SEXUAL TRANSMITTED DESEASES

2. Definition: Sexual transmitted infections are
diseases transmitted via intercourse
especially unprotected anal, oral and vaginal
sex. STI are spread to children as well during
pregnancy and childbirth.

3.  Causes
- Bacterial
• Gonorrhea
• Genital chlamydia
• Syphilis
• Chancroid
- Viral
• Genital papilloma virus
• Genital herpes

4. - Protozoan
• Trichomoniasis
- Fungal
• Genital candidiasis

5. Definition: It is an STI characterized by
presence of secretions (pus) from anterior
urethral accompanied by burning urethral
discomfort when passing urine. Gonorrhea is
transmitted through vaginal, anal and oral
intercourse or prenatally.
Cause
- Neisseria gonorrhoeae a Gram negative
intracellular diplococcus.

6. Signs and Symptoms
- In general: purulent discharge of the mucous
membranes
- In women
• Asymptomatic in 50% of the time
• Dysuria
• Vaginal discharge
• Bleeding between periods
• Swelling of the labial folds

7. - In men
• Acute arthritis
• Dysuria
• Urethral purulent discharge
• Prostatis
• Epedidimatis

8. Investigations
- Gram-stain of urethral/vaginal discharge
- Culture and sensitivity

9. Management
For adult
•Treatment of uncomplicated anogenital
infection
→ First choice recommended regimens
Ciprofloxacin, 500mg orally, BID for 7 days
(Contraindicated in pregnancy, children)
Or
Azithromycin, 2g orally, as a single dose
Or

10. Ceftriaxone, 250mg by intramuscular
injection,as a single dose
Or
Cefixime, 400mg orally, as a single dose
Or
Spectinomycin, 4g (trobicin) by IM injection,
as a single dose
Doxycycline, 100mg orally, twice daily for 7
days

11.  Treatment of complicated infection
→ Recommended regimens
Ceftriaxone, 1g by IM or IV, once daily for 7
days
OR
Spectinomycin, 2g by IM, twice daily for
7days.
→ For gonococcal meningitis and endocarditis
the same dosages apply but the duration of
therapy will need to be increased to 4 weeks
for endocarditis

12. Complications
- Urethral strictures(narrowing of the urethra)
- Pelvic inflammatory disease (PID)
- Chronic pelvic pain
- Infertility
- Ectopic pregnancy
- Gonococcal septicemia

13. • Gonococcal septicemia
-In neonates
• Purulent conjunctivitis
- Corneal erosion, perforation and blindness

14.  Recommendations
- Health education and behaviors change
- Screen /Treat partner for STI

15. It comprises Vulvo-vaginitis due to Candidiasis
(refer to fungal infections), Trichomonas
vaginalis and Chlamydia infections

16. A. Trichomonas Virginalis Infection
 Definition: STI caused by this protozoan; a
common cause of abnormal vaginal discharge

17. Signs and Symptoms
- In men
• Asymptomatic
- In female
• Vaginal pruritis
• Malodorous yellow green discharge

18. Complication
- Vulvo-vaginatis
Investigations
- Wet month microscopy
- Culture

19.  What is a wet mount?
 In a wet mount, the specimen is suspended
in a drop of liquid (usually water) located
between slide and cover glass. The water
refractive index of the water improves the
image quality and also supports the
specimen.

20.  Management
- Metronidazole, 2g orally, in a single dose OR
- Tinidazole, 2g orally, in a single dose
Alternative regimen
• Metronidazole, 500mg orally, twice daily for
7 days Or
• Tinidazole, 500mg orally, twice daily for 5
days

21.  Recommendations
- All sexual partners should be notified and
treated,
- Patients should be advised against sexual
intercourse until both patient and the
partner(s) are treated

22. B.Chlamydia Infections
 Definition: Chlamydia infection is an STI
characterized by urethral discharge
 Cause
- infection with Chlamydia trachomatis

23.  Signs and Symptoms
- In female
• Most of the time, asymptomatic
• Vaginal discharge
• Dysuria
• Bleeding after intercourse
• Abnormal vaginal bleeding

24. - In men
• Most of the time, asymptomatic
• Dysuria
• Mucopurulent discharge
• Itching sensation inside the urethra
 Complications
- Pelvic inflammatory disease (low abdominal
pain)
- Infertility

25.  Investigations
- Culture
- Serology
 Management
- First choice
• Azithromycin 1 g orally as one dose Or
• Doxycycline 200 mg orally daily for 10 days
for patients allergic to macrolide
(azithromycin)

26. • For pregnant women, Erythromycin 500mg 4
times per day for 7 days
 Recommendations
- All sexual partners should be notified and
treated
- Patients should be advised against sexual
intercourse until both patient and the
partner(s) are treated.

27. 2.1. Chancroid
Definition: Chancroid is a Sexual Transmitted
Infection (STI) characterized by painful
necrotizing genital ulcers accompanied by
usually unilateral adenopathy.
 Chancroid is transmitted sexually by direct
contact with purulent lesions and by
autoinoculation to non sexual sites such eyes
and skin

28.  Cause
- Haemophilus ducreyi (gram-negative
bacterium)
 Risk factors
- Endemic area
- Low economic status
- Prostitution

29.  Signs and Symptoms
- Lesions start as a tender papules that became
pistular then erodes to form an extremely
painful and deep single or multiple ulcers
- Tender, unilateral lymph node

30.  Complications
- Phimosis
- Urethral stricture
- Urethral fistula
- Super infection of ulcers with rapid
destruction of genitalia known as a
phagedenic chancroid

31.  Investigations
- Gram stain of ulcer exudates
- Culture
 Management
- First choice
• Ciprofloxacin 500mg twice daily orally for 5
days OR
• Erythromycin 500mg orally 6 hourly for 7
days

32. - Alternative
• Sulfamethaxole(400mg)-trimetoprim (80mg)
2x2/days for15 days
 Recommendations
- Follow up strictly medications
- Screen/treat partners
- HIV testing and counsel

33.  Definition: Granuloma inguinale is a chronic
bacterial infection that affect the skin and
mucus membrane in the genital lesions
 Cause
- Gram negative calymatobacterium
granulomatis (klebsiella granulomatis)

34.  Signs and Symptoms
- Nodule and papules at the site of inoculation
- Single or multiples ulcerations of genital area
- No adenopathy
- Absence of healing if no treatment

35.  Complications
- Elephantiasis swelling of the external genital
area
- Extra genital involvement by auto inoculation
or direct extension of lesions
 Investigation
- Gram stain of ulcer exudates

36.  Management
- Sulphametoprim (400mg)-trimetrprim(80mg),
2x2 /days /10-20 days Or
- Doxycycline 100 mg, 200mg a day for 10 days
(avoided in pregnancy)

37.  Definition: LymphoGranuloma Venereum is a
cutaneous and sometime systemic STI that
affects primarily lymphatic tissues of the
groin
 Cause
- Infection with Chlamydia trachomatis

38.  Signs and Symptoms
- First stage
• A small painless, papule/ulcers
- Second stage
• Lymph node involvement resulting in painful
buboes.
• Enlargement of lymph nodes above and
below the inguinal ligament result in the
classic “groove sign.”

39. - Third stage
• Rectal fistulas, especially in women,
resulting in scarring
and chronic lymphatic obstruction
 Complications
- Scarring and local tissues destruction with
fistula and stricture formation
- Rectal stenosis
- Elephantiasis of genital organs
- Systemic spread

40.  Investigations
- Samples for culture
- Serology
 Management
 Medical therapy
• First-line treatment is usually with
doxycycline 100mg twice-daily for 21 days,
Or
• Erythromycin 500 mg 4 times daily for 21
days

41.  Surgical therapy
• Buboes may be drained percutaneously to
relieve symptoms.
• Surgical excision is best avoided due to the
risk of sinus or fistula formation

42.  Recommendation
- The patient should refrain from unprotected
sexual intercourse until they and any
contacts have completed treatment and
follow-up.