Presentation is loading. Please wait.

Presentation is loading. Please wait.

Sexual Transmitted Infections June 2012 Huda Taha SpR.

Similar presentations


Presentation on theme: "Sexual Transmitted Infections June 2012 Huda Taha SpR."— Presentation transcript:

1 Sexual Transmitted Infections June 2012 Huda Taha SpR

2

3 Gonorrhoea  Gram negative diplococcus Neisseria gonorrhoeae  Primary sites; mucous membranes of the urethra, endocervix, rectum, pharynx and conjunctiva

4 Clinical features Men:  Urethral discharge and/ or dysuria within 2–5 days of exposure  Mucopurulent or purulent urethral discharge  Rarely, epididymal tenderness/swelling

5 Women:  Infection at the endocervix is frequently asymptomatic  Increased or altered vaginal discharge is common  Lower abdominal pain may be present  Urethral infection may cause dysuria but not frequency  Mucopurulent endocervical discharge, easily induced endocervical bleeding  Commonly, no abnormal findings

6 Complications  Transluminal spread of N.G from the urethra or endocervix/ epididymo-orchitis or prostatitis, and PID  Haematogenous dissemination may also occur from infected mucous membranes to cause skin lesions, arthralgia, arthritis and tenosynovitis (disseminated gonococcal infection)

7 Diagnosis  Microscopy of Gram-stained genital specimens direct visualization of N.G  Sensitivity (90–95%) in men with urethral discharge, recommended to facilitate immediate diagnosis in symptomatic men  Microscopy is not recommended for urethral smears in women

8  Detection of N.G can be achieved by NAATs or culture  NAATs are generally more sensitive than culture  NAATs show high sensitivity (96%) in both symptomatic and asymptomatic infection.  Antimicrobial susceptibility testing

9 Specimen collection Men:  First pass urine is the preferred sample for NAAT testing  Microscopy and culture require a urethral swab specimen  Rectal and pharyngeal swab specimens should be directed by sexual history, symptoms at these sites

10 Women;  Vaginal/ endocervical swab specimens are equally sensitive for detecting N.G by NAAT testing  Culture; endocervical and urethral swab specimen for maximum sensitivity  Urine is a suboptimal sample for the detection of N.G in women

11 Management  Patients; detailed explanation of their condition, long-term implications for the health of themselves and their partner(s).  Clear and accurate written information  Abstain from sexual intercourse, until they and their partner(s) have completed treatment

12 Treatment  Intracellular Gram-negative diplococci on microscopy of a smear from the genital tract  A positive culture for N. G from any site  A positive NAAT for N. G from any site  Recent sexual partner(s) of confirmed gonococcal infection  Consider offering on epidemiological grounds following sexual assault.

13  Ceftriaxone 500 mg IM stat dose with azithromycin1g po ALTERNATIVE REGIMENS  Cefixime 400 mg po  Spectinomycin 2 g IM  Quinolones not recommended, high prevalence of quinolone resistance worldwide.

14 TREATMENT OF COMPLICATED INFECTIONS Gonococcal PID  Ceftriaxone 500 mg IM, doxycycline 100 mg bd po plus metronidazole 400 mg bd for 14 days Gonococcal epididymo-orchitis  Ceftriaxone 500 mg IM, doxycycline 100 mg for 10–14 days

15 PREGNANCY AND BREASTFEEDING  Pregnant and breastfeeding women should not be treated with quinolone or tetracycline  Ceftriaxone 500 mg IM stat with Spectinomycin 2 g IM

16 SEXUAL PARTNERS  Partner notification should be pursued in all patients identified with gonococcal infection Follow up  Confirm compliance with treatment  Ensure resolution of symptoms  Enquire about adverse reactions  Take a sexual history if possibility of reinfection

17

18

19

20 Genital Herpes Initial episode  First episode HSV-1 or HSV-2 dependent on whether the individual has had prior exposure to the other type, this is further subdivided into:  Primary infection: first infection with either HSV-1 or HSV-2 with no pre-existing antibodies to either type  Non-primary infection: Infection with either HSV-1 or HSV-2 with pre- existing antibodies to the other type

21 Recurrent episode  Recurrence, due to reactivation of pre-existent HSV-1 or HSV-2 infection after a period of latency Clinical Features  Patient may be asymptomatic, the disease unrecognised  Local symptoms; painful ulceration, dysuria, blistering, ulceration of the external genitalia, tender lymphadenitis  Systemic symptoms; fever and myalgia

22 Complications  Autonomic neuropathy, resulting in urinary retention  Autoinoculation to fingers and adjacent skin e.g thighs  Aseptic meningitis

23 Diagnosis  Virus detection and characterization, by direct detection of HSV in genital lesions  Virus typing to differentiate between HSV-1 and HSV-2 in all patients  HSV DNA detection by PCR

24 Management  Saline bathing/ analgesia  Antiviral drugs; within 5 days of the start of the episode  Aciclovir, 200 mg 5x/d reduce the severity, duration of episodes  Antiviral does not alter the natural history of the disease  Topical agents are less effective than oral agents.  Combined oral and topical treatment is of no benefit

25 Recurrent Genital Herpes  Self-limiting, minor symptoms  Management made in partnership with the patient  Strategies include o supportive therapy only o episodic antiviral treatments o suppressive antiviral therapy (aciclovir 400mg bd)  The best strategy for managing an individual patient may change over time according to recurrence frequency, symptom severity, and relationship status

26 Pregnancy  First and second trimester acquisition  First episode HSV has been associated with first trimester miscarriage  Vaginal delivery should be anticipated  Daily suppressive aciclovir from 36 weeks gestation may be considered

27  C S; all women presenting with first-episode HSV at delivery, within 6 weeks of the EDD  If VD is unavoidable or mother opts for a NVD, prolonged ROM, invasive procedures to be avoided  IV aciclovir given intraparum to the mother, subsequently to the neonate may be considered  Neonatologists

28  Recurrent Genital Herpes  Antiviral treatment is rarely indicated  Symptomatic recurrences during the third trimester; likely to be brief; NVD if no lesions are present at delivery

29

30

31 Chlamydia trachomatis  Most common curable STI in Britain  ~ 5-10% of sexually active women under 24, men may be currently infected  Risk factors; age under 25yrs, new sexual partner or >1 sexual partner in the past year  New sexual partner being more important than number of partners and lack of consistent use of condoms

32 Clinical features  Women  Asymptomatic in approximately 70%  PCB or IMB  Lower abdominal pain  Purulent vaginal discharge  Mucopurulent cervicitis and/or contact bleeding  Dysuria

33 Men  Asymptomatic in over 50%  Urethral discharge  Dysuria Diagnosis Nucleic Acid Amplification Technique 90-95% sensitive

34 Treatment  Doxycycline 100mg bd for 7 days OR  Azithromycin 1gm po stat dose Alternative regimens:  Erythromycin 500mg bd for days OR  Ofloxacin 200mg bd for 7 days

35 Pregnancy and breast feeding  Erythromycin 500mg qds for 7 days OR  Amoxicillin 500 mg tds for 7 days OR  Azithromycin 1 gm stat

36

37 Syphilis  Infection with the spirochete bacterium Treponema pallidum subsp pallidum. Classificaation Acquired or congenital Acquired syphilis: Early (primary, secondary, early latent < years of infection) Late (late latent>2 years of infection, tertiary including gummatous, cardiovascular and neurological)

38 Primary syphilis  Painless ulcer ( chancre), regional ymphadenopathy Secondary syphilis  Multisystem involvement first 2 years of infection  Generalized maculo papular rash affecting palms and soles  Condylomata lata, mucocutaneous lesions, generalized lymphadenopathy  Less commonly: patchy alopecia, ant. uveitis, meningitis, cranial nerve palsies, hepatitis, splenomegaly, periosteitis and glomerulonephritis

39 DIAGNOSIS  Hx and examination  Symptoms of early syphilis  Details, previous Rx, blood donation, antenatal screening  Other treponemal infections; yaws, pinta, Hx of living in endemic region  Examination of the genitals, skin, mucosal surfaces and lymph nodes for signs of primary and secondary syphilis  Late and congenital syphilis a thorough clinical examination  Full systems review

40 DEMONSTRATION OF T. PALLIDUM  Dark ground microscopy  If the initial test is negative repeat daily for three days  PCR  Serological test for syphilis -

41 Treponemal and non-treponemal  Treponemal tests; look for a direct antigen from the T. P or antibody to it, TPPA  remain in the bloodstream for years post exposure to syphilis  Thus, +ve result for a treponemal test does not necessarily indicate active syphilis infection  Non-treponemal tests; cardiolipin, VDRL; incidental marker, released when treponeme damages cells during infection  +ve non-treponemal tests indicative of an active infection  But a confirmatory test with a treponemal test is required to verify that it is indeed a syphilis infection that is causing elevated cardiolipin levels

42 Treatment Incubating syphilis/ epidemiological Rx  Benzathine penicillin G 2.4 MU i.m. stat  Doxycycline 100 mg PO b.d. 14 days  Azithromycin 1 g po stat Early syphilis (primary, secondary and early latent)  Benzathine penicillin G 2.4 MU i.m. stat  Procaine penicillin G U i.m. 10 days

43 Alternative regimens  Penicillin allergy or refusing parenteral treatment.  Doxycycline 100 mg po b.d. 14 days  Azithromycin 2 g po stat  Ceftriaxone 500 mg i.m. daily 10 days Late latent, cardiovascular, gummatous syphilis  Benzathine penicillin 2.4 MU i.m. weekly for two weeks (three doses)  Procaine penicillin 600,000 units i.m. o.d. for 17 days

44 Early syphilis in pregnancy  Benzathine penicillin G 2.4 MU i.m. stat in 1 st & 2ed trimesters  3 rd trimester, 2ed dose Alternative regimens  Amoxycillin 500 mg po q.d.s. plus probenecid 500 mg po q.d.s. 14 days  Ceftriaxone 500 mg i.m. daily 10 days Late syphilis in pregnancy  Manage as in non-pregnant patients but without the use of doxycycline.

45 Follow up  Early syphilis, clinical, serological (VDRL) f u at months 1, 2, 3, 6 and 12, then six monthly until VDRL/RPR negative or serofast  Late syphilis minimum serological f u is three monthly until serofast

46

47

48

49

50

51 Warts  Ano-genital warts are caused by HPV of which over 100 genotypes have been identified  Symptoms  Treatment: Cryotherapy podophyllotoxin Imiquimod Surgical/scissor excision TCA

52

53

54 Vaginal discharge

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72


Download ppt "Sexual Transmitted Infections June 2012 Huda Taha SpR."

Similar presentations


Ads by Google