2.  Sexually transmitted diseases (STDs) are the venereal disorders that are caused by a variety of pathogenic microorganisms.  In almost all the countries STDs are the most common of all infectious diseases. Among which Syphilis, Gonorrhea, and AIDS are predominant

3.  INFECTIOUSDISEASE - CAUSATIVE ORGANISM Bacterial  Gonorrhea - Neisseria gonorrhoeae  Syphilis - Treponema pallidum  Non gonococcal urethritis -Chlamydia trachomatis -Ureaplasma urealyticum  Chancroid - Hemophilus ducreyi Viral  Herpes Genitalis - HSV 1 0r 2  AIDS - HIV  Hepatitis - Hepatitis A, B, and C

4. Parasites  Trichomniasis -Trichomonas Vaginalis  Giardiasis - Giardia lamblia  Scabies - Sarcoptes scabiei

5.  The fundamental factor that contributes for the spread of infection is sexual intercourse. It spreads both by homosexism and heterosexism.  To avoid the spread of the disease, it is important to identify the group of individuals who are more at risk.

6.  Men aged 18 – 34 years  Women aged 16 – 28 years  Commercial sex workers  Homosexual and Bisexual men with multiple partners  Frequent travelers (truck drivers)

7. Control of STDs Good clinical practice – which, includes:  Accurate diagnosis,  Effective treatment, and  Intensive follow-up to ensure the cure of disease.

8. It is an infection to the epithelium of the urethra, cervix, rectum, or pharynx that is caused by the organism called as Neisseria gonorrhoeae. Signs and symptoms:  In men, the incubation period is 2 – 14days  women it ranges from 7 – 21 days  discomfort in urethra  dysuria  purulent discharge  meatus may be red and swollen.

10. Diagnosis In male:  Signs and symptoms and  Gram stain of urethral discharge showing gram negative diplococci. In female:  Signs and symptoms and  Culture of cervical discharge showing gram negative diplococci

11. Disseminated gonococcal infection (DGI) This is more common in women than in men  Mild febrile illness  Malaise  Polyarthritis  Skin lesions often on the periphery of the limbs  Genital symptoms are often asymptomatic Detected by culture

12. Gonococcal arthritis  Similar to DGI  Fever  Severe joint pain and  Limitation in movement of the joints (swelling, redness, and warmth)

13.  Treatment for uncomplicated gonorrhea  Ceftriaxone 125 mg IM single dose  Or  Ciprofloxacin 500 mg PO single dose  Or  Cefixime 400 mg PO single dose  Or  Ofloxacin 400 mg PO single dose.

14. In pregnancy:  Ceftriaxone 125 mg IM single dose. Treatment for complicated gonorrhea:  Ceftriaxone 1gm IV / IM once daily for 3 – 7 days. Or  Ampicillin / ammoxicillin 1 gm PO q. 6 hours for 3 – 7 days.  NSAIDs preferred in gonococcal arthritis along with antibiotics.

15.  It is a contagious systemic disease caused by the spirochete Treponema Pallidum which is characterized by sequential clinical stages.  Primary syphilis  Secondary syphilis  Latent syphilis  Tertiary syphilis  Cardiovascular syphilis and neuro syphilis  Congenital syphilis

16. Primary syphilis: Incubation period is 14 – 28 days Characterized by –  Skin lesions (painless)  Regional lymph nodes are moderately enlarged

17. Secondary syphilis: Starts from 6-8 weeks after chancre (skin lesions) appearance Characterized by –  Mild fever  Malaise  Headache Dermatological manifestations like  Facial macular rash and  Genital ulcers may present Generalized Lymphadenopathy Diagnosis by signs & symptoms + +ve VDRL

19. Latent syphilis The late stages of syphilis called as latent syphilis (appears after 1 or 2 years of infection) patients are asymptomatic with elevated VDRL titer. Diagnosis can be made by +ve serology and prior history of syphilis.

20. Tertiary syphilis May present with –  Aortitis  Irtis  Gumma Diagnosis by H/o syphilis + positive VDRL It may cause end organ damage.

21. Cardiovascular syphilis and neuro syphilis May present with –  Ophthalmic / auditory symptoms  Signs of meningitis  psychosis  Dementia Diagnosis CSF abnormalities Positive VDRL.

22. Congenital syphilis  In pregnant women with syphilis, T. Pallidum can cross the placenta at any time during pregnancy  Transmission of syphilis during pregnancy can result in fetal death, prematurity or congenital syphilis  Symptoms can be seen during first month of life (early congenital syphilis) or in later stages of childhood or adolescence (late congenital syphilis)

24. Clinical manifestations  Early congenital syphilis resemble with secondary syphilis  Late congenital syphilis resembles with latent syphilis.

26. Diagnosis:  Venereal disease research laboratory ( VDRL ) test.  Rapid plasma regin ( RPR )  T.Pallidum hemagglutination assay ( TPHA ).  ELISA.

27. Treatment of primary, secondary and latent stages of syphilis:  Procaine penicillin: 600 – 1200 mg IM OD for 12 days Or  Doxycycline: 100 mg orally q.8 hours for 15 days Or  Tetracycline: 500 mg orally q 6hours for 15 days.

28.  Treatment of cardiovascular / neuro syphilis  Crystalline penicillin – 18 – 24 million units IV q. 6 hours for 10 – 14 days Congenital syphilis:  Crystalline penicillin- 50,000 units/kg IV q. 12 hours during first 7 days of life for 10 days.

29. Organism : Herpes simplex virus Signs and symptoms:  Fever  Headache  Erythematous ulcers (chronic cases)  Local itching  Vaginal / urethral discharge Diagnosis Clinical presentations / culture

30.  STDs are common infectious diseases in both developed and developing countries especially in young adults.  Recent advances in technical medicine assures 100% cure for most of the STDs.  The advancements in the diagnosis of STDs help in early detection and management of diseases, which minimizes complications and healthcare cost.

31.  Applicable for STDs also  Avoiding sexual contact with infected persons i.e. by avoiding multiple sex partners  Using proper physical and chemical barriers during intercourse.