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SYPHILIS Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum . The primary route of transmission is through sexual contact, however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis

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Different manifestations occur depending on the stage of the disease

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Primary Syphilis: it’s the first stage after infection painless & localized ulcer with rolled edge (chancres). single or multiple. appear 2-3 weeks after contact. most common site are cervix , vagina , vulva , anus and mouth. regional L.N become enlarged. Dx : darkfield microscopy (+) (VDRL) or (RPR) not yet positive. TT: resolve spontaneously without treatment after a few weeks .

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Secondary Syphilis: Systemic 1-6 months after contact fever, malaise, general adenopathy and non-itchy maculopapular skin rash “money spot” . involve the palms of the hands and the soles of the feet. “condyloma lata” wart like lesion appear in the vulva. Mucous patches and linear (snail track) ulcers are seen on the mucosal surfaces. Dx: darkfield microscopy (+) (VDRL) or (RPR) (+) Serological tests: (FTA) This is the most sensitive and specific test for syphilis.

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Latent syphilis Absent of symptoms or physical finding. 1\3 proceed to tertiary. Tertiary syphilis Ocurre 1-10 years after infection gummas: ulcerative nodule in the skin, bone and nervous system as a result of hypersensitivity reactions. Systemic manifestation: CVS, CNS and bone

Congenital Syphilis: 

Congenital Syphilis Mode of transmission: - trans placental passage from infected mother - at birth Congenital infection is associated with several adverse outcomes including: -low birth wt -congenital anomalies -premature birth -miscarriages or death of baby Clinical manifestation after birth are divide into: -early { < = 2 years } -late { > 2 years}

Congenital Syphilis: 

Congenital Syphilis Early: -skin lesions , maculopapular tissue -Lymphadenopathy -Hepatosplenomegaly -failure to thrive -jaundice , anemia - osteochondritis Late: -gummatous ulcers -bony prominence of forehead -Saddle nose -Short maxilla -keratitis, 8 nerve deafness and dental deformities


Prevention Avoiding multiple sexual partners use of barrier contraceptive. Treatment The first-choice treatment for all manifestations of syphilis is penicillin. Parenteral penicillin G is the only therapy with documented effect during pregnancy. Non-pregnant individuals who have severe allergic reactions to penicillin may be effectively treated with oral tetracycline or doxycycline


HIV “Human Immunodeficiency Syndrome” A specific type of virus (a retrovirus) HIV invades the helper T cells to replicate itself. No Cure


AIDS Acquired Immunodeficiency Syndrome HIV is the virus that causes AIDS Disease limits the body’s ability to fight infection A person with AIDS has a very weak immune system No Cure

Four Stages of HIV: 

Four Stages of HIV

Primary HIV infection : 

Primary HIV infection lasts for a few weeks and is often accompanied by a short flu-like illness. HIV symptoms are serious enough to consult a doctor, but the diagnosis of HIV infection is frequently missed.

Stage 2 - Asymptomatic: 

Stage 2 - Asymptomatic Lasts for an average of ten years This stage is free from symptoms There may be swollen glands The level of HIV in the blood drops to very low levels HIV antibodies are detectable in the blood

Stage 3 - Symptomatic: 

Stage 3 - Symptomatic The symptoms are mild The immune system deteriorates emergence of opportunistic infections and cancers

Stage 4 - HIV  AIDS: 

Stage 4 - HIV  AIDS The immune system weakens The illnesses become more severe leading to an AIDS diagnosis

Modes of HIV/AIDS Transmission: 

Modes of HIV/AIDS Transmission

Blood Detection Tests: 

Blood Detection Tests Enzyme-Linked Immunosorbent Assay/Enzyme Immunoassay (ELISA/EIA) Radio Immunoprecipitation Assay/Indirect Fluorescent Antibody Assay (RIP/IFA) Polymerase Chain Reaction (PCR) Western Blot Confirmatory test

Antiretroviral Drugs: 

Antiretroviral Drugs Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Protease inhibitors Norvir (Ritonavir)

Four ways to protect yourself?: 

Four ways to protect yourself? Abstinence Monogamous Relationship Protected Sex Sterile needles

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Neisseria gonorrhoeae (gonococcus)

General Overview of Neisseria gonorrhoeae : 

General Overview of Neisseria gonorrhoeae Readily transmitted by sexual contact Gram-negative diplococci flattened along the adjoining side Fastidious, capnophilic and susceptible to cool temperatures, drying and fatty acids Requires complex media pre-warmed to 35-37C Soluble starch added to neutralize fatty acid toxicity Grow best in moist atmosphere supplemented with CO 2 Produce acid from glucose, but not from other sugars

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Females Males 50% risk of infection after single exposure 20% risk of infection after single exposure Asymptomatic infections frequently not diagnosed Most initially symptomatic (95% acute) Major reservoir is asymptomatic carriage in females Major reservoir is asymptomatic carriage in females Genital infection primary site is cervix (cervicitis), but vagina, urethra, rectum can be colonized Genital infection generally restricted to urethra (urethritis) with purulent discharge and dysuria Ascending infections in 10-20% including salpingitis, tubo-ovarian abscesses, pelvic inflammatory disease (PID) , chronic infections can lead to sterility Rare complications may include epididymitis, prostatitis, and periurethral abscesses Disseminated infections more common, including septicemia, infection of skin and joints (1-3%) Disseminated infections are very rare Can infect infant at delivery (conjunctivitis, opthalmia neonatorum) More common in homosexual/bisexual men than in heterosexual populatiuon

Pathogenesis of Neisseria gonorrhoeae : 

Pathogenesis of Neisseria gonorrhoeae Fimbriated cells attach to intact mucus membrane epithelium Capacity to invade intact mucus membranes or skin with abrasions Adherence to mucosal epithelium Penetration into and multiplication before passing through mucosal epithelial cells Establish infection in the sub-epithelial layer Most common sites of inoculation: Cervix ( cervicitis ) or vagina in the female Urethra ( urethritis ) or penis in the male

Prevention & Treatment : 

Prevention & Treatment Penicillin no longer drug of choice due to: Continuing rise in the MIC Plasmid-encoded beta-lactamase production Chromosomally-mediated resistance Uncomplicated infxn: ceftriaxone, cefixime or fluoroquinolone Combined with doxycycline or azithromycin for dual infections with Chlamydia Chemoprophylaxis of newborns against opthalmia neonatorum with 1% silver nitrate, 1% tetracycline, or 0.5% erythromycin eye ointments Treatment of newborns with opthalmia neonatorum with ceftriaxone Measures to limit epidemic include education, aggressive detection, and follow-up screening of sexual partners, use of condoms or spermicides with nonoxynol 9

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Source of virus feces blood/ blood-derived body fluids blood/ blood-derived body fluids blood/ blood-derived body fluids feces Route of transmission fecal-oral percutaneous permucosal percutaneous permucosal percutaneous permucosal fecal-oral Chronic infection no yes yes yes no Prevention pre/post- exposure immunization pre/post- exposure immunization blood donor screening; risk behavior modification pre/post- exposure immunization; risk behavior modification ensure safe drinking water Type of Hepatitis A B C D E

Hepatitis B - Clinical Features : 

Hepatitis B - Clinical Features Incubation period: Average 60-90 days Range 45-180 days Clinical illness (jaundice): <5 yrs, <10% 5 yrs, 30%-50% Acute case-fatality rate: 0.5%-1% Chronic infection: <5 yrs, 30%-90% 5 yrs, 2%-10% Premature mortality from chronic liver disease: 15%-25%

Modes of Transmission : 

Modes of Transmission Sexual - sex workers and homosexuals are particular at risk. Parenteral - IVDA, Health Workers are at increased risk. Perinatal - Mothers who are HBeAg positive are much more likely to transmit to their offspring than those who are not. Perinatal transmission is the main means of transmission in high prevalence populations.


Diagnosis A battery of serological tests are used for the diagnosis of acute and chronic hepatitis B infection. HBsAg - used as a general marker of infection. HBsAb - used to document recovery and/or immunity to HBV infection. anti-HBc IgM - marker of acute infection. anti-HBcIgG - past or chronic infection. HBeAg - indicates active replication of virus and therefore infectiveness. Anti-Hbe - virus no longer replicating. However, the patient can still be positive for HBsAg which is made by integrated HBV. HBV-DNA - indicates active replication of virus, more accurate than HBeAg especially in cases of escape mutants. Used mainly for monitoring response to therapy.


Treatment Interferon - for HBeAg +ve carriers with chronic active hepatitis. Response rate is 30 to 40%. Lamivudine - a nucleoside analogue reverse transcriptase inhibitor. Well tolerated, most patients will respond favorably. However, tendency to relapse on cessation of treatment. Another problem is the rapid emergence of drug resistance. Successful response to treatment will result in the disappearance of HBsAg, HBV-DNA, and seroconversion to HBeAg.


Prevention Vaccination - highly effective recombinant vaccines are now available. Vaccine can be given to those who are at increased risk of HBV infection such as health care workers. It is also given routinely to neonates as universal vaccination in many countries. Hepatitis B Immunoglobulin - HBIG may be used to protect persons who are exposed to hepatitis B. It is particular efficacious within 48 hours of the incident. It may also be given to neonates who are at increased risk of contracting hepatitis B i.e. whose mothers are HBsAg and HBeAg positive. Other measures - screening of blood donors, blood and body fluid precautions.

Hepatitis C - Clinical Features : 

Hepatitis C - Clinical Features Incubation period: Average 6-7 wks Range 2-26wks Clinical illness (jaundice): 30-40% (20-30%) Chronic hepatitis: 70% Persistent infection: 85-100% Immunity: No protective antibody response identified

Transmission of HCV: 

Transmission of HCV Transfusion or transplant from infected donor Injecting drug use Hemodialysis (yrs on treatment) Accidental injuries with needles/sharps Sexual/household exposure to anti-HCV-positive contact Multiple sex partners Birth to HCV-infected mother

Laboratory Diagnosis: 

Laboratory Diagnosis HCV antibody - generally used to diagnose hepatitis C infection. Not useful in the acute phase as it takes at least 4 weeks after infection before antibody appears. HCV-RNA - various techniques are available e.g. PCR and branched DNA. May be used to diagnose HCV infection in the acute phase. However, its main use is in monitoring the response to antiviral therapy. HCV-antigen - an EIA for HCV antigen is available. It is used in the same capacity as HCV-RNA tests but is much easier to carry out.


Treatment Interferon - may be considered for patients with chronic active hepatitis. The response rate is around 50% but 50% of responders will relapse upon withdrawal of treatment. Ribavirin - there is less experience with ribavirin than interferon. However, recent studies suggest that a combination of interferon and ribavirin is more effective than interferon alone.

Prevention of Hepatitis C : 

Prevention of Hepatitis C Screening of blood, organ, tissue donors High-risk behavior modification Blood and body fluid precautions