1. OVERVIEW OF SEXUALLY TRANSMITTED DISEASES Assist Prof Dr. Syed Yousaf Kazmi

2. OBJECTIVES 1.Describe the pathogenesis of genital infection. 2.Discuss the clinical manifestations of genital infection. 3.Identify the common methods used in the diagnosis of genital infection. 4.Discuss the management plan of genital infection. 5.Summarize appropriate preventive methods of genital infection. 6.Describe the epidemiology, public health importance, prevention and screening of genital infection.

3. WHO WAS HE? He was the Hollywood celebrity It was because of him that I first heard the disease HIV in 1980s

4. INTRODUCTION  Definition: “An illness that has a significant probability of transmission between humans or animals by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex”  Some STIs can also be transmitted via the use of IV drug needles, through childbirth or breastfeeding  STIs is preferable term than STDs, Venereal Diseases  Infection vs disease e.g.  “Venereal diseases” ''Veneris'' is the Latin word from Venus–the Roman goddess of love

5. LIST OF STDs (CDC) 1.Bacterial Vaginosis (BV) 2.Chlamydia 3.Gonorrhea 4.Hepatitis, Viral 5.Herpes, Genital 6.HIV/AIDS 7. Human Papillomavirus (HPV) 8.Pelvic Inflammatory Disease (PID) 9.Syphilis 10.Trichomoniasis 11.Other STDs a.Chancroid b.Lymphogranuloma Venereum (LGV) c.Pubic Lice Infestation d. Scabies

6. STIs VIDEO

8. PATHOGENESIS Many STDs are (more easily) transmitted through the mucous membranes of the penis, vulva, rectum, mouth, throat etc. Pathogens -able to pass through breaks/ abrasions of the skin, even minute ones Probability of transmitting many STIs is far higher from sex than by more casual non-sexual means e.g. touching, hugging, shaking hands Some STIs can be transmitted by direct skin contact e.g. Herpes simplex and HPV

9. PATHOGENESIS  Some STIs spread only during active lesions e.g. HSV/ HPV  Most other spread when infected person is asymptomatic e.g. HIV, gonorrhea, etc.  All sexual activities between two (or more) people - two-way route for the transmission of STDs  Most STIs infects local tissues e.g. chlamydia, gonorrhea, HSV, HPV  Many STIs disseminate to other organs e.g. HIV, Syphilis

10. PATHOGENESIS STI org enter the abrasions Multiply locally-either disseminate or produce inflammation locally Usually urethritis, cervicitis- discharge Local skin lesions e.g. HSV, HPV, Syphilis chancre Discharge/ local lesions-mean of spread of inf Individual STI has peculiar natural course of inf e.g. HIV, Syphilis etc. Complications of primary inf Urethral discharge in gonorrhea Chancre on glans penis

11. CLINICAL PRESENTATION Usually asymptomatic in majority Urethral discharge, dysuria in male Vaginal discharge, dysuria, Pruritus on external genitalia Ulcerative lesions on external genitalia Edema, pus discharge from wound, Warts on external genitalia Gen symptoms fever, malaise, etc. Specific symptoms of disease like HBV, HCV etc. Vulval warts

12. CLINICAL PRESENTATION Symptoms of local spread e.g. PID, ectopic pregnancy, infertility etc. in female & Prostatitis, epididymitis, epididymo-orchitis in male Symptoms of distant dissemination e.g. sepsis syndrome, death Symptoms of peculiar practices e.g. pharyngitis, proctitis, etc. Vulvo-vaginal Trichomoniasi s

13. DIAGNOSIS OF STIs Thorough clinical history Detailed clinical exam Appropriate samples Focused lab tests Proper technique Proper transportation Timely processed Reports

14. DIAGNOSIS OF STIs Direct Microscopy e.g. in Syphilis (dark field microscopy of chancre) Gram stain of discharge/ ulcer/ pus- Ns. gonorrheae, H. ducryei etc. Culture and antimicrobial sensitivity of discharge/ ulcer/ pus Serological tests (non specific & specific tests of syphilis, HIV etc.) Nucleic acid amplification tests e.g. PCR on appropriate sample Dark field microscopy-Treponema pallidum Neisseria gonorrheae colonies on CA

15. DIAGNOSIS OF GONORRHEA Gram Staining of urethral discharge smear Pus cells numerous Gram negative intra and extracellular bean shaped diplococci Culture of urethral discharge Freshly obtained urethral discharge streaked on selective medium for Neisseria gonorrheae (Modified Thayer- Martin medium, Chocolate agar) and incubated in 5% CO2 at 35-37 o C.

16. DIAGNOSIS OF GONORRHEA Nucleic acid amplification tests (PCR test) More sensitive and rapid tests. Can be performed on urine specimen Serology Antibodies against pili and outer membrane proteins detected by ELISA/ Radioimmunoassay

17. MANAGEMENT OF STIs Depends upon type of STI Usually bacterial causes of STIs are treated by antimicrobials E.g. case of gonococcal urethritis/ cervicitis is treated by parenteral 3 rd gen cephalosporins Additionally doxycycline is added for 7 days ??? Syphilis is universally sensitive to Penicillin Genital herpes-Acyclovir 200 mg q5hrly for 7-10 days HIV infection-HAART

18. MANAGEMENT OF STIs Management of partner-very imp Follow up checkup for other STIs e.g. HIV/ HPV/HSV etc. Counseling of partner and patient Education of patient and partner about STI Offer vaccination for vaccine preventable STIs

19. PREVENTIVE METHODS Abstinence Reduction of number of Sex Partners Pre-exposure Vaccination –HPV(quadri-valent Gardasil, bivalent Cervarix) –HBV, HAV Male Condoms Female Condoms, Diaphragm, Topical Microbicides/ Spermicides Male Circumcision Post-exposure Prophylaxis (PEP) for HIV and STD Partner management Education about “SAFE SEX”

20. LIFE IS BEAUTIFUL CONFINE TO YOUR LIFE PARTNER