SEXUALLY TRANSMITTED INFECTIONS

1. Sexually Transmitted
Infections

2. • Sexually transmitted infections (STIs) include
those infections, which are predominantly
transmitted through sexual contact from an
infected partner

3. GONORRHEA

4. Causative organism
• Neisseria gonorrheae - Gram-negative diplococcus

5. Site of invasion
• Columnar
• Transitional epithelium of the genitourinary tract.

6. Primary Sites of infection
• endocervix,
• urethra,
• Skene’s gland
• Bartholin’s gland.

7. Other sites of infection
• Oropharynx
• anorectal region
• conjunctiva

8. Clinical Features in adult
• 50 percent of patients with gonorrhea are
asymptomatic
• The clinical features are claasified as:
• Local.
• Distant or metastatic.
• PID

9. Local
• Urinary symptoms such as dysuria (25%)
• Excessive irritant vaginal discharge (50%)
• Acute unilateral pain and swelling over the labia due
to involvement of Bartholin’s gland

10. • There may be rectal discomfort due to associated
proctitis from genital contamination
• Others: Pharyngeal infection, intermenstrual
bleeding.

11. Distant or Metastatic
• Perihepatitis
• Septicemia

12. • Perihepatitis results from spread of infection to the liver
capsule.
• There is formation of adhesions with the abdominal wall.

13. • Septicemia is characterized by low grade fever,
polyarthralgia, tenosynovitis, septic arthritis,
perihepatitis, meningitis, endocarditis, and skin
rash.

14. COMPLICATIONS
• Infertility,
• ectopic pregnancy (due to tubal damage),
• dyspareunia,
• chronic pelvic pain,
• tubo-ovarian mass
• Bartholin’s gland abscess

15. DIAGNOSIS
• NAAT (Nucleic acid amplication testing)
• Thayer - Martin medium

16. TREATMENT
• PREVENTIVE
• CURATIVE

17. PREVENTIVE
• Adequate therapy for gonococcal infection and meticulous follow up
are to be done till the patient is declared cured.
• To treat adequately the male sexual partner simultaneously.
• To avoid multiple sex partners.
• To use condom till both the sexual partners are free from disease.

18. FOLLOW UP
• Cultures should be made 7 days after the therapy.
• Repeat cultures are made at monthly intervals following menses
for three months.
• If the reports are persistently negative, the patient is
declared cured.

19. CHLAMYDIAL INFECTIONS

20. CAUSATIVE ORGANISM
• Chlamydia trachomatis

21. INCUBATION PERIOD
6-14 days

22. SITE OF INVASION
• Columnar and transitional epithelium of the
genitourinary tract.
• SUPERFICIAL invasion

23. Site of infection
• Urethra
• Bartholin’s gland
• Cervix.

24. CLINICAL FEATURES
• 75% - non-specific and asymptomatic
• Dysuria,
• dyspareunia,
• postcoital bleeding
• intermenstrual bleeding

25. COMPLICATIONS
• Urethritis and bartholinitis
• Chlamydial cervicitis spreads upwards to produce
endometritis and salpingitis.
• Chlamydial salpingitis  infertility and ectopic
pregnancy

26. DIAGNOSIS
• Chlamydial nucleic acid amplification testing
• Polymerase chain reaction (PCR) is a very sensitive and specific test
(95%)
• ELISA  sensitivity less compared to NAAT
• Chlamydia can be demonstrated in tissue culture  100% specific

27. SYPHILIS

28. CAUSATIVE ORGANISM
• Treponema pallidum

29. MODE OF SPREAD
• Syphilitic lesion of the genital tract is acquired by direct
contact with another person who has open primary or
secondary syphilitic lesion.
• Transmission occurs through the abraded skin or mucosal
surface.

30. SITE OF INFECTION
• PRIMARY LESION  Labia (may be single/
multiple)
• Other sites:-
• Fourchette,
• Anus
• Cervix
• nipples

31. CLINICAL FEATURES
• Incubation period ranges between 9 and 90 days.
• PRIMARY  A small papule is formed, which is quickly eroded to
form an ulcer.
• The margins are raised with smooth shiny floor.
• The ulcer is painless
• The inguinal glands are enlarged and painless.
• The primary chancre heals spontaneously in 1–8 weeks leaving
behind a scar.

32. Secondary syphilis—
• Coarse, flat-topped, moist, necrotic lesions
• Systemic symptoms like fever, headache, and sore throat.
• Maculopapular skin rashes are seen on the palms and soles.
• Other features  generalized lymphadenopathy, mucosal
ulcers, and alopecia.

33. • LATENT SYPHILIS  dormant phase after secondary syphilis
• TERTIARY SYPHILIS when not treated. Damages CNS, CVS,
MUSCULOSKELETAL SYSTEM.
• GUMMA Deep punched ulcer with rolled out margins.
• It is painless with a moist leather base

34. DIAGNOSIS
• History of exposure to an infected person.
• Identification of the organism—Treponema
pallidum, an anaerobe.
• VDRL  +ve 6 weeks after initial infection

35. SPECIFIC TEST
• Treponemapallidum hemagglutination (TPHA) test,
• Treponema pallidum enzyme immunoassay (EIA),
• fluorescent treponemal antibody absorption (FTA-abs)
test
• Treponema pallidum immobilization (TPI) test.

36. FOLLOW UP:
• Serological test is to be performed 1, 3, 6, and 12
months after treatment of early syphilis.
• In late symptomatic cases, surveillance is for life
• The serological test is to be done annually.

37. HIV & AIDS

38. INCIDENCE
• Spreading fast and has become a global problem.

39. MODE OF TRANSMISSION
• Sexual intercourse
• Intravenous drug abusers.
• Transfusion of contaminated blood or blood products.
• Use of contaminated needles, needlestick injuries.
• Breastfeeding

40. • Perinatal transmission—The vertical transmission to the neonates
of the infected mothers is about 25–35%.
• The baby may be affected in utero (30%) through transplacental
transfer,
• During delivery (70–75%) by contaminated secretions and blood of
the birth canal.

42. Gynecological symptomatology
• Infection of the genital tract
• Vaginitis – recurrent candidiasis
• PID with other STIs
• Neoplasms of the genital tract are increased
• Increased incidence of wound infection

43. • Menstrual abnormality: Menorrhagia, amenorrhea, or
abnormal uterine bleeding may be due to associated
weight loss, thrombocytopenia or opportunistic
infections or neoplasms.

44. DIAGNOSIS
• CD 4 cells
• Detection of IgG antibody to Gp 120 (envelope glycoprotein
component)
• Viral P-24 antigen  Detected soon after the infection
• ELISA is extremely sensitive (99.5%) but less specific.
• Western blot or immunoblot—It is highly specific but complicated
and time consuming
• HIV RNA by PCR is the gold standard for diagnosis of HIV.

45. TREATMENT
• Safer sex with barrier methods
• Male circumcision reduces transmission by 50%.
• Use of blunt tipped needles to avoid needle stick injury during
surgery.
• HIV negative blood transfusion
• HIV negative frozen semen to use for artificial donor insemination.
• Termination of pregnancy in HIV positive women when requested.

46. • Wide spread voluntary counseling and testing
• Mother needs to be counseled as regard the risks and
benefits of breastfeeding. She is helped to make an
informed choice.