2. Brainstorming (10 Minutes)
What is the STI?
How can STI be transmited ?
What is the clinical presentation of STI?
Complications of STI
Prevention and treatment of STI
3. STI
The name of this group of diseases was changed from “venereal
diseases” to “sexually transmitted diseases” or “STDs”
And now “sexually transmitted infections or “STIs.”
STI – Infections acquired through sexual intercourse (may be
symptomatic or asymptomatic)
STD – Symptomatic disease acquired through sexual intercourse
STI is most commonly used because it applies to both symptomatic
and asymptomatic infections
4. Definition
Sexually transmitted infection is Acquired through sexual
contact with an infected person
Infection of the genitals and reproductive organs (as well as
body tissues)
5. STIs are a Significant Problem
5
The consequences of untreated STIs
Ectopic pregnancy (7-10 times increased risk
in women with history of PID)
Increased risk of cervical cancer
Chronic abdominal pain (18% of females
with a history of PID)
6. STIs are a Significant Problem cont...
6
Infertility:
20-40% of males with untreated Chlamydia and
gonorrhea
55-85% of females with untreated PID
(8-20% of females with untreated gonorrhea develop
PID)
Increased risk of HBV and HIV/AIDS
transmission
7. STIs are a Significant Problem cont...
7
Infants can:
Be infected at birth with blinding , eye
infections and pneumonia (chlamydia, genital
herpes and gonorrhea)
Suffer central nervous system damage or die
(syphilis or genital herpes) as a result of STIs
9. Bacterial STIs
Chlamydia
gonorrhea
Syphilis
Chlamydia
• Bacteria - Chlamydia trachomatis
Transmission: mainly through penile vaginal intercourse. It
is also possible for a pregnant mother to transmit it to her
baby during vaginal delivery.
10. Most common STI
Females outnumber males 6 to 1
Cervix is site of infection
Most women are asymptomatic until the pain and
fever from PID occur
If symptomatic - discharge, painful urination, lower
abdominal pain, bleeding, fever and nausea
Complications include; cervicitis, infertility, chronic
pain, salpingitis, ectopic pregnancies, stillbirths,
reactive arthritis.
11. Effect of Chlamydia
1. On Pregnancy :
PID-
Postpartum or post
abortion endometritis
and salpingitis
Preterm delivery
PROM
Stillbirth
Ectopic pregnancy
Infertility and pain
2. On Neonatal :
Acquires infection from
mother
Infections to the
mucous membranes of
the eye, oropharynx,
urogenital tract and
rectum
LBW
Ophthalmia neonatorum
Pneumonia
Conjunctivitis
13. Recommended Treatment
Doxycycline 100 mg orally 2 times a day for 7 days or
Azithromycin (Zithromax) 1 g orally
Azithromycin and doxycycline are equally effective
abstain from sexual intercourse for 7 days
sex partners must be evaluated and treated
14. Gonorrhea
Etiologic agent: Neisseria gonorrhea
Mucus membranes affected include: cervix, anus,
throat, eyes
Bacteria neisseria gonorrhea organism attacks cervix
as first site of infection
S/Sx:
mucopurulent vaginal discharge
burning urination, and
severe menstrual or abdominal cramps
10 to 40 percent women develop PID
15. Effects of gonorrhoea
1.Pregnancy
Chorioamnionitis
Intrauterine growth
restriction (IUGR)
Pelvic abscess or
Bartholin’s abscess
PID
Postpartum sepsis
Preterm delivery
PROM
Spontaneous septic
abortion
2. Neonate
Acquires infection from
mother
Ophthalmia
neonatorum-blindness
bacterial sepsis
nasopharyngeal,
vaginal, anal, ear
throat and mouth
infection; may enter
the bloodstream &
invade joints, heart,
liver, CNS
16. Consequences:
Female :- PID with infertility; ectopic pregnancy,
severe pelvic pain; infant conjunctivitis.
Male:- prostate abscesses with fever, difficult
urination; gonococcal epididymitis with ? sterility
Diagnosis:
Gram stain
Gram negative intracellular diplococci
Tissue Culture
DNA probe
17. Treatment
Ceftriaxone (Rocephin) 125 mg IM or
Cefixime 400 mg orally or
Ciprofloxacin (Cipro) 500 mg orally or
Ofloxacin (Floxin) 400 mg orally
Plus: (for chlamydia)
Doxycycline 100 mg 2 times a day for 7 days or
azithromycin 1 g orally
19. SYPHILIS
Caused by bacteria treponema pallidum
Spreads throughout the body within hours of infection
Transmitted primarily through sexual intercourse, but also
from infected mother to fetus
Appearance of red or brown painless sore on mouth, fingers,
reproductive organs in primary syphilis (CHANCERS)
Appearance of rash on palms, soles, looks like eczema,
psoriasis, measles or sunburn and flu like symptoms in
secondary syphilis
21. Latent Syphilis
In this stage, you can still infect a sexual partner.
begins when secondary syphilis symptoms end.
This stage can start from 2 years to over 30 years
after the primary infection.
In early latent syphilis, you may not have syphilis
symptoms, but the infection remains in your body.
22. Tertiary Syphilis
In this stage of syphilis, the bacteria can damage
almost any part of the body, but most commonly
affects the:-
Heart ,Eyes ,Brain ,Nervous system , Bone,
Liver ,Joints
This damage can happen years or even decades
after the primary stage of syphilis.
24. Pregnancy
complications:
Preterm labor
Spontaneous abortion
Stillbirth
any stage of maternal
syphilis may result in
fetal infection
Neonatal
complications:
Acquires infection from
mother
Blindness
Bone and tooth
abnormalities
Brain damage
Hearing loss
Death
26. Recommended Treatment
Primary and secondary syphilis and early latent syphilis (<1 year
duration):
benzathine penicillin G 2.4 million units IM in a single dose.
Late latent syphilis or latent syphilis of unknown duration and late
syphilis
Benzathine penicillin G 7.2 million units total, as 3 doses of 2.4
million units IM, at 1-week intervals.
Neurosyphilis:
Aqueous penicillin G, 18-24 million units a day, as 3-4 million
units IV q4h for 10-14 days.
27. Viral STIs
Herpes simplex
Genital Warts (HPV)
Hepatitis B virus
HIV ( AIDS virus)
28. HERPES
Etiologic agent:-Herpes Simplex Virus
Contagious viral infection that spreads from direct
skin to skin contact particularly in the oral and
genital areas.
HSV1:Nongenital herpetic infection
In form of cold sores, fever blisters, primarily
around the mouth and it affects around 80 % of all
adults
HSV2: Genital herpetic infection
Recurrent, incurable viral disease
29. HERPES cont...
Primary infection is indicated by no prior
antibodies to HSV-1 or HSV-2
incubationperiod:3-6 days followed by a papular
eruption with itching or tingling which becomes
painful and vesicular, with multiple vulvar and
perineallesions .
30. Nonprimary: first episode defines newly acquired
HSV-2 infection with preexisting HSV-1 cross-
reacting antibodies
fewer lesions, systemic manifestations, less pain, and
briefer duration of lesions and viral shedding
Recurrent infection is reactivation of prior HSV-1 or
HSV-2 infection in the presence of antibodies to the
same type of HSV
viral particles reside in nerve ganglia during latency
period.
lesions generally are fewer in number, less tender,
shed virus for shorter periods (2 - 5 days)
32. HSV 2
Symptoms vary from one individual to another
Active phase may include itching, burning, swelling,
and flu like symptoms
Appearance of small painful blisters on genitals
rupture, crust over and heal
Virus travels down nerve to ganglia near spine &
remains dormant until another outbreak and virus
travels up nerve to skin
Control efforts for HSV 2 are difficult because 75%
are unaware they are infected
33. HSV 2 cont...
There is no cure for HSV2, the drug acyclovir is prescribed for
minimizing the discomfort
Sexual activity should be avoided when sores are active
Antiviral drugs neither eradicate latent virus nor affect the risk,
frequency or severity of recurrences
complication
Pregnancy complications:
Cesarean delivery
Neonatal complications:
Acquires infection from mother
Juvenile laryngeal papillomata (JLP)
34. Recommended Treatment
First clinical episode:
Acyclovir 400 mg orally 5 times a day for 7-10 days, or
famciclovir 250 mg orally 3 times a day for 7-10 days, or
valacyclovir 1 g orally 2 times a day for 7-10 days.
Recurrent episodes:
acyclovir 400 mg orally 3 times a day for 5 days, or 800
mg orally 2 times a day for 5 days or famciclovir 125 mg
orally 2 times a day for 5 days.
35. HUMAN PAPILLOMA VIRUS
HPV refers to a group of over 70 different types of
viruses 1/3 of which cause genital problems
Most reproductive-aged women become infected
within a few years of becoming sexually active,
although most infections are asymptomatic and
transient.
High-risk HPV types 16 and 18
36. HUMAN PAPILLOMA VIRUS cont...
Mucocutaneous external genital warts are usually
caused by HPV types 6 and 11 .
Genital warts or condyloma are usually spread by
direct contact on vaginal and/or anal areas.
Warts remain undetected when located inside
vagina, cervix or anus.
38. HUMAN PAPILLOMA VIRUS cont...
Warts can be small to large, raised to flat, or single to clustered
There is no cure for HPV although lesions can be removed
Methods include: cryotherapy, chemicals, and laser therapy.
HPV is associated with cervical cancer or cervical dysplasia
Early detection reduces mortality
Also linked to cancers of the oral cavity.
39. External Genital Warts
For unknown reasons, genital warts frequently
increase in number and size during pregnancy.
may sometimes grow to fill the vagina or cover the
perineum, thus making vaginal delivery or
episiotomy difficult
40. TREATMENT
Treatment in pregnancy:
there could be an incomplete response to treatment
lesions commonly improve or regress rapidly
following delivery so eradication of warts during
pregnancy is not always necessary.
The goal is minimizing treatment toxicity to the
mother and fetus.
41. Management
Patient may apply podofilox 0.5% solution or gel 2 times a
day for 3 days, followed by 4 days of no therapy, for a total
of up to 4 cycles, or imiquimod 5% cream at bedtime 3
times a week for up to 16 weeks. Treatment area should be
washed with mild soap and water 6- 10 hours after
application
or podophyllin resin 10-25% in compound tincture of
benzoin in small amounts to each wart, repeat weekly if
necessary;
; or surgical removal.
Vaginal warts:
cryotherapy with liquid nitrogen, or TCA 80-90%, or
podophyllin 10-25%
42. HEPATITIS B VIRUS
Transmission is similar to HIV and HBV is more
easily transmitted than HIV
Nearly 95 % of persons with HBV recover
Vaccination for HBV recommended especially for
health personnel
Hepatitis B virus is present in all body fluids
Perinatal transmission accounts for 35-50% of
hepatitis B carriers
70-90% of infants born to positive women will be
chronically infected
it can be passed to the baby through the placenta
during pregnancy childbirth, as well as through breast
milk.
43. Infants of all Hepatitis B s Ag positive patients
should receive:
Immune globulin (HBIG)
Vaccination for Hep B
Vertical transmission rates are very low with
immunoprophylaxis.
44. Severe HBV includes jaundice and may result in
prolonged illness or death
Neonatal complications:
Acquires infection from mother
Life-long carrier
Liver disease and liver cancer
Pregnant women at risk for HBV infection during
pregnancy should be vaccinated.
45. Vaginal infection
Vaginitis is an inflammation of the vagina caused by
infections.
- Bacterial Vaginosis, Trichomoniasis, & Vaginal Yeast
Infections are the three most common types of
Vaginitis.
46. Bacterail vaginosis
Not an infection
maldistribution of normal vaginal flora.
Numbers of lactobacilli are decreased
caused by Gardnella vaginalis
Often no s/s…but some times it associated with:
vulvular vaginal irritation
Greyish-white-foul smelling discharge
47. Treatment
Metronidazole, 500 mg twice daily orally for 7
days.
Alternatives are 0.75-percent metronidazole gel,
250-mg applicator-dose intravaginally three times
daily for 7 days
2-percent clindamycin cream, one applicator dose
inserted intravaginally at bedtime for 7 days
48. Trichomoniasis
Trichomonas: may be transmitted through
nonsexual contact too
( a “fomite: ex. Toilet seat)
Commonly seen vaginal infection as well as a STI
Caused by Trichomonas vaginalis
49. Asymptomatic for years
Large amount of frothy foul smelling creamy to
green color discharge
Redness, swelling, itching, burning of the genital
area
Painful intercourse and dysuria, and prostatitis in
men
51. Candidiasis
Fungal or yeast infection
Normal habitat is mouth, throat, large
intestines and vagina
Propagates in areas that is moist and warm
Mucous membrane and tissue folds
Candida albican also found in patients
currently on antibiotic therapy (develop a
secondary infection)
< bacteria -altering natural protective organisms,
normal flora is off balance!
52. Signs and Symptoms
Vaginal discharge that causes itching and possible
irritation
Discharge appears watery, thick, tenacious and may
contain white cheese-like particles
Burning sensation on urination
Symptoms > severe prior to menstruation
less responsive to treatment during pregnancy
53. Diagnostic Test
Microscopic identification of spores and hypae on
a glass slide prepared from a discharge specimen
and potassium hydroxide
Management
Nystatin
Ketoconazole
Clotrimazole
Fluconazole
Itraconazole
Gresofluvin