SEXUALLY TRANSMITTED INFECTIONS

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Sexually transmitted infections

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PowerPoint Presentation: 

Dr.T.V.Rao MD 1/12/2013 Dr.T.V.Rao MD 1

What is a Sexually Transmitted Infection or STI?: 

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 ?. 1/12/2013 Dr.T.V.Rao MD 2

STDs: 

STDs STDs are diseases and infections which are capable of being spread from person to person through: sexual intercourse oral-genital contact or in non-sexual ways. IV drugs 1/12/2013 Dr.T.V.Rao MD 3

Four Classes of STD’s: 

Four Classes of STD’s Bacterial Fungus Parasites Viruses- NOT curable ? 1/12/2013 Dr.T.V.Rao MD 4

Common STI’s: 

Common STI ’ s Chlamydia Gonorrhea Genital Herpes (HSV-2) Genital Warts (HPV) Hepatitis B HIV and AIDS Pubic Lice Syphilis Trichomoniasis 1/12/2013 Dr.T.V.Rao MD 5

What are some common Symptoms of STIs?: 

What are some common Symptoms of STIs? The symptoms vary among the different types of STIs.  Some examples of common symptoms include: Unusual discharge from the penis or vagina Sores or warts on the genital area Burning while urinating Itching and redness in the genital area Anal itching, soreness, or bleeding If having any of these symptoms or think you might have an STI, talk to your health care provider. 1/12/2013 Dr.T.V.Rao MD 6

STIs in Women: 

STIs in Women Women are more vulnerable biologically, culturally, socioeconomically Most are asymptomatic (no symptoms)in women 1/12/2013 Dr.T.V.Rao MD 7

STDs of Concern: 

8 STDs of Concern Actually, all of them “ Sores ” (ulcers) Syphilis Genital herpes (HSV-2, HSV-1) Others uncommon in the U.S. Lymph granuloma venereum Chancroid Granuloma inguinale 1/12/2013 Dr.T.V.Rao MD

STDs of Concern (continued): 

9 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 1/12/2013 Dr.T.V.Rao MD

PowerPoint Presentation: 

Scientifically known as the gonococcus, or Neisseria gonorrhea Gonorrhoea 1/12/2013 Dr.T.V.Rao MD 10

Signs & Symptoms: 

Signs & Symptoms Most infected women have no symptoms Include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods 1/12/2013 Dr.T.V.Rao MD 11

NEISSERIA GONORRHOEAE: 

NEISSERIA GONORRHOEAE 3 rd most common STD i It is a G-ve diplococci Infects the endocervix  mucopurulent cervicitis Majority of infections are asymptomatic It is a leading cause of PID Dx  endocervical culture N gonorrhea & chlamydia coexist in 50% of patients Rx  ceftriaxone 125 mg IM cefixime 400 mg PO Followed by Rx for chlamydia Husband should be treated Can cause purulent conjunctivitis of the newborn 1/12/2013 Dr.T.V.Rao MD 12

Gonorrhea - Clinical Manifestations : 

13 Gonorrhea - Clinical Manifestations Urethritis - male Incubation: 1-14 d (usually 2-5 d) Sx: Dysuria and urethral discharge (5% asymptomatic) Dx: Gram stain urethral smear (+) > 98% culture Complications Urogenital infection - female Endocervical canal primary site 70-90% also colonize urethra Incubation: unclear; sx usually in l0 d Sx: majority asymptomatic; may have vaginal discharge, dysuria, urination, labial pain/swelling, abd. pain Dx: Gram stain smear (+) 50-70% culture Complications 1/12/2013 Dr.T.V.Rao MD

Gonorrhea: 

14 Gonorrhea Source : Florida STD/HIV Prevention Training Center 1/12/2013 Dr.T.V.Rao MD

Gonorrhea: 

Gonorrhea 1/12/2013 Dr.T.V.Rao MD 15

Gonorrhea Gram Stain: 

16 Gonorrhea Gram Stain Source : Cincinnati STD/HIV Prevention Training Center 1/12/2013 Dr.T.V.Rao MD

Effects on Pregnancy: 

Effects on Pregnancy Can also be spread from mother to child during birth Can cause fertility problems, birth defects, skin problems, arthritis, blood poisoning, and heart and brain infections 1/12/2013 Dr.T.V.Rao MD 17

Nongonococcal Urethritis: 

18 Nongonococcal Urethritis Etiology: 20-40% C. trachomatis 20-30% genital mycoplasmas ( Urea plasma urealyticum, Mycoplasma genitalium ) Occasional Trichomonas vaginalis , HSV Unknown in ~50% cases Sx: Mild dysuria, mucoid discharge Dx: Urethral smear  5 PMNs (usually 15)/OI field Urine microscopic  10 PMNs/HPF Leukocyte esterase (+) 1/12/2013 Dr.T.V.Rao MD

Treatment: 

T reatmen t Several antibiotics can successfully cure gonorrhea Because of drug-resistance the successful treatment o single shot of ceftriaxone 125 mg or a single dose of cefixime 400 mg taken by mouth are currently the recommended antibiotic treatment Azithromycin (Zithromax) 2g in a single dose may be used for people who have severe allergic reactions to ceftriaxone, cefixime, or penicillin. f gonorrhea is becoming more difficult 1/12/2013 Dr.T.V.Rao MD 19

Bacterial Vaginitis: 

20 Bacterial Vaginitis Controversy: STD - yes or no Need for treatment 1980: only if patient complains 2002: increased risk of: Preterm birth / premature rupture of membranes Amniotic fluid infection Chorioamnionitis / Postpartum endometritis Pelvic inflammatory disease Postsurgical infection Cervical intraepithelial neoplasia Mucopurulent cervicitis Acquisition of HIV infection 1/12/2013 Dr.T.V.Rao MD

SYPHILIS: 

SYPHILIS 1/12/2013 Dr.T.V.Rao MD 21

About Syphilis: 

About Syphilis Researchers tracing origins(CBC, 5:03) Incidence US: 13,997 in 2009 Top 13 states = 75% of cases per CDC Data by sex (males on the increase, females on the decrease) King County: 289 early syphilis cases in 2010 285 - men, 4 - women Over 90% among men (MSM) Source: 2009 King County STD Epidemiology Report Caused by bacteria, therefore curable Transmission via vaginal, oral, anal sex 1/12/2013 Dr.T.V.Rao MD 22

Syphilis Symptoms: 

Syphilis Symptoms Syphilis is a multi-stage disorder: Primary stage - painless, infectious chancre Several days-few months after infection Genitals, mouth, rectum, other areas Sometimes there is no chancre Ulcer heals; many may think there is no problem Illustration: male (MayoClinic) Photos: oral male, female, mix (CDC, Univ. of South Carolina Integrated Biomedical Sciences; University of Quebec; Cincinnati STD/HIV Prevention Training Center; istdpictures.com) 1/12/2013 Dr.T.V.Rao MD 23

Primary Syphilis - Clinical Manifestations : 

24 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 1/12/2013 Dr.T.V.Rao MD

Primary Syphilis Chancre: 

25 Primary Syphilis Chancre Source : Florida STD/HIV Prevention Training Center 1/12/2013 Dr.T.V.Rao MD

Primary Syphilis: 

26 Primary Syphilis Source : Centers for Disease Control and Prevention 1/12/2013 Dr.T.V.Rao MD

Syphilis Symptoms: 

Syphilis Symptoms Secondary stage Infectious rash 3-6 weeks following infection Hands, soles of feet; other areas Fever and flu-like symptoms may also be apparent Rash typically heals after several weeks Condylomata Lata Wart-like lesions (on female, male, CDC ) 1/12/2013 Dr.T.V.Rao MD 27

Secondary Syphilis - Clinical Manifestations : 

28 Secondary Syphilis - Clinical Manifestations Represents haematogenous 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 1/12/2013 Dr.T.V.Rao MD

Secondary Syphilis Rash: 

29 Secondary Syphilis Rash Source : Florida STD/HIV Prevention Training Center 1/12/2013 Dr.T.V.Rao MD

Secondary Syphilis: Generalized Body Rash: 

30 Secondary Syphilis: Generalized Body Rash Source : CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides 1/12/2013 Dr.T.V.Rao MD

Secondary Syphilis Rash: 

31 Secondary Syphilis Rash Source : Cincinnati STD/HIV Prevention Training Center 1/12/2013 Dr.T.V.Rao MD

Syphilis : 

Syphilis 1/12/2013 Dr.T.V.Rao MD 32

Syphilis Symptoms: 

Syphilis Symptoms Latent Stage Infection hides in body, often central nervous system Infected person can remain in this stage for years There may be no symptoms for a long time Disease begins to attack organs Latent further divided into early, late, or unknown stages based on when infection occurred Late/Tertiary Stage Severe symptoms develop: paralysis/numbness; blindness; heart disease; dementia 1/12/2013 Dr.T.V.Rao MD 33

Secondary Syphilis: 

34 Secondary Syphilis Source : Diepgen TL, Yihune G et al. Dermatology Online Atlas 1/12/2013 Dr.T.V.Rao MD

Syphilis Treatment: 

Syphilis Treatment Penicillin or other antibiotics Communicate with all sex partners regarding syphilis Refrain from sexual activity until infection is gone Condoms may help prevent syphilis transmission 1/12/2013 Dr.T.V.Rao MD 35

Chancroid: 

Chancroid A sexually transmitted disease caused by a bacterium. M ore commonly seen in men than women, particularly uncircumcised males Chancroid is spread by having unprotected anal, vaginal or oral sex. Some symptoms include: sores or raised bumps on the genitals which eventually if untreated, becomes filled with pus and eventually ruptures leaving a painful sore/ulcer. The bacterial may also infect the lymph glands in the groin. These glands may become enlarged, hard and painful. In Women, ulcers appear on the genitals, painful urination and painful intercourse Chancroids are contagious as long as the person as open sores. The open sores contain bacteria and any contact with these sores can result in infection. Chancroids may be treated with certain antibiotics. The ulcers generally heal within 2 to 3 weeks. 1/12/2013 Dr.T.V.Rao MD 36

PowerPoint Presentation: 

Chancroid ulcers CDC / Center for Disease Control and Prevention/ Division of STD Prevention 1/12/2013 Dr.T.V.Rao MD 37

PowerPoint Presentation: 

Chancroid Male- Regional adenopathy CDC / Center for Disease Control and Prevention/ Division of STD Prevention 1/12/2013 Dr.T.V.Rao MD 38

Chlamydia: 

Chlamydia Bacterial Infection Spread During unprotected anal, vaginal, or oral sex. Symptoms: Occur within 7-21 days of infection. Men: Clear thick discharge from Penis, burning during urination Women: Painful Urination, itching, burning or bleeding from vagina. 1/12/2013 Dr.T.V.Rao MD 39

Chlamydia trachomatis : 

40 Chlamydia trachomatis More than three million new cases annually Responsible for causing cervicitis, urethritis, proctitis, lymphogranuloma venereum, and pelvic inflammatory disease Direct and indirect cost of chlamydial infections run into billions of dollars Potential to transmit to newborn during delivery Conjunctivitis, pneumonia 1/12/2013 Dr.T.V.Rao MD

Chlamydia: 

Chlamydia Chlamydia is one of the most common STIs, infecting an estimated 1 in 6 teens. An infected person with no symptoms can still pass the disease to others, or have serious complications. Symptoms in a male may include: a slight discharge (drip) from the penis, and a tingling sensation or pain with urination. A female may experience irregular bleeding, pain during intercourse, a vaginal discharge, belly pain, or pain with urination. Untreated chlamydia can lead to fertility problems. This disease can also be passed to babies during birth. Chlamydia is treated with antibiotics To prevent chlamydia use latex or plastic condoms each time you have sex. 1/12/2013 Dr.T.V.Rao MD 41

Chlamydia: 

Chlamydia Four million new cases occur each year SYMPTOMS: fever, weight loss for no reason, swollen glands, fatigue, diarrhea, white spots on the mouth. FEMALE SYMPTOMS: Vaginal discharge (white or grey) or burning with urination Lower abdominal pain Bleeding between menstrual periods. Low-grade fever (later symptom) MALE SYMPTOMS: Discharge from the penis and/or burning when urinating Burning and itching around the opening of the penis Pain and swelling in the testicles Low –grade fever (associated with epididymitis – inflammation of the testicles) 1/12/2013 Dr.T.V.Rao MD 42

Chlamydia: 

Chlamydia 1/12/2013 Dr.T.V.Rao MD 43

PowerPoint Presentation: 

Chlamydia Cervicitis Source : St. Louis STD/HIV Prevention Training Center 1/12/2013 Dr.T.V.Rao MD 44

Chlamydia Complications: 

Chlamydia Complications Conjunctivitis in newborn (eye drops given) Reiter ’ s Disease (sensitive photos) Pelvic Inflammatory Disease ( “ PID ” Illustration) Infection Disease-causing organisms migrate to uterus, fallopian tubes, ovaries Untreated, PID leads to scarring, pelvic pain, tubal pregnancy, infertility Treatment includes antibiotics Approximately 1 million women affected each year Approximately 100,000 women become infertile each year ) 1/12/2013 Dr.T.V.Rao MD 45

Chlamydia Complications: 

Chlamydia Complications Epididymitis 600,000 cases a year Inflammation of epididymis Tube located in back of testicle Holds maturing sperm Disease-causing microbe enters urethra, travels Symptoms include fever, pain, discharge, swelling Treatment includes antibiotics, STD treatment if applicable Chronic epididymitis does not threaten fertility 1/12/2013 Dr.T.V.Rao MD 46

Lymphogranuloma venereum: 

Lymphogranuloma venereum From different chlamydia bacteria More prevalent in Asia, Africa, South America, but increasing in North America; now required to be reported in WA Per DOH, six cases in 2008-2009 Painless pimple or lesion on genitals Infection spreads to lymph tissue 1/12/2013 Dr.T.V.Rao MD 47

PowerPoint Presentation: 

Lymphogranuloma Venerum (LGV) CDC / Center for Disease Control and Prevention/ Division of STD Prevention Complication of Chlamydia 1/12/2013 Dr.T.V.Rao MD 48

PowerPoint Presentation: 

Herpes Simplex Virus (HSV-2), which is related to the viruses that belongs to the same family of viruses that cause chicken pox and shingles Herpes Simplex 1/12/2013 Dr.T.V.Rao MD 49

About Herpes: 

About Herpes Transmission via vaginal, oral, anal sex Transmission of virus can also occur through fingers (touching a sore, then touching a membrane) Transmission of virus possible when no sores present Transmission to fetus possible, but not typically if herpes was contracted before pregnancy If pregnant woman contracts herpes toward end of pregnancy, transmission to fetus more likely If pregnant woman has active herpes, Cesarean performed Transmission may occur outside body contact, but no proof 1/12/2013 Dr.T.V.Rao MD 50

HERPES GENITALIS: 

HERPES GENITALIS It is a recurrent sexually transmitted disease Caused by Herpes simplex virus HSV-1  10% of genital lesions HSV-2  90% of genital lesions HSV-1 & 2 also infect the orofacial skin in reversed % The virus causes prolonged lifelong infection of the nerve cells of the affected area 1-PRIMARY (FIRST) INFECTION  multiple vesicles which will ulcerate forming shallow superficial ulcers over the external genitalia There is often simultaneous involvement of the vagina & cx 1/12/2013 Dr.T.V.Rao MD 51

Herpes Symptoms: 

Herpes Symptoms Most common symptom is blisters First (primary) outbreak occurs within a few weeks of contact May continue for a couple weeks, longer for those with compromised immune system May feel painful, itchy, tingle/burn 1/12/2013 Dr.T.V.Rao MD 52

HERPES GENITALIS: 

HERPES GENITALIS It causes severe pain, itching, vaginal discharge & painful urination  urine retention that may require catheterization Associated with fever, general malaise & headache It takes 2-4 weeks to heal 2-SECONDARY (RECURRENT ) HERPES The viruses that are already present in the nerve cells will be reactivated by various stresses such as generalized illness, menses, emotional stress or trauma It is less painful, circumscribed, not associated with generalized symptoms & lasts an average of 7 days 1/12/2013 Dr.T.V.Rao MD 53

Herpes: 

Herpes 1/12/2013 Dr.T.V.Rao MD 54

PowerPoint Presentation: 

Source : CDC/NCHSTP/Division of STD, STD Clinical Slides Oral Herpes 1/12/2013 Dr.T.V.Rao MD 55

PowerPoint Presentation: 

Oral Herpes 1/12/2013 Dr.T.V.Rao MD 56

PowerPoint Presentation: 

Herpes Simplex Oralis patient age: 15 years, patient sex: male 1/12/2013 Dr.T.V.Rao MD 57

Herpes Simplex 1 & 2: 

Herpes Simplex 1 & 2 45 million people in the United States ages 12 and older have herpes 1 out of 5 of the total adolescent and adult population, are infected with Herpes Simplex 1/12/2013 Dr.T.V.Rao MD 58

PowerPoint Presentation: 

Primary Herpes, vulva CDC / Center for Disease Control and Prevention/ Division of STD Prevention 1/12/2013 Dr.T.V.Rao MD 59

Genital Herpes Simplex - Clinical Manifestations : 

60 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 1/12/2013 Dr.T.V.Rao MD

HERPES GENITALIS: 

HERPES GENITALIS There may be an association between the Herpes virus & precancerous & cancerous conditions of the genital tract . The virus has been detected in in squamous cell carcinoma of the cx vagina & vulva It was not proven to a causative factor for these cancer Transmission of AIDS virus is increased in the presence of genital ulcers caused by infections such as Herpes or Syphilis 1/12/2013 Dr.T.V.Rao MD 61

Herpes Type 2 (HSV-2): 

Herpes Type 2 (HSV-2) Cause lesions around and on the genital areas Bumps form on the lips and sometimes in the mouth, tongue, and throat Blisters crust over and heal within 10-16 days 1/12/2013 Dr.T.V.Rao MD 62

Epidemiology of Genital Herpes: 

63 Epidemiology of Genital Herpes One of the 3 most common STDs, increased 30% from late 70s to early 90s 25% of US population by age 35 HSV-2: 80-90%, HSV-1: 10-20% (majority of infections in some regions) Most cases subclinical Transmission primarily from subclinical infection Complications: neonatal transmission, enhanced HIV transmission, psychosocial issues Sores 1/12/2013 Dr.T.V.Rao MD

Genital Herpes Simplex: 

64 Genital Herpes Simplex Source : Diepgen TL, Yihune G et al. Dermatology Online Atlas 1/12/2013 Dr.T.V.Rao MD

Genital Herpes Simplex: 

65 Genital Herpes Simplex Source : CDC/NCHSTP/Division of STD, STD Clinical Slides 1/12/2013 Dr.T.V.Rao MD

Genital Herpes Simplex: 

66 Genital Herpes Simplex Source : Florida STD/HIV Prevention Training Center 1/12/2013 Dr.T.V.Rao MD

Effects on Pregnancy: 

Effects on Pregnancy Type 2 Viral shedding from cervix, vagina, vulva plays the primary role in transmitting the disease from mother to infant About 60% of newborns infected and not treated will die or be severely damaged 1/12/2013 Dr.T.V.Rao MD 67

HERPES GENITALIS: 

HERPES GENITALIS Dx Viral culture of a suspicious lesion Blood test for detection of antibodies  helpful to Dx asymptomatic individuals or to confirm a past infection Rx Acyclovir 200mg orally 5 times /day for 10 days   duration of ulcerative lesions Improve the symptoms Used for 1ry infection -2ry infection  no Rx -Supportive care  keeping the area clean & dry xylocaine jelly Applying compresses Tylenol 1/12/2013 Dr.T.V.Rao MD 68

HERPES GENITALIS: 

HERPES GENITALIS Patients with recurrence ≥ 6 years  prophylactic Acyclovir 400 mg twice a day To reduce sexual transmission  couples should avoid direct sexual contact (by abstinence or using condom) when the infected individual has a lesion or experiencing a prodrome “tingling, itching, or pain felt before the recurrent lesion appear” 1ry infection in pregnancy close to delivery  risk of transmission to the newborn  50% If the mother have active lesions  elective CS should be performed Infection to the newborn is devastating  disseminated infection with CNS involvement & 50% mortality 1/12/2013 Dr.T.V.Rao MD 69

LYMPHGRANULOMA VENEREUM “A disease of Tropical Countries”: 

LYMPHGRANULOMA VENEREUM “ A disease of Tropical Countries” Caused by Chlamydia trachomatis, serotype L1,2,3 A chronic infection of the lymphatic tissue ♂ : ♀ 5 : 1 Incubation period 4-21 days Involves : Vulva  most frequent site Cx, urethra, rectum 3 phases of the disease -Primary phase Shallow , painless ulcer of the vestibule, labia or perirectal Heals without Rx -Secondary phase 1-4 wk after 1ry Painful lymphadenopathy in the inguinal or perirectal areas 1/12/2013 Dr.T.V.Rao MD 70

LYMPHGRANULOMA VENEREUM: 

LYMPHGRANULOMA VENEREUM 2/3 unilateral adenopathy ½ Systemic symptoms “malaise & fever Tertiary phase -The nodes enlarged, tender , matted together & adherent to the overlaying skin “bubos” -7-15 days the bubo  rupture spontaneously  multiple draining sinuses & fistulas -Extensive tissue destruction of the genitalia & anorectal region  elephantiasis, multiple fistulas & stricture Treatment -Doxycycline 100 mg bd for 21 days 1/12/2013 Dr.T.V.Rao MD 71

GRANULOMA INGUINALE (DONOVANOSIS) “A disease of Tropical Countries”: 

GRANULOMA INGUINALE (DONOVANOSIS) “ A disease of Tropical Countries” Caused by G-ve , nonmotile , encapsulated rod  Calymmatobacterium granulomatous Transmitted sexually & by close nonsexual contact Incubation period 1-12 wk Dx Donovan bodies in specimen taken from the ulcers  dark staining bacteria with safety pin appearance in the cytoplasm of mononuclear cells Painless red ulcer with fresh granulation tissue Multiple ulcers of the vulva  destroy normal vulvar architecture  scarring & lymphatic obstruction  marked enlargement of the vulva Rx  Tatracycline 500 mg qid for 3 wk 1/12/2013 Dr.T.V.Rao MD 72

PowerPoint Presentation: 

Known as “Human Papillomavirus ” HPV 1/12/2013 Dr.T.V.Rao MD 73

Human Papillomavirus (HPV): 

Human Papillomavirus (HPV) 20 million people are currently infected with HPV Very common amongst sexually active college students 1/12/2013 Dr.T.V.Rao MD 74

Human Papilloma Virus : 

Human Papilloma Virus Known as Genital Warts. NOT Curable!!! It causes growths of tiny, skin-colored, cauliflower-like warts to appear on the penis, vulva, vagina, and the cervix, in or around the anus or the throat. Spread by sexual or skin to skin contact with someone who has HPV. Symptoms: Irritation or itching in both men and women. HPV is extremely dangerous for women because it can lead to cervical cancer. Warts caused by HPV are treated with an ointment, laser surgery, burning it with acid or freezing it with liquid nitrogen! 1/12/2013 Dr.T.V.Rao MD 75

Signs & Symptoms: 

Signs & Symptoms Most common manifestation of HPV is warts Includes warts on skin such as plantar warts or in the genital area, known as genital warts 1/12/2013 Dr.T.V.Rao MD 76

PowerPoint Presentation: 

HPV Penile Warts Source : Cincinnati STD/HIV Prevention Training Center 1/12/2013 Dr.T.V.Rao MD 77

PowerPoint Presentation: 

Condylomata acuminata, anal 1/12/2013 Dr.T.V.Rao MD 78

Signs & Symptoms: 

Signs & Symptoms May be associated with discomfort such as itching, burning, or tenderness in the genital area Most women with HPV do not have any symptoms at all 1/12/2013 Dr.T.V.Rao MD 79

Signs & Symptoms: 

Signs & Symptoms Include fever, general muscle aches, swollen lymph nodes in the neck, flu-like symptoms Increased salivation and sometimes bleeding in the mouth 1/12/2013 Dr.T.V.Rao MD 80

Treatment: 

Treatment No effective treatment Warts may be treated with agents designed to reduce or remove the warts, including creams, oral medications, or surgery The infection usually goes away without treatment, but for high risk HPV 1/12/2013 Dr.T.V.Rao MD 81

HPV and Cervical Cancer: 

82 HPV and Cervical Cancer 1/12/2013 Dr.T.V.Rao MD

HPV and Cervical Cancer: 

83 HPV and Cervical Cancer Infection is generally indicated by the detection of HPV DNA HPV infection is causally associated with cervical cancer and probably other anogenital squamous cell cancers (e.g. anal, penile, vulvar, vaginal) Over 99% of cervical cancers have HPV DNA detected within the tumor Routine Pap smear screening ensures early detection (and treatment) of pre-cancerous lesions HPV and Cervical Cancer 1/12/2013 Dr.T.V.Rao MD

PowerPoint Presentation: 

HIV-Human Immunodeficiency Virus AIDS-Acquired Immune Deficiency Syndrome HIV/AIDS 1/12/2013 Dr.T.V.Rao MD 84

HIV/AIDS: 

HIV/AIDS HIV is the virus that causes AIDS The definition of AIDS relates to CD4+ T-cells Count Healthy adults usually have CD4+ T-cell counts of 1,000 or more Aids and some HIV sufferers have less than 200 CD4+ T-cells 1/12/2013 Dr.T.V.Rao MD 85

Modes of Transmission: 

Modes of Transmission blood blood products sexual fluids People can be infected and NOT look sick or even have AIDS but can still transmit HIV 1/12/2013 Dr.T.V.Rao MD 86

Signs & Symptoms: 

Signs & Symptoms rapid weight loss dry cough recurring fever or profuse night sweats profound and unexplained fatigue swollen lymph glands diarrhea white spots or unusual blemishes on the tongue, in the mouth, or in the throat 1/12/2013 Dr.T.V.Rao MD 87

Effects of Pregnancy: 

Effects of Pregnancy 70% transmission occurs at the time of delivery 30% amount occurs antenatally (before delivery ) A significant contributor to transmission is breastfeeding 1/12/2013 Dr.T.V.Rao MD 88

TREATMENT IN PREGNANCY: 

TREATMENT IN PREGNANCY Zidovudine monotherapy  vertical transmission 25% 8% Standard triple therapy should be offered Zidovudine should be included in the Rx to prevent perinatal transmission Zidovudine IV intrapartum to the neonate for the first 6 wk of life Elective CS recommended if -Women did not receive antiretroviral therapy -Monotherapy -Detectable viral load > 500 RNA copies /ml -Viral load determination not done -No prenatal care 1/12/2013 Dr.T.V.Rao MD 89

AIDS-related Opportunistic Infections: 

AIDS-related Opportunistic Infections Kaposi’s Sarcoma Yeast Infections 1/12/2013 Dr.T.V.Rao MD 90

Treatment: 

Treatment Antiviral drugs drug’s that boost the immune system have allowed many people with HIV to resist infections, stay healthy, and prolong their lives, but these medications are not a cure 1/12/2013 Dr.T.V.Rao MD 91

STD increases HIV susceptibility: 

STD increases HIV susceptibility STD causes infection and desquamation of squamous or columnar cells producing an inflammatory response Results in increased number of HIV target cells (lymphocytes) on mucous membrane surfaces and a portal of entry for HIV STD/HIV Inter-Relationships 1/12/2013 Dr.T.V.Rao MD 92

STD increases HIV transmission: 

STD increases HIV transmission For a person with HIV, having an STD: Brings inflammatory cells loaded with HIV to the genital tract Increases HIV viral shedding from mucous membranes 1/12/2013 Dr.T.V.Rao MD 93

HEPATITIS: 

HEPATITIS Hepatitis A, B, and C  all can be transmitted sexually Hepatitis B is the most common & its sexual transmission is the most efficient Hepatitis A & B  can be prevented by vaccination Sexual transmission accounts for 45% of new cases Hepatitis B immunoglobulin's  post exposure prophylaxis within 14 days Pregnant mothers with Hepatitis B  transmit the infection to their infants during or after birth Newborn infant should receive Immunoglobulin's + Vaccination within 12 hrs of birth 1/12/2013 Dr.T.V.Rao MD 94

PowerPoint Presentation: 

Parasitic Infection of the vagina in women and urethra in men. Mostly passed through sexual contact. It is also spread through damp towels, bathing suits or wash clothes shared with an infected person. There are frequently no symptoms. Men: discharge from penis, mild discomfort in penis and swelling in genitalia. Women: green to yellow discharge with bad odor, vaginal itching, painful urination, inflammation in genitals. Sometimes in lower abdomen. Trichomoniasis can usually be cured with the prescription drug, metronidazole, given by mouth in a single dose T richomoniasis 1/12/2013 Dr.T.V.Rao MD 95

TRICHOMONIASIS: 

TRICHOMONIASIS Caused by a protozoan Trichomonas vaginalis Symptoms  diffuse malodorous yellowish green discharge vulvar irritation Dx  m icroscopy of vaginal secretion sensitivity 60-70% culture  more sensitive Rx  Metronidazole 2 gm orally single dose Husband  should be treated & they should avoid intercourse until they are cured Vaginal Trichomoniasis has been associated with adverse pregnancy outcome  PROM, preterm delivery & low BWt. Metronidazole is safe in pregnancy 1/12/2013 Dr.T.V.Rao MD 96

PID(Pelvic Inflammatory Disease): 

PID( Pelvic Inflammatory Disease ) Caused by a complication of bacterial vaginosis and/or gonorrhea/chlamydia. Sexually active women aged 15-25 are at highest risk for developing PID. A woman’s genital tract becomes inflamed and infected causing swelling, scarring, fever and pain. PID is a major cause for infertility. Symptoms: Abdominal and pelvic pain, vaginal bleeding, discharge and pain during sex. 1/12/2013 Dr.T.V.Rao MD 97

Candidiasis : 

Candidiasis The 2 nd most common cause of vaginal irritation or vaginitis and can also occur on male genitals. It can also appear in the mouth and throat as white sores. Contrary to popular belief, Candidiasis is rarely transmitted by sexual contact. It is generally passes by Everyone has this fungus on and inside their bodies. Most of the time it is harmless and keeps the bacterial levels in your body in check, but if there is an overgrowth of this fungus it can lead to a variety of problems Some symptoms include: In Women: A thick white discharge that looks like cottage cheese, itching and burning as well as a rash on the outer lips of the vagina. In Men: Soreness, itching and redness of the head of the penis, scrotum and foreskin. (Uncircumcised men are more likely to develop yeast because it thrives in moist areas) An 1/12/2013 Dr.T.V.Rao MD 98

Infections with Trichomoniasis and Candia : 

Infections with Trichomoniasis and Candia 1/12/2013 Dr.T.V.Rao MD 99

PowerPoint Presentation: 

1/12/2013 Dr.T.V.Rao MD 100

PowerPoint Presentation: 

1/12/2013 Dr.T.V.Rao MD 101

SCABIES: 

SCABIES Scabies is a fairly common infectious disease of the skin caused by a mite. Scabies mites burrow into the skin producing pimple-like irritations or burrows. Scabies mites are transferred by direct skin-to-skin contact. Indirect transfer from undergarments or bedclothes can occur only if these have been contaminated by infected people immediately beforehand. Scabies can also be transmitted during sexual contact. The most prominent symptom of scabies is intense itching particularly at night. The areas of the skin most affected by scabies include the webs and sides of the fingers, around the wrists, elbows and armpits, waist, thighs, genitalia, nipples, breasts and lower buttocks. Skin lotions are available through a physician's prescription for the treatment of scabies. 1/12/2013 Dr.T.V.Rao MD 102

ECTOPARASITIC INFESTATION PEDICULOSIS PUBIS: 

ECTOPARASITIC INFESTATION PEDICULOSIS PUBIS Humans are the only reservoir for pubic lice Can be transmitted by sexual & close nonsexual contact Pruritus is the most common symptom Rx  Washing the area with pediculicide formulations Washing the clothes & linens with very hot water 1/12/2013 Dr.T.V.Rao MD 103

PowerPoint Presentation: 

Scabies (under the skin crabs) 1/12/2013 Dr.T.V.Rao MD 104

PowerPoint Presentation: 

Scabies (under the skin crabs) 1/12/2013 Dr.T.V.Rao MD 105

What STD screening tests would you order?: 

What STD screening tests would you order? Urine for GC and CT and syphilis serology Urine for GC and CT and syphilis and HSV-2 serology Urine and rectal GC and CT tests, pharyngeal GC, and syphilis serology Urine, rectal and pharyngeal GC and CT, and syphilis and HSV-2 serology

STI Prevention: 

STI Prevention Abstain from sexual intercourse—vaginal, oral, or anal Be in a monogamous relationship with an uninfected partner 1/12/2013 Dr.T.V.Rao MD 107

PowerPoint Presentation: 

Reduce Number of Partners Get to know the Person Get tested together Try celibacy Learn about HIV/STDs together Talk to your partner about what you know How many can you think of…? More Ways of Prevention 1/12/2013 Dr.T.V.Rao MD 108

PowerPoint Presentation: 

Ways of Prevention Abstinence Wear Latex Condoms Get Tested! Get To Know Your Partner GET EDUCATED WAIT!! LOVE YOURSELF 1/12/2013 Dr.T.V.Rao MD 109

PowerPoint Presentation: 

Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World from Various WEB RESSOURCES Email doctortvrao@gmail.com 1/12/2013 Dr.T.V.Rao MD 110