SEXUALLY TRANSMITTED INFECTION

SEXUALLY TRANSMITTED INFECTION

Def : Sexually transmitted infections (STIs) are

infections whose primary route of transmission is through sexual contact. The infection can be caused by a broad range of pathogens that affect both the sexually active couple & neonates born to an infected mother.

The most common STIs :

Gonococcal inf Chlamydial inf Genital wart Genital herpes Trichomoniasis

*CVV & scabies are often diagnosed in STI clinics although not usually acquired sexually

 A. Characterized by ulcer :
1. 2. 3. 4. 1. 2. 3. 4. 5. Syphilis Ulcus Mole Herpes Simplex LGV

B. Characterized by urethral/vaginal discharge :

Nisseria Gonorrhoeae inf Nonspecific Genital inf Trichomoniasis Bacterial Vaginosis CVV

C. Other STI :
1. 2. 3. 4.

Human Papiloma Virus (condyloma accuminata) Syphilis (condylomata lata) Molluscum Contagiosum Virus Scabies

SYPHILIS (Lues, Raja Singa)

Def :
chronic systemic inf, characterized by the appearance of a painless ulcer/chancer at the site of inoculation, associated with regional lymphadenopathy. *Shortly after inoculation syphilis becomes a systemic infection with characteristic secondary and tertiary stages *Syphilis is the great imitator~ other skin diseases

 Etiol : venereal syphilis : Treponema pallidum

subspecies pallidum (T pallidum) * Yaws: T pallidum subspecies pertenue * Bejel (endemic syphilis) : T pallidum subspecies endemicum * Pinta : T carateum

Transmission :

- sexual contact : inf lesion (contact with chancre, primary sy), mucous patch, condyloma latum, cutaneous lesions (secondary sy) - Congenital nf : in utero/perinatal transmission - Blood products : transfusion

 Lab :
- Dark-field microscopespirochaete bacterium from ulcer, cutaneous lesions, condylomata lata - spirochaete 6-10 - STS : - VDRL(non specific) : - TPHA (specific): 1/80 1/1024

Time after exposure

Early infectious
- Primary - Secondary - Latent (early) 9-90 days 6 weeks - 6 months (4-8 weeks after primary lesion) <two years

Late (non-infectious)
Latent (late) Neurosyphilis Cardiovascular Gummatous syphylis >2 years 3-20 years >10-40 years 3-12 years after primary inf

 3 stages of sy :

* Primary sy (L1) - symptom : painless ulcer (genital/extra genital) - incubation : 21 drange 10-90 d - skin lesions :(heal within 3-10 weeks) Clinical feature: button like papule few mm-1-2 cm, painless clean ulcer (firm indurated border, scanty, serous exudate) *extragenital fingers may be painfull

 Predilection :

: corona sulcus, shaft, base, inner prepuce : servix, vagina, vulva - extragenital : anus/retum, mouth, lips, tongue, tonsil, fingers (painful), toes, breast, nipple. General exam : 7d regional lymphadenopathy discrete nodes, firm, rubbery, nontender,painless,unilateral persist for months

Lab : Dark-field & STS(+) 2w

 DD :
Genital herpes Fixed drug eruption Ulcus Mole LGV Dx : Clinicaly & Lab

 Secondary Sy
2-6 m primary inf (contact) 2-10 w appearance of primary chancre 6-8 w healing of chancre *Symptom : - fever, sore throat, loss of weight, malaise, anorexia, headache - asymptomatic mucocutaneous lesions duration of lesions : weeks

*Skin lesions : - Trunk : generalized eruptionmacules, papules 0,5-1cm, round oval, pink/brownish/red - Head (hair line, nasolabial, scalp), neck, palms & soles hyperkeratotic-psoriasisform, anular/polycyclic (face in dark-skinned) - Neonatal congenital Sy : vesico-bullous palms & soles - Genital (anogenital, mouth) : condylomata-lata soft, flat-topped, moist, red-pale papules, nodules or plaques

-Hair : diffuse hair loss, patchy moutheaten alopecia (scalp & beard), loss of eyelashes 1/3 lat *Generalized lymphadenopathy & splenomegaly *Lab : - spirochaete from the lesions - STS *Dx : - clinical suspicion dark-field - STS

 Latent Sypphilis
- no sign & symptom - STS (+) - history of primary or secondary lesion, history of exposure to sy, delivery of infant with congenital sy early latent <1 year late latent 1 year

 Tertiary / Late Sy

- 15% untreated late benign, mostly skin lesions - duration 3-7 year history - Gumma 15year

*Physical exam : - Gumma ; nodular/pappulosquamous ulcer heal expand rapidly destruction location : skin (scalp, face, chest), internal (skeletal system) - Neurosyphilis : 25% untreated 25% asymptomatic 20% clinical neurosyphilis tabes dorsalis, general paresis - Cardiovascular sy : 10% untreated 10-40 y after inf aortitis,regurgitation

 DD : cutaneous tuberculosis
invasive fungal inf Dx : clinical findings STS

 Congenital Syphilis

- transmission : during gestation/inpartum - adequad tx <19 w pregnancy prevent fetal demage - clinical manifestation : early : <2 yoften 2-10 w, very inf, rhinitis/snuffles (23%), bullae/vesicles, superficial desquamation/ papulosquamous, ptechiae, condylomata latum, hepatosplenomegaly, lymphadenopathy late : >2 y, noninfectious, ~ late acquired sy - residual stigmata : - Hutchinson teeth - abnormal facies : frontal bossing, saddle nose, poorly developed maxillae TX: baca buku UI hal 409 dan ABC of sexually transmitted infection

Haemophilus Ducreyi Inf

(soft chancre, ulcus molle, chancroid)

Def : acute STD characterized by a painful

ulcer at the site of inoculation, usually on the external genitalia Etiol : Haemophilus Ducreyi, gramnegative streptobacillus Transmission : sexual intercourse Incubation : 4-7 d Skin lesions :

 Skin lesions :

tender papule with erythematous halo pustule erosion/ulcertender,painful,nonindurated multiple ulcer (autoinoculation) Distribution : : prepuce, frenulum, coronal sulcus, glans penis, shaft : labia, vestibule, clitoris, perianal, vaginal wall, introitus, cervix

 Lab : gram-stain30-50% grouped

bacillus / chain-like DD : Genital Herpes Primary Syphilis LGV Traumatic Lesions Dx : Clinicalpainful ulcer + tender lymphadenopathy Tx : azitromycin 1 gr PO single dose or ceftriaxone 250mg IM single dose or ciprofloxacin 500mg PO bid 3d or erythromycin 500mg PO qid 7d * Sex partners : evaluation & treatment

Genital Herpes Simplex

Def : chronic viral inf, primary / recurrence, symptomatic
or asymptomatic. Symptomatic is characterized by grouped vesicles arising on an erythematous base on mucous membrane Neonates are susceptible to HSV Etiol : Herpes simplex virus-2 (HSV-2)> HSV-1 Epid : - Transmission : skin-skin, skin-mucous, mucous-skin - Inc periode : 2-20d (average 6d) - Precipit facs : altered hormonal milieu (menstruation), fever, common cold, altered immune states *Genital Herpes recures more frequently than labial.

 DD : ulcus Molle, primary sy, impetigo Dx : clinical, giemsa-stain : Tzank cell Tx : not specific

Limphogranuloma Venereum
Def : venereal disease is characterized by a
transient primary genital lesion followed by multilocular suppurative regional lymphadenopathy. Etiol : chlamidya trachomatis Incubation : 2-12d Lesion : - acute : small painless vesicle or nonindurated ulcer/papule on penis - ingunal synd : unilat painful inguinal adenopathy 2-6w after presumed exposure.

 Urethral synd : infiltrat at the posterior

urethrafish mouth urethra Dx : culture, serologic tests Tx : Azythromycin 1 g PO single dose or Doxycycline 100mg PO bid 7 d

Neisseria Gonorrhoeae inf

Def : mucosal inf that caused N Gonorrhoeae. Transmission : sexually, neonates that exposed

to infected secretions in birth canal. Incubation : 5-14d urethritis , : servicitis, asymptomatic Lab : gramstain : gram-negative diplococci within polymorphonuclear leukocytes. Dx : Clinical suspicion, Lab Complication : baca UI hal 368-370

 Tx : cefixim 400mg PO single dose or

ceftriaxone 125mg IM single dose or ciprofloxacin 500mg PO single dose or ofloxacin 400mg PO single dose azithromycin 1 g PO single dose

Nonspecific Genital inf

(NSGI)

Def : genital inf that caused by other than

N gonorrhoeae, candida albican, trychomonas vaginalis, gardnerela vaginalis. Etiol : chlamydia trachomatis, ureaplasma urealyticum & mycoplasma hominis Incubation : 1-3 w />after contact

 Physical exam :

: urethritis seropurulent discharge : dysuria, vaginal discharge, bartolinitis DD : genital inf that characterized by urethritis & vaginal discharge Dx : clinically & lab Tx : Doxycycline 100mg PO bid 7d or Azithromycin 1 g PO single dose or Erythromycine 500mg PO qid 7d

Trichomoniasis
Def : acute or chronic urogenital inf Etiol : T Vaginalis Physical Exam:
- : mild urethritis - : seropurulent discharge, yellowish / yellow-green, malodorous, foamy Lab : T. Vaginalis from fresh discharge Dx : lab finding Tx : Metronidazole 2g PO single dose or Metronidazole 500mg PO tid or Nimurazole 2 g PO single dose or Omidazole 1,5 g PO single dose

RESUME
The three most common presenting symtoms of an STI
are :
Urethra discharge Genital ulceration Vaginal discharge

Way STI are important :

Common Often asymptomatic Mayor complication and sequelae Expensive Sinergy with HIV

Sexually Transmitted Infection And Associated Presenting Symtomps

NO 1 2 3 4 5 6 Gonore Non Gonococus Urethritis Sifilis Chancroid L.G.V Herpes Genitalis Urethral Discharge ++ + Vaginal Discharge +/+/++ ++ + ++ + Genital Skin Ulceration Simptoms

Mayor Sequelae of STI

Women Men

Cervical cancer Anal cancer Infertility Ectopic pregnancy Spontaneus abortion Neuro sifilis

Penile cancer Anal cancer Epididymitis Infertility Neurosifilis