BIO 301 - SEXUALLY TRANSMITTED INFECTIONS AND GENITAL INFECTIONS

 

  1. General
    1. 15 million new cases/year

      2.  

       

       

       

       

       

       

    2. Some are "reportable" diseases
      1. Gonorrhea, Syphilis, Chlamydia
      2. HIV
    3. Magnitude of the problem

     

     

     

     

     

     

     

     

  2. Chlamydia
    1. Cause: Chlamydia trachomatis (bacterium)
    2. Transmission: Contact w/ mucus membranes of infected tissue or discharge
      1. Mouth, eyes
      2. Urethra, rectum
      3. Vagina, cervix
    3. Symptoms - may be asymptomatic
      1. Time: Usually 1-3 weeks after exposure (i.e. incubation period)
      2. Males: "NGU" (Nongonococcal Urethritis) - Burning during urination, mucoid discharge from penis
      3. Females: Unnoticed or mild in majority
        1. Cervicitis (inflammation of cervix) - possible spotting/discharge between periods
        2. Salpingitis (inflammation of Fallopian tubes) - pain and subsequent scarring
      4. Fetus (passing through birth canal):
        1. Opthalmia neonatorium -
        2. Pneumonia (1-3 months after birth)
    4. Complications
      1. A leading cause worldwide of preventable blindness
      2. Epididymitis and inflammation of vas deferens leading to infertility
      3. Ectopic tubal pregnancy or sterility
      4. Increased risk of stillbirth or premature delivery
    5. Diagnosis
      1. Often misdiagnosed as gonorrhea
      2. Test kits available to test cervical and urogenital swabs; results in 15-45 minutes
      3. ELISA (enzyme-linked immunosorbent assay) - checks for antigens
        1. "Chlamydiazyme"
        2. Results in 4 hours
    6. Treatment (Antibiotics)
      1. Azithromycin (1 megadose), Doxycycline, Ofloxacin
      2. Erythromycin or Amoxicillin for PG women
      3. NOT penicillin
      4. Treat both partners simultaneously
      5. Treat simultaneously for gonorrhea
    7. Newborns - Silver nitrate drops, or erythromycin or tetracycline ointment at birth SOP

     

  3. Gonorrhea
    1. Cause: Neisseria (gonococcus) gonorrheae (bacterium)
    2. Transmission: genital, oral-genital, genital-anal, to newborn via birth canal

      3.  

    3. Symptoms - (5-20% males asymptomatic; 80-85% females asymptomatic)
      1. Time: 3-8 days
      2. Men: Pain & burning during urination, cloudy discharge from penis; primary site is urethra
      3. Women: Similar to chlamydia (cervicitis, salpingitis); primary site is interior of cervix
      4. Fetus: Opthalmia neonatorium (eye infection) when passing through birth canal

       

       

    4. Complications (if untreated)
      1. Scarring of vas deferens, sterility
      2. PID (Pelvic Inflammatory Disease)
    5. Diagnosis
      1. Symptoms similar to chlamydia, therefore test for both
      2. Grow culture from cervical and urogenital samples
      3. ELISA "Gonozyme"

       

       

    6. Treatment (Antibiotics)
      1. Formerly: Penicillin, Tetracycline
      2. Now 4 strains of resistant bacteria to these and others

        3.  

         

      3. Currently: Injection of ceftriaxone or 500 mg cipro orally; also cefixime, ofloxacin, doxycycline
      4. Newborn: Silver nitrate drops, or erythromycin or tetracycline ointment at birth

     

  4. Genital Warts
    1. Cause: Condylomata acuminata (HPLV - human papilloma virus; several strains)
    2. Transmission: Primarily sexual; autoinoculable

      3.  

    3. Symptoms (May appear asymptomatic - hidden or too small to see)
      1. Time: usually 1-2 months; as long as 20 years
      2. Male: Raised warty areas on penis, scrotum, anus, rectum, in urethra; itching/burning during intercourse may occur
      3. Female: Labia, vagina, cervix, anus, urethra; itching/burning during intercourse may occur
    4. Complications: Increased risk of cervical cancer; recurrence
    5. Diagnosis
      1. Acetic acid wash whitens/reveals warts
      2. Virapap used to identify which strain
    6. Treatment
      1. Cryotherapy
      2. Laser
      3. Podophyllin (plant extract) topically
      4. New research on inactivating virus
        1. Sodium dodecyl sulfate ("SDS" – detergent in shampoo)
        2. Povidone-Iodine
      5. Vaccine research improbable
  5. Genital Herpes
    1. Cause: Herpes Simplex Virus Type II

      2.  

       

       

    2. Transmission: Usually sexual
      1. Contact between infected and vulnerable non-infected skin
      2. Contact with genital secretions w/shed virus
      3. Herpes Type I transferred to genitals via fingers or mouth
      4. Can be shedding virus even if asymptomatic

       

       

       

    3. Symptoms of Primary Infection
      1. Time: 2-20 days
      2. Men: Tingling, itching ("prodroma") followed 24 hours later by very painful blisters, lesions anywhere on genitalia, anus,mouth
      3. Women: Same; lesions on vulva, vagina, cervix, anus, perineum, thighs, buttocks
      4. Fetus: fatal in 60% of infected newborns; high risk of brain damage in rest
      5. Primary infection lasts an average of 12 days; may also include fever, loss of appetite, headaches
        1. Contagious until sores disappear
        2. Asymptomatic viral shedding
      6. Latent Stage: virus resides on sacral dorsal root ganglia for months or years
      7. Recurrence: triggered by any form of stress, sunlight, menstruation, sexual activity
          1. Preceded by prodroma
          2. Lesions usually less painful
          3. Lasts an average of 4-5 days

       

    4. Complications: Increased risk of cervical cancer
    5. Diagnosis
      1. Examination of lesion morphology (not same as chancre, cyst)
      2. Cultivation of virus from lesion
    6. Treatment
      1. Acyclovir (Zovirax), Famcclovir, Valacyclovir orally to alleviate symptoms and speed healing

        2.  

         

         

         

      2. No sexual activity while lesions or prodroma present
      3. Vaccine development underway

     

  6. Syphilis
    1. Cause: Treponema pallidum (bacterium)
    2. Transmission
      1. All forms of sexual contact
      2. Blood transfusion; IV drug use
      3. Directly through cut or scratched skin, mucous membranes
      4. Congenital (mother to fetus)
    3. Symptoms
      1. Time: 10-90 (mean=21) days; Four stages
      2. Primary Stage: chancre -
        1. Glans, cervix, labia, vagina, nipples, anus, scrotum, mouth
        2. Extremely contagious
        3. Heals and disappears 1-6 weeks
        4. May also get swollen lymph nodes

         

      3. Secondary Stage: pale red body rash (no pain or itch), fever, sore throat, loss of appetite, headache, joint pain
        1. Occurs 2 weeks to 6 months after chancre healed
        2. Lasts several months but may be sporadic
        3. Highly contagious - spreading to body via blood

         

         

      4. Latent Stage: Asymptomatic
        1. 6 months to 2 years after initial infection
        2. Bacteria spreading -
        3. Latency may last up to 30 years
      5. Tertiary (Late) Stage:
        1. Gumma (ulcers)
        2. Blindness
        3. Organ damage/failure (leading to death)
        4. Mental disorders (neurosyphilis)

       

    4. Diagnosis
      1. Blood tests (VDRL, Wassermann)
      2. Examination of fluid from chancre
    5. Treatment (Antibiotics)
      1. Penicillin (injection), Tetracycline, Doxycycline, Erythromycin
      2. Dosage dependent upon length of infection

     

  7. Hepatitis B (virus)
    1. Cause: HBV (240,000 new/year)
    2. Transmission: Most frequent mode is sexual; also blood, saliva, human milk, needles (for any use); virus less concentrated in tears, sweat, urine
    3. Symptoms: Most people asymptomatic (carriers); 30-40% will develop hepatitis

      4.  

       

    4. Treatment: Vaccines

 

 

 

 

Common Genital Infections

 

  1. Candidiasis - "yeast", "moniliasis" -
    1. Cause: fungus; usually Candida albicans
    2. Diagnosis:
      1. Females: white, clumpy discharge (cottage cheese), intense vaginal/vulvar itching, dyspareunia
      2. Males: Balanitis

     

  2. Treatment:
    1. Anything w "azole" in it (usually intravaginally; may be oil-based and weaken latex)
      1. Butoconazole
      2. Clotrimazole
      3. Miconazole
    2. Nystatin – less effective than the "azoles"

     

  3. Bacterial vaginosis
    1. Cause: A variety of bacteria
    2. Diagnosis: white (usually, but may be grayish, yellowish, greenish) discharge w/fishy odor (esp. w/semen contact)
    3. Treatment
      1. Metronidazole (orally or vaginal cream/gel)
      2. Clindamycin (orally or vaginal cream/gel)

     

  4. Trichomoniasis – Endoparasite
    1. Cause: protozoan (Trichomonas vaginalis)
    2. Diagnosis: a diffuse, malodorous, yellow-green discharge with vulvar irritation (sore, redness, itching)
    3. Treatment: Only Metronidazole (2 g orally in a single dose or 7 days 500 mg)

      4.  

     

  5. Crabs – Ectoparasite
    1. Cause: Pubic lice (Phthirus pubis)
    2. Transmission: Sexual, clothes, bedding, towels; may be transferred to armpits and scalp
    3. Symptoms: Itching
    4. Treatment:
      1. Permethrin 1% creme rinse applied to affected areas and washed off after 10 minutes
      2. Lindane 1% shampoo applied for 4 minutes to the affected area, and then thoroughly washed off. This regimen is not recommended for pregnant or lactating women
      3. Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes.

 

 

CMBrady 09-07-00