Sexual Transmitted Disease

輔大醫學系七年級 李英誠

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Pathogen
• Virus
• Bacteria
• Parasite

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Virus
• HPV
• Herpes simplex
• HIV
• Hepatitis B virus
• Molluscum contagiosum

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Bacteria
• Treponema pallidum
• Neisseria gonorrhoeae
• Haemophilus ducreyi
• Chlamydia trachomatis
• Mycoplasma genitalium
• Ureaplasma

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Parasite
• Trichomonas vaginalis
• Scabies

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Condylomata
acuminata

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Condylomata acuminata
• Anogenital Wart
• 菜花
• 尖銳濕疣

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Etiology – HPV virus
• Human Papillomavirus
• Nonenveloped, double-stranded DNA viruses
• over 100 types of HPV
• Low risk :HPV 6,11
• High risk :HPV 16, 18, 31, 45

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Associated malignancy
• Cervical cancer
• Oropharyngeal cancer
• Vulvar,penile,anal squamous intraepithelial neoplasia

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Clinical manifestation
• External anogenital warts
• vulva, penis, groin, perineum, perianal skin
• Shape
• single or multiple, flat, dome-shaped, cauliflower-shaped,
• filiform, fungating, pedunculated, cerebriform,
• plaque-like, smooth (especially on the penileshaft),
• verrucous or lobulated
• Color varies
• white, skin-colored, erythematous(pink or red),
• brown, or hyperpigmented. 11
Clinical manifestation
• Anogenital warts
• soft to palpation
• 1 mm to more than several centimeters in diameter.
• typically asymptomatic but may be pruritic.
• Involve cervix, urethra or anal canal
• Extensive CA
• disfigurement , defecation difficulties.
• urethral bleeding , urinary obstruction
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Diagnosis
• Clinical

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Treatment

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Prevention
• Vaccination
• (Cervarix 保蓓): HPV 16 and 18
• (Gardasil嘉喜): HPV types 6, 11, 16, and 18
• 9-valent: HPV types 6, 11, 16,18, 31, 33, 45, 52, 58
• 3-dose series of IM injections over a 6-month period

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Herpes simplex

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Etiology – Herpes simplex virus
• Herpesvirus family
• Ds strand, enveloped, DNA virus
• Entry by skin and mucous membrane
• Migration to sensory ganglion
• Both HSV-1 and HSV-2 can cause genital herpes

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Clinical menifestation
• Single or clustered vesicles
• Painful vesicles
• Ulcerations before resolving
• Crusting

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Complication of HSV
• Acute urinary retention (particularly in women)
• Aseptic meningitis (including a recurrent form)
• Disseminated herpes
• Encephalitis
• Hepatitis
• Neonatal infection

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Clinical menifestation
• Vary widely
• Primary infection
• Nonprimary infection
• Recurrent infection

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Primary infection
• First occurrence
• More severe
• Painful genital ulcers, dysuria, fever
• Tender inguinal lymphadenopathy
• May be mild, subclinical, or entirely asymptomatic
• No clear differences betweem HSV1 or 2
• Average incubation : four days
• Resolved after a mean of 19 days
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• Tend to be more severe in women than in men
Nonprimary infection
• HSV-2 infected genital lesion of a patient with
pre-existing HSV-1 antibodies
• prior HSV-1 infection increased the likelihood of
asymptomatic infection three-fold
• migrates to sacral ganglion

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Recurrent infection
• Least severe
• Reactivation occurs due to various triggers
• mean duration of lesions is generally shorter

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Diagnosis
• Clinical finding
• PCR
• Viral culture
• Tzanck smear
• Multinucleated giant cell

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Treatment
• Acyclovir 400 mg orally three times a day for 7–10d

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Syphilis

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Etiology – Treponema pallidum
• Spirochete

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Natural History of syphilis

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Primary syphilis
• Chancre : firm, indurate, painless, highly infectious.
• Modest, rubbery, non-tender inguinal LAD
• Incubation Period – 21 days (median)
• Unnoticed in 15-30% of patients
• Resolves in 1-5 weeks

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Seconday syphilis
• Represents haematogenous dissemination
• Usually 2-8 weeks after chancre appears
• Findings:
• whole body (includes palms/soles)
• mucous patches

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Tertiary syphilis
• Gumma : invade skin, bone or muscle
• Cardiovascular syphilis : aortic aneurysm, aortitis

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Congenital syphilis
• Early : <2y
• SGA
• Blister
• Maculopapulo Rash (silimilar to 2nd syphilis)
• Hepatosplenomegaly
• Desquamation
• Hemotology abnomality
• Bone lesion
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Congenital syphilis
• Late : >2y
• Hutchinson triad
• Hutchinson tooth
• Interstitial keratitis
• Nerve deafness

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Diagnosis
• Dark field microscopic exam
• Nontreponemal tests
• RPR (rapid plasma reagent)
• VDRL(venereal disease research laboratory)
• Treponemal tests
• FTA-ABS (fluorescent treponemal Ababsorbed)
• TPHA ( T.pallidum hemagglutination test)

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Non-treponemal testing
• RPR / VDRL
• Cardiopilin detect antibody (IgM and IgG)
• False positive : TB, RA, SLE, pregnancy, malaria, lymphoma
• Performed manually on serum
• Titer x8 consider significant
• Monitor treatment efficacy
• 3 month VDRL titer decrease 4 fold
• 6-12 month VDRL titerdecrease 8 fold

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Treponemal testing
• FTA-ABS / TPHA
• Detect antibodies directed against T. pallidum proteins
• more expensive and technically complex
• become positive 14 days after the primary chancre appears

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Diagnosis

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Treatment
• Primary, secondary, early Latent Syphilis
• Benzathine penicillinG 2.4 million units IM
• Late Latent Syphilis or of Unknown Duration
• Benzathine penicillin G 7.2 million units total,
• administered as 3 doses of 2.4 million units IM
• 1-week intervals
• Jarisch–Herxheimer reaction
• acute febrile reaction occur within the first 24 hours
• headache, myalgia, fever 40
Gonorrhea

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Etiology – Neisseria gonorrhoeae
• Gram-negative coccus
• Intracellular
• Obligate aerobe

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Clinical menifestation
• Women
• Urethritis
• Cervicitis
• Pelvic inflammatory disease
• infertility, ectopic pregnancy, and chronic pelvic pain
• Perihepatitis (Fitz-Hugh-Curtis syndrome)
• Complications of pregnancy
• chorioamnionitis, premature rupture of membranes
• preterm birth, small for gestational age infants
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Clinical menifestation
• Men
• Urethritis
• Epididymitis

• Extragenital infection
• Proctitis
• Pharyngitis
• Conjunctivitis
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Diagnosis
• Clinical
• Nucleic acid amplification testing
• Culture

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Treatment
• Uncomplicated
• Ceftriaxone 250 mg IM in a single dose +
• Azithromycin 1g orally in a single dose
• Uncomplicated
• Ceftriaxone 1g IM in a single dose +
• –Metronidazole 400mg bid×10, orally or
• – Doxycycline 100mg bid×10, orally

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Chancroid
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Etiology – Haemophilus ducreyi
• Tropical area

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Clinical menifestation
• Painful genital ulcer
• 軟性下疳 (Chancroid)
• Tender suppurative inguinal adenopathy
• Dysuria
• Dyspareunia

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Diagnosis
• Clinical
• 1) the patient has one or more painful genital ulcers;
• 2) regional lymphadenopathy
• 3) the patient has no evidence of T. pallidum infection
by darkfield examination of ulcer exudate
• 4) HSV PCR test or HSV culture performed on the ulcer
exudate is negative.
• Nucleic acid amplification tests : PCR
• Culture 50
Treatment
• Azithromycin 1 g orally in a single dose
• Ceftriaxone 250 mg IM in a single dose
• Ciprofloxacin 500 mg orally twice a day for 3 days
• Erythromycin base 500 mg orally three times a day for 7
days

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Chlamydia

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Etiology – Chlamydia trachomatis
• Ovoid in shape and nonmotile
• Obligate intracellular
• Weak Gram-negative
• Causing cell apoptosis

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Clinical menifestation
• Vaginal discharge
• Mucopurulent cervicitis
• Dysuria
• Urethritis, salpingitis, and proctitis
• Lower abdominal pain
• Post coital bleeding – friable cervix
• Pelvic inflammatory disease
• 50% of females are asymptomatic
• Symptoms less abrupt in onset and milder than
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gonorrhea
Clinical menifestation
• Extra genital organ
• Trachoma
• Conjunctivitis
• Infective arthritis
• Preterm labor
• Conjunctivitis may lead to blindness in newborn

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Diagnosis
• Nucleic acid amplification tests : PCR
• Chlamydia culture

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Treatment
• Antibiotics
• Azithromycin 1 g orally in a single dose
• Doxycycline 100 mg orally twice a day for 7 days

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Lymphogranuloma Venereum
• 性病性淋巴肉芽腫
• Serovars L1，L2，L3
• Primary stage：painless self-limited genital ulcer, recover
within 1 week
• Secondary stage：invade lymph node，inguinal LAD, 1/3
bilateral. Pus or fistula, groove sign
• Tertiary stage：years, proctitis , chronic lymph
inflammation, recurrent ulcer, possible malignant change

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Trichomoniasis

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Etiology - Trichomonas vaginalis
• Protozoa
• Flagella
• Only in GU tract
• high pH conditions
• Ingesting cell fracment

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Clinical menifestation
• within 5 to 28 days of exposure
• female
• vaginal discharge (Vaginitis)
• Strawberry cervix (Cervicits)
• Painful and frequent urination
• dyspareunia
• male
• asymptomatic
• discomfort in urethra
• inflamed head of the penis 63
Diagnosis
• Wet mount :Flagellated, motile trichomonads
• Nucleic acid amplification test
• Culture (5day)
• Other FDA approved tests:
• OSOM Trichomonas Rapid Test
• Affirm VP III

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Treatment
• Antibiotic
• Metronidazole 2 g orally in a single dose
• Tinidazole 2 g orally in a single dose

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Thanks for your listening!

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