Clinical Manifestations of STI-RTI

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CLINICAL MANIFESTATIONS OF STI/RTI

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ULCER DISCHARGE BUBO GROWTH LOWER ABDOMINAL PAIN (FEMALE)

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SINGLE PRIMARY SYPHILIS MULTIPLE CHANCROID GENITAL HERPES GRANULOMS INGUINALE GENITAL ULCER

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SINGLE ULCER PRIMARY SYPHILIS PAINLESS INDURATED NO BLEEDING NODES + TP + VDRL + Tt. BENZATHINE PENICILLIN

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MULTIPLE ULCERS CHANCROID SHORT INCUBATION ( 3 – 5 DAYS) MOST PAINFUL NODES +, PAINFUL GROIN ULCER POSSIBLE H. DUCREYI + ERYTHROMYCIN HERPES H/O VESICLES POLYCYCLIC BORDER SUPERFICIAL ULCER H/O RECURRENCE GEC +

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Syphilis involves all system. The causative organism, Treponema pallidum affects all system; Syphilis affects head to foot, hair to nail, does not spare any part of the body. Incubation period : 9 - 90 days SYPHILIS

PRIMARY SYPHILIS:

PRIMARY SYPHILIS Usually Single, indurated, painless hamcolour ulcer present with lymph nodes enlarged, discrete, painless and rubbery in consistency Sero negative Phase Sero Positive Phase

PRIMARY SYPHILIS :

PRIMARY SYPHILIS

PRIMARY SYPHILIS:

PRIMARY SYPHILIS

PRIMARY SYPHILIS:

PRIMARY SYPHILIS

SECONDARY SYPHILIS Occurs 3 - 6 months after the appearance of primary syphilis in the case of untreated patients :

SECONDARY SYPHILIS Occurs 3 - 6 months after the appearance of primary syphilis in the case of untreated patients

SECONDARY SYPHILIS:

SECONDARY SYPHILIS

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SECONDARY SYPHILIS

SECONDARY SYPHILIS :

SECONDARY SYPHILIS

SECONDARY SYPHILIS :

SECONDARY SYPHILIS

SECONDARY SYPHILIS:

SECONDARY SYPHILIS

INVESTIGATIONS:

INVESTIGATIONS Dark field microscopy RPR card test VDRL slide test TPHA assay FTA – ABS Biopsy

TREATMENT:

TREATMENT Early Acquired Syphilis ( <2 years from the date of contact (Primary / Secondary / Early latent syphilis) Inj.Benzathine Penicillin 24 Lakhs I.U I.M single dose (or) Inj.Procaine Penicillin 12 Lakhs I.U I.M daily for 10 days

LATENT SYPHILIS:

LATENT SYPHILIS No signs or symptoms Sreening test positive Specific test positive CSF – Normal X-ray chest - Normal

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CONGENITAL SYPHILIS

CONGENITAL SYPHILIS -VDRL:

CONGENITAL SYPHILIS -VDRL Mother Infant Infected Child Mother May be Passive Transfer Child FTAABS IgM in infant - Confirms

CHANCROID:

CHANCROID Causative agent : Haemophilus ducreyi Incubation period : 5-7 days Multiple Soft Painful easily bleeding ulcers with Bubo (Uni locular)

CHANCROID:

CHANCROID

CHANCROID:

CHANCROID

CHANCROID:

CHANCROID

Investigations 1.Smear – Grams stain 2.Culture –Blood enriched media Treatment T.Azithromycin 1.gm Single dose:

Investigations 1.Smear – Grams stain 2.Culture –Blood enriched media Treatment T.Azithromycin 1.gm Single dose CHANCROID

VENEREAL GRANULOMA:

VENEREAL GRANULOMA Causative agent : Calymmatobacterium granulomatis Granulomatous Ulcer with Velvety appearance and wavy margin. Inguinal Lymph nodes not involved

VENEREAL GRANULOMA:

VENEREAL GRANULOMA

VENEREAL GRANULOMA:

VENEREAL GRANULOMA

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Investigations Tissue smear – Leishman’s stain Giemsa stain Treatment T.Erythromycin 500 m.g q.i.d for 10 –14days (or) C.Doxycycline 100 m.g b.d for 10 –14days (or) C.Tetracycline 500 m.g q.i.d for 10 –14days

GENITAL HERPES:

GENITAL HERPES Caused by Herpes simplex virus Large DNA virus, herpesviridae Latency- ability to remain dormant 80-90% of genital herpes caused by HSV2 10-20% of genital herpes caused by HSV1 Increasing prevalence rate globally

PRIMARY GENITAL HERPES:

PRIMARY GENITAL HERPES Incubation period 5 -15 days Systemic symptoms – fever, headache, myalgia, malaise Local symptoms – discomfort, pain, itching, dysuria, urethral and vaginal discharge Lesions start as vesicles, soon rupture to form multiple, tiny, superficial, painful ulcers that coalesce to form polycyclic borders Tender inguinal adenopathy + Heals without scarring in 2-3 wks

Recurrence:

Recurrence Latency Recurrent genital ulcer - mild systemic and local symptoms - localised disease - no inguinal adenopathy - shorter time to heal ( 6-10 days)

DIAGNOSIS:

DIAGNOSIS CLINICAL DIAGNOSIS – History & C/F LAB DIAGNOSIS * demonstration of GEC – bedside test * Viral isolation - HSV DNA detection by PCR - HSV antigen detection by ELISA / FA - Tissue culture – GOLD STANDARD * serological test – limited value anti HSV 1 and 2 antibodies

Treatment of genital herpes:

Treatment of genital herpes For primary herpes T.Acyclovir 200 mg 5 times / day X 7 days For recurrence T.Acyclovir 200 mg 5 times / day X 5 days

Herpes Genitalis :

Herpes Genitalis

Herpes Genitalis :

Herpes Genitalis

Herpes in HIV+ female:

Herpes in HIV+ female

DAY 1:

DAY 1

4 wk:

4 wk

BEFORE AFTER :

BEFORE AFTER

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ANOGENITAL WARTS CLINICAL FEATURES AND DIAGNOSIS

Bowenoid Papulosis:

Bowenoid Papulosis

WARTS AND PREGNANCY:

WARTS AND PREGNANCY Increase in size and number. Due to 1. Increased hormone level. 2. Increased vascularity. 3. Immune deficiency. May cause dystocia, newborn infection. Resolves after delivery.

WARTS IN CHILDREN:

WARTS IN CHILDREN Mode of infection is uncertain. If acquired during delivery results in genital, laryngeal disease. Can occur as a result of sexual abuse. Can also occur through non sexual contact within a family.

NATURAL COURSE:

NATURAL COURSE Spontaneous regression occurs. In sub-clinical and latent cases infection persists.

TREATMENT OF ANOGENITAL WART:

TREATMENT OF ANOGENITAL WART

The treatment options include:

The treatment options include Cytotoxic agents Physically ablative therapies Immunomodulators Vaccines Psychotherapy

Podophyllin:

Podophyllin Plant compd - Rhizomes of Podophyllum peltatum, P.emodi 10-25% in alcohol/tincture benzoin collodion Application - protect normal skin, washed after 1-4hrs,applied weekly, upto 6 wks Complications - Bone marrow suppression, renal toxicity, seizures, paraesthesia, polyneuritis, coma, death Mutagenic - CONTRAINDICATED IN PREGNANCY

Podofilox (Podophyllotoxin):

Podofilox (Podophyllotoxin) Major biologically active lignan of podophyllin resin Advantage - Standardized formulation Self application Lower incidence of side effects Application - 0.5% soln., twice daily for 3 consecutive days followed by 4 days without treatment-this cycle rpt upto 6 times CONTRAINDICATED IN PREGNANCY

IMIQUIMOD:

IMIQUIMOD No direct antiviral activity Only immune response modifier Potent inducer of IFN alfa,IL-1/6/8,TNF Enhances cell mediated cytolytic activity Application - 5% cream-applied at bedtime every other day, washed after 6-10hrs max of 16wks Others - Cimetidine and Levamisole Also oral Isotretinoin - 1mg/kg for 3months

Management of sexual partners:

Management of sexual partners Majority of them are already sub-clinically infected though they do not have visible wart Use of condoms and abstinence reduces transmission to new partners Female sex partners of patients with genital wart should be regularly screened for cervical cancer

Pregnancy:

Pregnancy TCA or Surgical excision or cryotherapy or electrocautery are appropriate treatment options. Goal of treatment in pregnancy is primarily to minimize neonatal exposure to virus load. Caesarean delivery-not recommended as a routine but indicated if pelvic outlet is obstructed or vaginal delivery result in excessive bleeding.

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WE CAN ONLY TREAT WART BUT NOT CURE IT! CUTTING THE APPLE DOES NOT ERADICATE THE TREE….APPLES ARE REBOUND TO GROW ANYTIME…

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