca Terés, Hospital Materno Infantil La Paz, Madrid, Spain

40. Diagnosis
•Blood test
•Signs and symptoms
•History

41. HIV and AIDS

42. HIV and AIDS
 AIDS is one of the most deadly
diseases in history.
 AIDS is caused by HIV (Human
immunodeficiency virus).
 HIV destroys the body’s defense
system (the immune system).
 Thousands of teens in the U.S.
become infected each year.

43. Mother-to-Baby
 Before Birth
 During Birth
 Postpartum
◦ After the birth

45.  ELISA
 PCR
 CD4 counts
Treatment
 Nucleoside Reverse Transcriptase
inhibitors
◦ AZT (Zidovudine)
 Non-Nucleoside Transcriptase inhibitors
◦ Viramune (Nevirapine)
 Protease inhibitors
◦ Norvir (Ritonavir)
Diagnosis