Diagnosis of sexually Diagnosis of sexually transmitted infections

What are Sexually transmitted Infections, mean Today More than 30 bacterial, viral, and parasitic pathogens are transmissible sexually and constitute a group of infections referred to as sexually transmitted infections (STIs). Although some of the pathogens can be acquired through routes other than sexual transmission, epidemiologically, sexual contact is more important for their transmission from one person to another

Common STDs Estimated Annual Incidences Human papilloma Virus: 5.5 million Trichomoniasis: 5 million Chlamydia: 3 million Genital herpes: 1 million Gonorrhea: 650,000 Hepatitis B: 120,000 Syphilis: 70,000

Types of Sexually Transmitted Infections

Pubic lice

Overview of Complications of Sexually Transmitted Diseases Fetal Wastage* Low Birth weight* Congenital Infection* Upper reproductive tract infection Systemic Infection STDs Infertility Ectopic Pregnancy* Chronic Pelvic Pain HIV Infection* Cervical Cancer* * Potentially Fatal

Increased Transmission of HIV in the Presence of Other STDs Transmission increased 3-5 times Increased susceptibility – Mucosal breakdown due to genital ulcer may facilitate HIV entry – Recruitment of WBCs to site of active infection (inflammation) acts as an area of increased HIV receptors Increased infectiousness – Increase in HIV viral load in semen, genital secretions and genital ulcers

8 Genital Ulcer Diseases – Does It Hurt? Painful – Chancroid – Genital herpes simplex Painless – Syphilis – Lymphogranuloma venereum – Granuloma inguinale

Treponema pallidum – The Agent of Syphilis Spirochete Obligate human parasite Transmission – Sexual – Trans-placental – Percutaneous following contact with infectious lesions – Blood Transfusion 5 9

Syphilis – The “Great Imitator” Infectious Dose: ~57 organisms Incubation Period – 21 days (median) 3 clinical stages of syphilis – Primary: Painless sore (chancre) at inoculation site – Secondary: Rash, Fever, Lymphadenopathy, Malaise – Tertiary/Latent: CNS invasion, organ damage “The physician that knows syphilis knows medicine.” – Sir William Osler 6 10

Primary Syphilis

12 Primary Syphilis Chancre Source: Florida STD/HIV Prevention Training Center

Secondary syphilis occurs approximately four to ten weeks after the primary infection. Most commonly symptoms involve the skin, mucous membranes, and lymph nodes. There may be a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles Secondary syphilis Typical presentation of secondary syphilis with a rash on the palms of the hands

Tertiary syphilis may occur approximately 3 to 15 years after the initial infection There are three different forms: gummatous syphilis (15%), late neurosyphilis (6.5%), and cardiovascular syphilis (10%). Without treatment, a third of infected people develop tertiary disease. People with tertiary syphilis are not infectious. Tertiary syphilis Patient with tertiary (gummatous) syphilis Moulage of a Gumma in syphilis for training students

Congenital syphilis is that which is transmitted during pregnancy or during birth. Two-thirds of syphilitic infants are born without symptoms. Common symptoms that develop over the first couple years of life include: hepatosplenomegaly (70%), rash (70%), fever (40%), neurosyphilis (20%), and pneumonitis (20%). Latent syphilis is defined as having serologic proof of infection without symptoms of disease. Late latent syphilis is asymptomatic. Congenital and latent syphilis

Syphilis is difficult to diagnose clinically early in its presentation. Confirmation is either via blood tests or direct visual inspection using microscopy.blood testsmicroscopy Blood tests are more commonly used, as they are easier to perform. Diagnostic tests are, however, unable to distinguish between the stages of the disease Diagnosis of syphilis

Blood tests are divided into nontreponemal and treponemal tests.nontreponemal Nontreponemal tests are used initially, and include venereal disease research laboratory (VDRL) and rapid plasma reagin tests.venereal disease research laboratoryrapid plasma reagin However, as these tests are occasionally false positives, confirmation is required with a treponemal test, such as treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs).false positives treponemal pallidum particle agglutination fluorescent treponemal antibody absorption test Diagnosis of syphilis: Blood test

False positives on the nontreponemal tests can occur with some viral infections such as varicella and measles, as well as with lymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, and pregnancy.varicellameasleslymphomatuberculosismalaria endocarditisconnective tissue diseasepregnancy Treponemal antibody tests usually become positive two to five weeks after the initial infection. Neurosyphilis is diagnosed by finding high numbers of leukocytes (predominately lymphocytes) and high protein levels in the cerebrospinal fluid in the setting of a known syphilis infection. leukocyteslymphocytescerebrospinal fluid Diagnosis of syphilis: Blood test

Dark ground microscopy from a chancre may be used to make an immediate diagnosis. Dark ground microscopy Two other tests can be carried out on a sample from the chancre: direct fluorescent antibody testing and PCR testdirect fluorescent antibody Direct fluorescent testing uses antibodies tagged with fluorescein, which attach to specific syphilis proteins, PCR uses techniques to detect the presence of specific syphilis genes. These tests are not as time-sensitive, as they do not require living bacteria to make the diagnosis. Diagnosis of syphilis: Direct test