3. STDs of Concern “Sores” (ulcers) “Sores” (ulcers) Syphilis Syphilis Genital herpes (HSV-2, HSV-1) Genital herpes (HSV-2, HSV-1) Others uncommon Others uncommon Lymphogranuloma venereum Lymphogranuloma venereum Chancroid Chancroid Granuloma inguinale Granuloma inguinale

4. “Drips” (discharges) –Gonorrhea –Chlamydia –Nongonococcal urethritis / mucopurulent cervicitis –Trichomonas vaginitis / urethritis –Candidiasis (vulvovaginal, less problems in men) Other major concerns –Genital HPV (especially type 16, 18) and Cervical Cancer

5. Genital Ulcer Diseases – Does It Hurt? ► Painful  Chancroid  Genital herpes simplex ► Painless  Syphilis  Lymphogranuloma venereum  Granuloma inguinale

6. AIDS (Acquired Immune Deficiency Syndrome) Caused by HIV (Human Immunodeficiency Virus)

10. AIDS (Acquired Immune Deficiency Syndrome) Symptoms abdominal cramps coma coughing difficult or painful swallowing extreme fatigue fever lack of coordination mental symptoms such as confusion and forgetfulness

11. Symptoms ulcers in the genital region nausea pelvic inflammatory disease persistent or frequent yeast infections (oral or vaginal) persistent skin rashes or flaky skin seizures severe and persistent diarrhea severe headaches shortness of breath

12. Transmission The AIDS virus is transmitted from one person to another through several methods: The AIDS virus is transmitted from one person to another through several methods: Blood or blood products Blood or blood products Mother to infant Mother to infant Sexual contact Sexual contact Sharing of needles or syringes Sharing of needles or syringes

13. Syphilis Caused by Treponema Pallidum

14. Treponema Pallidum

16. Transmission In an infected person the bacterium spreads from the initial ulcer to the skin or mucous membranes of: In an infected person the bacterium spreads from the initial ulcer to the skin or mucous membranes of: –the anus of a sexual partner –the genital area –the mouth

17. Transmission The bacterium can pass through broken skin on parts of the body. The bacterium can pass through broken skin on parts of the body. The syphilis bacterium is very fragile and infection is usually spread by The syphilis bacterium is very fragile and infection is usually spread by an infected pregnant woman who can pass the bacterium to her unborn baby, which can result in the child being born with serious mental and physical problems an infected pregnant woman who can pass the bacterium to her unborn baby, which can result in the child being born with serious mental and physical problems sexual contact sexual contact

18. Symptoms An ulcer (a chancre ["shan-ker"]) appears within 10 days to 3 months after exposure, but usually within 2-6 weeks An ulcer (a chancre ["shan-ker"]) appears within 10 days to 3 months after exposure, but usually within 2-6 weeks The chancre may be painless and can remain undetected inside the body, so may go unnoticed The chancre may be painless and can remain undetected inside the body, so may go unnoticed

19. Symptoms The chancre usually appears on the part of the body exposed to the partner’s ulcer, such as:  the anus  the cervix  the lips  the penis  the tongue  the vagina  the vulva  other parts of the body

20. Common symptoms include: a rash of flat, red lesions over the whole body (including the palms of the hands and soles of the feet) fever swollen glands broad-based papules (lumps or warts) in warm, moist sites mucous patches or snail-track ulcers in the mouth, appearing from 3-6 weeks after the chancre develops

21. Common symptoms include: fatigue headache mild fever patchy hair loss sore throat swollen lymph glands throughout the body

22. Symptoms in Pregnant Women Skin ulcers Skin ulcers Rashes Rashes Fever Fever Weakened or hoarse crying sounds Weakened or hoarse crying sounds Swollen liver and spleen Swollen liver and spleen Yellowish skin (jaundice) Yellowish skin (jaundice) Anemia (low red blood cell count) Anemia (low red blood cell count) Various deformities Various deformities

23. Primary Syphilis - Clinical Manifestations Incubation: 10-90 days (average 3 weeks) Chancre –Early: macule/papule  erodes –Late: clean based, painless, indurated ulcer with smooth firm borders –Unnoticed in 15-30% of patients –Resolves in 1-5 weeks –HIGHLY INFECTIOUS

24. Primary Syphilis Chancre

25. Primary Syphilis

26. Secondary Syphilis - Clinical Manifestations Represents hematogenous dissemination of spirochetes Usually 2-8 weeks after chancre appears Findings: –rash - whole body (includes palms/soles) –mucous patches –condylomata lata - HIGHLY INFECTIOUS –constitutional symptoms Sn/Sx resolve in 2-10 weeks

27. Secondary Syphilis Rash

28. Secondary Syphilis: Generalized Body Rash

29. Secondary Syphilis Rash

31. Secondary Syphilis

32. Secondary Syphilis – Condylomata Lata

33. More images of Syphilis

39. Tertiary Syphilis - Joint

40. “Drips” (Discharges)  Gonorrhea  Nongonococcal urethritis  Chlamydia  Mucopurulent cervicitis  Trichomonas vaginitis and urethritis  Candidiasis

41. Gonorrhea Caused by Neisseria gonorrhoeae

42. Gonorrhea Risk factors for getting gonorrhea include:gonorrhea –Having multiple sex partners –Having high-risk partner(s) –Having unprotected sexual contact (not using condoms). –Being a man who has unprotected sex with other men. –Starting sexual activity before age 18.

44. Culture

45. Culture

46. Gonorrhea - Clinical Manifestations Urethritis - male Incubation: 1-14 d (usually 2-5 d) Sx: Dysuria and urethral discharge (5% asymptomatic) Dx: Gram stain urethral smear (-) > 98% culture Complications Urogenital infection - female Endocervical canal primary site 70-90% also colonize urethra Incubation: unclear; sx usually in l0 d Sx: majority asymptomatic; may have vaginal discharge, dysuria, urination, labial pain/swelling, abd. pain Dx: Gram stain smear (-) 50-70% culture Complications

47. Gonorrhea

48. Gonorrhea Gram Stain

49. Genital Herpes Simplex - Clinical Manifestations Direct contact – may be with asymptomatic shedding Direct contact – may be with asymptomatic shedding Primary infection commonly asymptomatic; symptomatic cases sometimes severe, prolonged, systemic manifestations Primary infection commonly asymptomatic; symptomatic cases sometimes severe, prolonged, systemic manifestations Vesicles  painful ulcerations  crusting Vesicles  painful ulcerations  crusting Recurrence a potential Recurrence a potential Diagnosis: Diagnosis: –Culture –Serology (Western blot) –PCR

50. Genital Herpes Simplex

52. Genital Herpes Simplex in Females

54. Genital Herpes Simplex

55. Nongonococcal Urethritis

56. Etiology: –20-40% C. trachomatis –20-30% genital mycoplasmas (Ureaplasma urealyticum, Mycoplasma genitalium) –Occasional Trichomonas vaginalis, HSV –Unknown in ~50% cases Sx: Mild dysuria, mucoid discharge Dx: Urethral smear  5 PMNs (usually  15)/OI field Urine microscopic  10 PMNs/HPF Leukocyte esterase (+)

57. Perianal Wart

58. Penile Warts

59. Intrameatal Wart of the Penis (and Gonorrhea)

60. Warts on the Thigh

61. SO GUYS!!

62. GENERAL ADVICE!!!

63. USE THIS!!

66. LADIES!!

67. YOU TOO!!

69. THANK YOU!!