1. STD & PID
Sexually transmitted disease
&
Pelvic inflammatory disease

2. STD/STI or venereal disease
Transmission by
human sexual behaviour

3. STI
 Bacterial-
 Gonorrhea- N.gonorrhoeae
 Syphilis- T.pallidum- painless ulcer with LNE, spont. healing
 Chancroid- H.ducreyi- painful ulcer with tender LNE
 Granuloma inguinale- K. granulomatis- painless beefy-red
ulcers
 Chlamydia- C.trachomatis
 Viral-
 HPV, HIV, HSV, HBV
 Protozoal-
 Trichomonas

4. Source
Venereal fluids,
saliva, mucosal secretions,
skin, others

5. Transmission
Through mucous membranes of
penis, vulva, rectum, urinary tract,
others

6. Clinical features
 Males-
 Urethritis- N.g, C.t, HSV, T.v- dysuria, discharge
 Epididymitis- C.t, N.g- U/L testicular pain
 Females-
 Cystitis/Urethritis- N.g, C.t- dysuria, frequency, pyuria
 Vulvovaginitis- bacteria, candida, trichomonas
 Cervicitis- N.g, C.t- mucopurulent discharge from cervix
 Both-
 Genital ulcer- chancroid, herpes, syphilis, donovanosis
 Proctitis- N.g, HSV, C.t- anorectal pain & discharge

7. Treatment
 Gonorrhea- Ceftriaxone, 250 mg IM
 Chlamydia- Doxycycline, 100 BD X 7 d
 Trichomonas- Metronidazole, 2 gm once
 Bacterial vaginosis- Metronidazole, 400 BD x
7 days
 Candida- Clotrimazole pessary, Fluocnazole
oral
 Chancroid- Azithromycin, 1 gm once
 Syphilis- penicillin G
 HSV- Acyclovir

8. Prevention
 Abstinence
 Condom-
 Made of latex/polyurethane
 Proper size & fit, leaving 1.5 cm at the tip for ejaculate
 No lubricant to be used
 Don’t reuse
 Vaccine- completed before sexual contact
 HBV
 HPV

9. PID
Inflammation of uterus, fallopian
tubes &/or ovaries

10. PID
A leading cause of infertility
A single episode causes infertility
in ~13% women

11. Cause
 STI- N.gonorrhoeae/C.trachomatis
 Post-partum
 Post-abortal
 IUD
 Hematogenous
 Lymphatic

12. Symptoms
 Often asymptomatic
 Fever
 Lower abdominal/back pain
 New/different discharge
 Bacterial- watery, foul-smelling
 Trichomonas- profuse watery, with itching
 Candidal- thick, causes itching
 Painful intercourse
 Irregular menstrual bleeding
 Cervical motion tenderness

13. Investigation
Elevated WBC- neutrophils
Ultrasound
Laparoscopy

14. Differential diagnosis
 Ectopic pregnancy
 Spontaneous abortion
 Endometriosis
 Appendicitis
 Ruptured/twisted ovarian cyst
 Degeneration of leiomyoma
 Acute enteritis

15. Treatment
 Bacterial- antibiotics with
gram +ve & anaerobic coverage i.e.
Cefoxitin/Cefotetan, Clindamycin,
Co-amoxyclav
 Oral if mild infection
 Inpatient & IV –TO abscess, very ill,
immunodeficient, pregnant
 Trichomonas- Metronidazole
 Chlamydia- Doxycycline
 Candida- Fluconazole

16. Prevention
 Abstinence
 Condom
 Timely evaluation & treatment
 Treatment of partner- N.g, C.t, T.v