Cause of Increase in STD's
> Resistance to antibiotics |
> Promiscuity |
> New, emerging diseases - mainly viral |
> "it won't happen to me" attitudes |
> Multiple sexual partners |
> Many are polymicrobial |
> Migrant labour and travel |
> Mostly poor ethnic minority groups affected |
Chlamydia trachomatis:
Serotypes D-K |
World-wide distribution |
Associated with eye infections |
Restricted to columnar and transitional epithelial cells |
Lymphogranuloma verereum/ inguinale:
> Serotypes L1,L2,L3
> Restricted to Africa, Central and South America, Caribbean and S-East Asia
> Systemically spread
Chlamydia Infection:
Symptoms: |
Prevention: |
Painless sores in the mouth |
Use condom or barrier when performing oral sex on penis |
Lesions similar to cold sores around the mouth |
Use dental dam or cut open a condom top to make a square the use it as a barrier between the vagina or anus and mouth |
Tonsilitis |
Redness with white spots resembling strep throat |
Scratchy dry throat |
Treatment: |
doxycycline, erthomycin |
Laboratory Diagnosis:
> Throat swab
> Serology unreliable
> Growth in cell cultures
> Specimen suspended in fluid
> Centrifuged onto monolayer of tissue culture cells pretreated with cycloheximide
> Contains glycogen so stain with iodine
> ELISA
Gonorrhoea
Neisseria gonorrhoea |
Symptoms: |
> Changing sexual practice and oral sex predisposes the sex partners with involvement of oropharengeal regions |
- Pharyngitis |
| |
- 50% asymptomatic |
Prevention: |
Contact tracing |
Follow-ups |
S.pyogenes tonsillitis
- Natural reservoir: humans
- Asymptomatic carriers rarely found
- Clinical syndromes: tonsillitis and pharyngitis
- Common in school children and adolescents
- Less frequent in adults
|
|
Scarlet Fever:
> Combination of strep sore throat and erythema |
> Due to erythogenic toxin coded for by a lysogenic phage |
> Rash begins in the face and spreads to most of the body except palms and soles |
> Rash fades after 1 wk followed by extensive desquamation |
> Symptoms: headache, chills and muscle ache |
Syphilis:
Transmitted sexually or congenitally |
Occurs worldwide, no season |
Causative organism: Treponema pallidum |
Treatment: penicillin, tetracycline, doxycycline |
Syphillis:
Primary: |
Secondary: |
Tertiary: |
- Lips, buccal mucosa, tongue & tonsils |
- Most infectious |
- Gummas (bone,skin, tissues) Neurosyphyllis, cardiovascular syphillis |
- Site of inoculation: 3 wk after infection, papule breaks down to form an ulcer (chancre) |
- secondary stage= after 6-8wks &lasts 2-10wks |
- May develop after asymptomatic period of a few years to decades |
- Oral chancre: painless ulcer w/ smooth surface, raised borders & indurated margin |
- Clinical features = Malaise, low grade fever, headache, lacrimation. sore throat, weight loss, myalgia, arthralgia & generalized lymphadenopathy |
- Non tender cervical lymphadenopathy |
- Spontaneous healing |
Gummas:
Develops in 15% of untreated cases within 1-10 years after infection |
Highly destructive tertiary syphillis lesions that usually occur in skin and bones but may also occur in other tissues |
Slowly progressive, painless, dull red nodule or plaque |
Breakdown into ulcer with wash-leather floor |
Regional Ln are enlarged |
Not infectious |
Congenital Syphillis:
- Acquired in 1st trimester |
- Silent infection - not apparent till after about 2 years |
- Teeth and bone malformation (mulberry teeth) |
- Fatal for foetus |
-IgM Ab in infants |
- Retested after 6 months |
- Elevated levels remain |
Laboratory Diagnosis:
Dark field or phase contrast microscopy
Serology:
> Non-specific tests:
-venereal disease research laboratory (VDRL)
-rapid plasma reagin test (RPR)
-positive 4-6wk after infection (1-2wks post primary chancre)
>Specific Tests:
-treponemal Ab test (TAT)
-fluorescent treponemal Ab absorption (FTA-ABS)
-microhaemagglutination assay (MHA-TP)
-positive in pt w/late syphillis
|
|
Chancroid (soft chancre):
> Caused by Haemophilus ducreyi
> Symptoms appear 3-5 days after contact
> Painful irregularly shaped soft ulcers
> May be confused with genital herpes but usually larger and more ragged
> Self-limiting, easily cured
> Does not affect distant organs
> Common in Africa and Asia
Chancre vs. Chancroid:
Lab Diagnosis:
- school fish appearance
- cultured on GC agar w/ 1-2% haemaglobin, 5% foetal-bovine serum, 10% vancomycin @ 33 degrees Centigrade
- in 5-10% Carbon dioxide
Treatment:
> Azithromycin
>Ceftriaxone
>Erythromycin
>Ciprofloxicin
Cheilitis:
Corners of the mouth |
Malnutrition |
Medications |
Infections: Candida or Staph. aureus |
Impetigo:
Common in children and adults involved in contact sport |
Appears as red spots which mature into blisters |
Blisters burst yielding a clear fluid and develop a yellow-brown crust |
Accompanied by itching |
Generally appears around nose and mouth (can occur anywhere) |
Associated w/ insect bites, cuts or abrasions |
Staphyloccus aures (80% Streptococcus pyogenes (20%) |
Staphylococcus Infections:
Treatment
>mild cases heal on their own w/good hygiene
>Carbuncles: incision and drainage
>Dicloxacillin, cephalexin
>MRSA-trimethoprim-sulfamethoxazole, clindamycin
Corynebacterium diptheriae:
Gram + bacillus |
non-motile, anerobe |
Usually affects children and adolescents |
Transmitted by droplets |
3 Biotypes: 1. C.gravis , 2 C.mitis, 3 C. intermedius |
Lab diagnosis: Elek agar (immunodefusion), Tellurite, Blood agar |
Albert's Stain = Metachromatic granules
Gram Stain = Chinese lettering
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