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Gabriel Schembri. Definition Chlamydia trachomatis is an obligate intracellular gram negative bacterium recognised as one of the most.

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Presentation on theme: "Gabriel Schembri. Definition Chlamydia trachomatis is an obligate intracellular gram negative bacterium recognised as one of the most."— Presentation transcript:

1 Gabriel Schembri

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10 Definition Chlamydia trachomatis is an obligate intracellular gram negative bacterium recognised as one of the most common sexually transmitted agents in the world

11 Aetiology Chlamydia trachomatis Serovars D-K cause STDs Serovars A-C cause trachoma Serovar L causes lymphogranuloma venereum (LGV)

12 Epidemiology Most prevalent treatable bacterial STI but still second to TV in rank of common STIs 10% of under-25s screened via the national chlamydia screening programme are testing positive for chlamydia The highest rates of chlamydia are among females aged 16-24 years and males aged 20-24

13 Transmission One episode of SI ~10% for both sexes. Condom reduces the risk by ~40% 94% clear infection without treatment after 4 years 2/3 of contacts of chlamydia test positive for the infection

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15 Signs and symptoms Men 50% asymptomatic, most of these will have no clinical signs Dysuria Discharge (clear/whitish) or ‘threads’ in urine Meatitis Epididymitis

16 Signs and symptoms Females Asymptomatic in 70%, most of whom will have no physical signs on examination Deep dypareunia Pelvic pain +/-PID Intermenstrual bleeding Post coital bleeding Mucopurulent cervicitis Dysuria

17 Complications Epididymitis PID (?up to 40%) – pain, infertility, ectopic Bartholinitis +/- abscess Endometritis – irregular bleeding Adverse pregnancy outcomes Neonatal infection ?cervical neoplasia Sexually associated reactive arthritis/Reiter’s syndrome Fitz-Hugh curtis syndrome

18 Management General Explain the condition and provide written material Screen for other STIs Contact trace (look 4 weeks back if patient symptomatic, 6 months if asymptomatic) Advise no SI for 1 week (including oral sex) and until 1 week after partner is treated (if in a relationship)

19 Management - uncomplicated Azithromycin 1g po stat OR Doxycycline 100mg bd x7 days Alternatives: Ofloxacin 200mg bd x7 days (expensive) Erythromycin 500mg bd x14 days (GI upsets!!!)

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21 Definition Infection with Neisseria gonorrhoeae - Infects columnar epithelium of mucous membranes i.e. endocervix and pelvic organs, urethra, epididymis, prostate, rectum, pharynx, conjunctivae

22 Infectivity Almost exclusively sexual Exceptions :- Conjunctivitis – sexual but also autoinoculation, accidental transfer from affected individuals living in poor hygiene Vertical – ophthalmia neonatorum (40%), rarely neonatal sepsis, abscesses, anogenital infection

23 Infectivity After 1 episode of UPSI – 20-80% Females more susceptible Condoms can reduce risk by up to 75% ¼ of cases are attributable to oral sex

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25 Symptoms Males: Urethral infection: urethral discharge (80%), dysuria (50%), asymptomatic (10%) pharyngeal and rectal infection are usually asymptomatic (occasionally anal discharge and pain or sore throat) Females asymptomatic in 50% abnormal vaginal discharge, abdominal pain, dysuria and menstrual abnormalities sometimes occur

26 Signs Males Meatitis/balanitis with mucopurulent or purulent discharge Epididymo-orchitis Females Mucopurulent cervicitis PID signs Both sexes Asymptomatic esp. females Rectal discharge, pain, tenesmus Dissemination: pustular/petechial skin rash, arthralgia, septic arthritis

27 Management Screen for other STIs Contact trace as appropriate Treat for presumed concurrent chlamydia First line: Ceftriaxone 250mg IM stat Cefixime 400mg po stat (spectinomycin 2g IM stat)

28 Management Alternatives/allergy Ciprofloxacin 500mg po stat Ofloxacin 400mg po stat (spectinomycin 2g IM stat) Pregnancy/breastfeeding Cefixime, ceftriaxone, spectinomycin and ampicillin can be used Quinolones must be avoided

29 Management Pharyngeal infection More difficult to eradicate, therefore avoid the less effective spectinomycin and ampicillin regimes Can use cephalosporins and quinolones as per genital infections Needs a test of cure (TOC) Cefixime not in the guidelines but emerging evidence supports its effectiveness

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31 Family:Retroviridae Genus:Lentivirus Species: HIV 1 and HIV 2

32 p24 Matrix, p17 Integrase and Protease enzymes RNA binding proteins, p7, p9

33 Origin of HIV A: Chimpanzee, the source of HIV-1, lives in Central Africa B: Sooty mangabey, the source of HIV-2, lives in West Africa

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35 HIV-1 subtypes A1, A2, A3, A4 F1, F2 variation between subtypes ~ 30% } Sub-subtypes: genetic variability ~ 15% } QUASISPECIES - variations in a single individual 1% genetic variability

36 Quasispecies Primary infection Multiple rounds of rapid replication with errors Daughter viruses become genetically distinct (though very closely related) A number of quasispecies exist in equilibrium in a human host (unless there is selection pressure). These are archived in memory cells

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