6 STDs of Concern “Sores” (ulcers) Syphilis BackgroundSTDs of Concern“Sores” (ulcers)SyphilisGenital herpes (HSV-2, HSV-1)Others uncommon in the TurkeyLymphogranuloma venereumChancroidGranuloma inguinale
7 STDs of Concern (continued) BackgroundSTDs of Concern (continued)“Drips” (discharges)GonorrheaChlamydiaNongonococcal urethritisMucopurulent cervicitisTrichomonas vaginitis / urethritisCandidiasis (vulvovaginal, less problems in men)Other major concernsGenital HPV (especially type 16, 18) and Cervical Cancer
12 Secondary Syphilis - Clinical Manifestations SoresSecondary Syphilis - Clinical ManifestationsRepresents hematogenous dissemination of spirochetesUsually 2-8 weeks after chancre appearsFindings:rash - whole body (includes palms/soles)mucous patchescondylomata lata - HIGHLY INFECTIOUSconstitutional symptomsSn/Sx resolve in 2-10 weeks
13 Secondary Syphilis Rash Generalized LAP Condylomata lata CNS involvementFeverGlomerulonephritisHepatitisArtralgia
14 Secondary Syphilis Rash SoresSecondary Syphilis RashSource: Florida STD/HIV Prevention Training Center
15 Secondary Syphilis: Generalized Body Rash SoresSecondary Syphilis: Generalized Body RashSource: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides
16 Secondary Syphilis Rash SoresSecondary Syphilis RashSource: Florida STD/HIV Prevention Training Center
17 Secondary Syphilis Rash SoresSecondary Syphilis RashSource: Cincinnati STD/HIV Prevention Training Center
18 Secondary Syphilis Sores Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas
19 Secondary Syphilis – Condylomata Lata SoresSecondary Syphilis – Condylomata LataSource: Florida STD/HIV Prevention Training Center
20 Tersier and late syphilis Gom (Syphilitic granulomas)CNS and CVS involvement
21 Syphilis Latent syphilis Serology (+), Clinic (-) Varies from several months to several yearsMore duration less infectivityEarly (<2 years) Late (>2 years)NeurosyphilisAny neurological symptom or sign
22 Syphilis - DiagnoseDark field microscopySerology
23 Syphilis - Diagnose Non-spesific serological tests VDRLRPRSpesific serological testsFTA-ABSTPHAMHA-TPELISA- The only positive thing of my life is my VDRL test!!!
24 Genital Herpes Simplex - Clinical Manifestations SoresGenital Herpes Simplex - Clinical ManifestationsDirect contact – may be with asymptomatic sheddingPrimary infection commonly asymptomatic; symptomatic cases sometimes severe, prolonged, systemic manifestationsVesicles painful ulcerations crustingRecurrence a potentialDiagnosis:Tzanck smearCultureSerology (Western blot)PCR
25 Epidemiology of Genital Herpes SoresEpidemiology of Genital HerpesOne of the 3 most common STDs, increased 30% from late 70s to early 90s25% of US population by age 35HSV-2: 80-90%, HSV-1: 10-20% (majority of infections in some regions)Most cases subclinicalTransmission primarily from subclinical infectionComplications: neonatal transmission, enhanced HIV transmission, psychosocial issues
36 Chlamydia Life Cycle Drips Source: California STD/HIV Prevention Training Center
37 Chlamydia trachomatis DripsChlamydia trachomatisResponsible for causing:Cervicitis,UrethritisProctitisLymphogranuloma venereumPelvic inflammatory diseasePotential to transmit to newborn during deliveryConjunctivitis, pneumonia
39 DripsNormal CervixSource: Claire E. Stevens, Seattle STD/HIV Prevention Training Center
40 Chlamydia Cervicitis Drips Source: St. Louis STD/HIV Prevention Training Center
41 Mucopurulent Cervicitis DripsMucopurulent CervicitisSource: Seattle STD/HIV Prevention Training Center
42 Laboratory Tests for Chlamydia DripsLaboratory Tests for ChlamydiaTissue culture has been the standardSpecificity approaching 100%Sensitivity ranges from 60% to 90%Non-amplified testsEnzyme Immunoassay (EIA), e.g. Chlamydiazymesensitivity and specificity of 85% and 97% respectivelyuseful for high volume screeningfalse positivesNucleic Acid Hybridization (NA Probe), e.g. Gen-Probe Pace-2sensitivities ranging from 75% to 100%; specificities greater than 95%detects chlamydial ribosomal RNAable to detect gonorrhea and chlamydia from one swabneed for large amounts of sample DNA
43 Laboratory Tests for Chlamydia (continued) DripsLaboratory Tests for Chlamydia (continued)DNA amplification assayspolymerase chain reaction (PCR)ligase chain reaction (LCR)Sensitivities with PCR and LCR 95% and 85-98% respectively; specificity approaches 100%LCR ability to detect chlamydia in first void urine
44 Chlamydia Direct Fluorescent Antibody (DFA) DripsChlamydia Direct Fluorescent Antibody (DFA)Source: Centers for Disease Control and Prevention
45 Pelvic Inflammatory Disease (PID) DripsPelvic Inflammatory Disease (PID)l0%-20% women with GC develop PIDIn Europe and North America, higher proportion of C. trachomatis than N. gonorrhoeae in women with symptoms of PIDCDC minimal criteriauterine adnexal tenderness, cervical motion tendernessOther symptoms includeendocervical discharge, fever, lower abd. painComplications:Infertility: 15%-24% with 1 episode PID secondary to GC or chlamydia7X risk of ectopic pregnancy with 1 episode PIDchronic pelvic pain in 18%
47 HPV and Cervical Cancer Infection is generally indicated by the detection of HPV DNAHPV infection is causally associated with cervical cancer and probably other anogenital squamous cell cancers (e.g. anal, penile, vulvar, vaginal)Over 99% of cervical cancers have HPV DNA detected within the tumorRoutine Pap smear screening ensures early detection (and treatment) of pre-cancerous lesions
48 Estimates for HPV-Associated Cancers HPV and Cervical CancerEstimates for HPV-Associated CancersCervical cancer:In the U.S., an estimated 14,000 cases and 5,000 deathsWorldwide, an estimated 450,000 cases and 200,000 deaths
49 Perianal Wart HPV and Cervical Cancer Source: Cincinnati STD/HIV Prevention Training Center
50 HPV Penile Warts HPV and Cervical Cancer Source: Cincinnati STD/HIV Prevention Training Center
51 HIV Infection Infection of immun system Seen oppurtunistic infections and neoplastic diseases in the last stage
56 Genital siğiller HPV (human papilloma virus) etkendir Erkek ve kadın genital bölgesinde ve anus çevresinde sert, ağrısız, küçük siğillerdir.•Virüsün 6 ve 11. alt tipleri dış genital bölgede;•16, 18 ve 31. alt tipleri ise, servikal displazi ve karsinomla ilişkilidir.
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