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What is an STD?
-Sexually transmitted disease, transmitted by mixing and matching of mucus membranes (MMMM)
Which microbes can cause STDs?
- 1. Bacteria: chlamydia, gonorrhea, Syphilis
- 2. Virus: Herpes simplex, HIV, Papilloma Virus
- 3. Fungi: Candida Albicans
- 4. Parasites: Trichomonas vaginalis
How lethal are STDs?
-Generally not lethal, more morbidity than mortality except HIV
What are the transmissions of STDs?
- -Direct sexual contact
- -Depends on type and frequency of intercourse and # of partners
- -Asymptomatic carries are silent transmitters of STD
- -Infection occurs in packs ( multiple infections)
What are the sites of primary infection for females?
- -Port of entry, genital organ
- -Vulvovaginitis: inflammation of all or part of external vulva
- -Vagina: vaginitis
- -Cervix: Cervicitis
- -Uterus: Endometritis, PID
- -Fallopian tubes: Salpingitis
- -Peritoneal cavity: Peritonitis
What are the sites of primary infection in men?
- - Port of entry, genital organ
- -External genitalia
- -Urethra (urethritis)
What is the vulva?
-External genital organ of the female
What is the vagina?
-THe stretchable passage that connects a woman's outer sex organs with the cervix and uterus
What is the sequelae at other sites from STDs?
-There is a concern for spreading from primary site to other organs such as heart, brain, eye, joints
What is the geographic prominence?
- -Worldwide epidemic or pandemic
- -Highest STD in Indiana is women
- - Chlamydia #1 in world/Indiana
What is neisseria gonorrhea?
- -Gram negative, bean-shaped diplococci
- -Grow in chocolate agar
- -Oxidase test: positive
What are the virulence factors of gonorrhoea?
- -Fimbriae (pili): Mediate attachment and is antiphagocytic
- -Outer membrane proteins: Help invade mucosal epithelial cells
- -Lipopolysaccharide: induces overt inflammation and tissue damage
- -IgA protein: protects microorganism from mucosal antibody IgA
- -Serological diversity: more than million types
What is the prevalence of gonorrhea (CLAP)?
- -Human is only natural host
- -Gonorrhea is second most commonly reported infectious disease in US.
- -150 million cases per year
What is the pathology of gonorrhea?
- -Starts with superficial infection and goes deeper.
- -Urethritis: NGU (non gonococci) (chlamydia) Most symptomatic in men. 2-8 day incubation, dysuria, purulent discharge
- -Cervicitis: 50% asymptomatic
- -Pahryngitis (oral sex), proctitis (rectal gonorrhea)
- -Conjunctivitis: Newborns of infected mother, ophthalmia neonatorium, may lead to blindness, can treat with silver nitrate or erythromycin drop at birth
What is the invasive disease of gonorrhea?
- -happens if 10% of women do not get treatment
- Pelvic Inflammatory Disease (PID): Infection of the female reproductive organs
- -More than one million women are affected by PID each year, the rate highest among teens
- -Yearly, 50,000 women become infertile in the US from PID
- -May be asymptomatic 2/3 of the time
- - PID can cause scarring inside the reproductive organs leading to infertility, scarring
What is salpingitis?
- -Inflammation of fallopian tubes
- -Gonorrhea can cause this
- -Symptoms (Fever, flank pain, painful sex, discharge, abnormal bleeding)
- -Gonococci cause about 40-60% of salpingitis cases
What is peritonitis?
- -Infection spreads beyond fallopian tube into peritoneal cavity.
- -High mortality
- -ectopic pregnancy risk
What is the systemic disease of gonorrhea?
- -Disseminated gonococcal infection (DGI)
- -Occurs following gonococcal bacteremia resulting in: Arthritis (in sexually active young individuals), dermatitis (skin lesions), and conjunctivitis (inflammation of conjunctiva)
- -If untreated may spread to bloodstream and to the body.
- -Common symptoms are rash, joint pain, conjunctivitis
Which gender is most likely to complain of pain?
How do you diagnosis Gonorrhea?
- -Based on symptoms
- -Gram stain the discharge
- -More difficult in females (need additional tests, oxidase test)
- -ICDC and PMN both gonorrhea and chlamydia
- -PMN/DC- gonorrhea
What is the therapy of gonorrhea infections?
- -For treatment of uncomplicated urogenital and anorectal gonorrhea, CDC now recommends a single intramuscular dose of Ceftriaxone (cephalosporin) or oral doses
- -Persons with gonorrhea should be treated for chlamydia as well
What is the history of gonorrhea treatment?
- -Earlier years was treated with penicillin and tetracycline
- -Then gonorrhea became resistant
- -in 2000, CDC recommends fluoroquinolone to treat
- -2007, CDC announced it does not recommend fluoroquinolone but cephalosporines!
- -Cell wall antibiotics, Rocephin, Z pack
What is the prevention of gonorrhea?
- -Vaccine unsuccessful since millions type of pili antigen
- -Long term mutually monogamous relationship with a partner that has been tested
- -Contact tracing: notify all recent sex partners so they can see a health car provider and be treated
What is chlamydia trachomatis?
- -Leading cause of bacterial STDs
- -Obligate intracellular pathogen (energy parasite, cant produce ADP on own
- -Gram negative structure, has no cell wall (PG), atypical
- -Two complex life cycles: elementary and reticulate
- -Have to grow them in cell cultures
- -2.8 Americans infected each year
- -70% of women, 50% of men asymptomatic
- -Can be transmitted at birth, which may lead to eye infection or pneumonia
- -40% will have PID, 20% will be infertile and 9% will have an ectopic pregnancy
What is the elementary body of chlamydia?
-EB is not biologically active. Resistant to environmental stresses and can survive outside of a host. Infectious form which converts to reticulate body once in the cell
What is the reticulate body of chlamydia?
Biologically active, inside the cell, dividing form, noninfectious form which converts back to elementary body once enough are made
What is the virulence of chlamydia?
-Prevents phagolysosome fusion during intracellular growth and grows within phagosomes (inclusion bodies) of host cells
What is the pathology of Chlamydia?
- -Surface infections
- Males: NGU, 50% of males are symptomatic may lead to infertility
- Females: Cervicitis: 70% of women are symptomatic, may lead to infertility
- Both: Trachoma, leading cause of blindness in the world, mostly underdeveloped countries
- New born: Inclusion conjunctivitis: New born at birth
What are the invasive diseases of chlamydia?
- -Males: Prostatitis/ epididymitis: May lead to infertility
- -Female: Salpingitis, PID, Sterility (increases with PID), Lymphogranuloma venerem (infection of inguinal lymph nodes which may lead to swelling of buboes and ma lead to elephantiasis of the genital organs.
- New born: Infantile pneumonia: most common newborn lung infection in the world, usually not fatal
How do you diagnosis for chlamydia?
- -Cant do gram stain or grow on agar plates
- -Have to grow in cell culture
- -Can do fluorescent antibody staining (FAS)
- -DNA hybridization
What is the therapy for chlamydia?
- -Azithromycin: 1 g orally in a single dose
- -Doxycycline: 100 mg orally twice a day for 7 days
- -For neonatal conjunctivits: Erythromycin by mouth (PO) for 2 weeks
What are risk factors for developing for PID?
- -Having STD
- -Age (under 25) sexually active
- -Multiple sex partner
- -Douch: douching can push germs into the womb, ovaries, tubes, causing infection. Douching can also hide the signs of an infection
- -Intrauterine device (IUD): need to get tested and treated for any infections before getting an IUD
What is treponema pallidum (syphilis)?
- -Historial STD, 15th century epidemics
- -Spirochete, long spiral shaped organism
- -Very motile with axial filaments. Atypical cell wall (PG)
- -Visualized by Dark field microscopy
- -Cannot be grown in culture
- -No gram stain
What is the virulence factor of syphilis?
-Axial filament allows penetration into tissues
What are the three stages of syphilis?
-Primary, secondary, and tertiary
What is primary syphilis?
- Primary cutaneous lesion (Chancre) is usually the first sign, appearing 10 days to 3 months after exposure on the part of the body where the infection was transmitted (genital organ)
- -Painful then goes away
- -Untreated, the chancre tends to heal spontaneously in 4-6 weeks, around which time the symptoms of secondary syphilis may occur
What are chancre characteristics?
- -Indolent, punched out appearance
- -Raised border
- -Red, smooth base
- -Serous secretions
What is secondary syphilis?
- -Begins 2-8 weeks after chancre heals
- -Bacteria spread throughout the body, causing fever, fatigue and aching and many types of rash, especially on the palms of hands and soles of feet. These signs and symptoms may disappear within 4-6 weeks or repeatedly come and go for as long as a year
What is latent syphilis?
- -In secondary stage
- -In some people, in which no symptoms are present-may follow the secondary stage. Signs and symptoms may never return, or disease may progress to tertiary stage
What is the tertiary syphilis?
- Without treatment 40% of infected individuals progress to tertiary syphilis within 5 to 20 years
- Some of the signs and symptoms include:
- -Neurological problems: stroke, meningitis, poor muscle coordination, numbness, paralysis, deafness, or visual problems, personality changes, dementia -Cardiovascular: There may include bulging and inflammation of aorta and other vessels
What is congenital syphilis?
- -T. pallidum can be passed from mother to child during fetal development or at birth
- -Newborns may be asymptomatic and are only identified on routine prenatal screening
- -By definition, early congenital syphilis occurs in children between 0-2 years old. After that they can develop late congenital syphilis
How do you diagnosis syphilis?
- -Hard to diagnosis in latent stage
- -Dark field microscopy of lesions
- -By serological techniques for detecting antibody response to T.pallidum
What is the prevention of syphilis?
-NO vaccine, rely on early diagnosis
What is the therapy of syphilis?
- -Syphilis is easy to cure in its early stages
- -A single intramuscular injection of penicillin (Benzathine) treats all stages of syphilis
- -If a pregnant mother is identified as being infected with syphilis, treatment can effectively prevent congenital syphilis from developing in the unborn child, especially if she is treated before the 16th week of pregnancy.
What is STD in relation to antibiotic resistance?
-The prevalence of gonorrhea in the US and abroad, has decreased in last two decades. As of recently though higher rates of infection have been reported due to the increase of antimicrobial- resistant gonococci
What is the transmission and education of STDs?
- -Educate high risk STD group
- -STD is much higher in teen girls than boys
Are all bacterial STDs treatable?
What is the importance of STD?
- -Treat the society to protect our young ones
- -Surveillance of transmitters (Contact tracing)
What is circumcision?
- -Surgical procedure that removes some or all of the foreskin from the penis
- -Most common in Middle East, USA, and parts of Africa/Asia
- -According to WHO 30% of men have been circumcised
- -2007 WHO recognized male circumcision as an effective intervention for HIV prevention.