1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 40 Sexually Transmitted Diseases

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins External Infections Condylomata Herpes Chancroid Granuloma

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Condylomata (Genital Warts) Human papillomavirus (HPV) Transient or persistent May be asymptomatic Associated with genital cancers Vaccine recently developed

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

5. Question Tell whether the following statement is true or false. The HPV vaccine is currently available for both males and females.

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: The FDA has approved the vaccine for girls (optimal age is 9–12 years old). The vaccine is a series of three injections. Clinical trials are currently underway evaluating the efficacy of the vaccine in males, but the vaccine will not be available for males until the trials are complete and the FDA approves it.

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Genital Herpes Herpes simplex virus 2 (related to chickenpox and cold sores) Causes genital ulcers Grows in neurons Can remain dormant in neurons for years Can reactivate and spread back down neuron

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Bacterial Diseases of External Genitalia Chancroid –Haemophilus ducreyi Granuloma inguinale (genital ulcers) –Calymmatobacterium

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Vaginal Infections Candidiasis Trichomoniasis Bacterial vaginitis

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Normal Bacterial Flora Many species of bacteria normally live in the vagina Lactic-acid-producing bacteria dominate –Acid helps control growth of other bacteria Species composition of flora varies –Between individuals –Between ethnic groups (Zhou, et al., [2004]. Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods. Microbiology,150, 2565-2573. Retrieved September 22, 2005, from http://mic.sgmjournals.org/cgi/content/full/150/8/2565.0).

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Candidiasis “Yeast infection” or “thrush” Causes include: –Decreased normal bacterial flora (antibiotics) –Increased estrogen/progesterone levels –Decreased immune system activity Results in: –Inflammation –Thick, odorless discharge

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Trichomoniasis Inflammation Frothy, malodorous, green or yellow discharge Associated with tubular infertility or pelvic inflammatory disease

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Bacterial Vaginosis Nonspecific: may be caused by many different bacteria Imbalance of normal vaginal bacterial flora Thin discharge with fishy odor Usually treated only if symptomatic or associated with other risk conditions (pregnancy, hysterectomy)

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which vaginal infection is associated with suppressed immune function? a.Candidiasis b.Trichomoniasis c.Bacterial vaginitis d.Chancroid

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer a.Candidiasis Candidiasis (yeast infection/thrush) is associated with diminished immune function. When the normal flora is decreased, Candida albicans has room to thrive.

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Urogenital—Systemic Infections Chlamydia Gonorrhea Syphilis

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chlamydia Intracellular parasites –Signs at site of infection: hypertrophy, drainage –Signs of urinary tract infection: urinary frequency, dysuria, discharge, postcoital bleeding –Signs of upper genital tract infection: irregular uterine bleeding, abdominal/pelvic discomfort Complications include infertility and ectopic pregnancy May cause conjunctivitis

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Gonorrhea Bacterium Neisseria gonorrhoeae May be asymptomatic May cause pain and discharge May cause conjunctivitis

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Syphilis Spirochete Treponema pallidum Primary syphilis –Chancre at site of exposure

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

21. Syphilis (cont.) Secondary syphilis –Disseminates to other organs –Skin rash –Mucosal lesions Tertiary syphilis –Gumma lesions develop in organs –CNS and heart often affected

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

23. Question Which of the following STDs may cause conjunctivitis? a.Chlamydia b.Gonorrhea c.Syphilis d.a and b e.All of the above

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer d.a and b Rationale: Certain STDs affect other body systems; chlamydia (caused by an intracellular parasite/virus) and gonorrhea (caused by a bacteria) may both result in conjunctivitis. Syphilis affects the skin, organs, and CNS.