• Sexually Transmitted Diseases (STDs)

OR

• Sexually Transmitted Infections (STIs)

 Objectives
General Goal:
• To know the major cause(s) of these infections, how
they are transmitted, and the major manifestations
of the infections.
Specific objectives

5. To identify the common cause of each of the STD,

and to know the common or pathognomonic signs of
the infections.
2. To know the major manifestations of each infection
and differentiate it from other infections in the
course.
7. Use serology in diagnosing syphilis, and to be familiar
with the pathogenesis of syphilis.
8. To know how to diagnose, treat and prevent these
infections.
 STDs will be divided into 5 different groups
based on their clinical presentations

2. Diseases Characterized by Genital Ulcers

3. Diseases Characterized by Urethritis and Cervicitis
4. Other STDs
– Pelvic inflammatory Disease
– Genital Warts (Human Papillomavirus Infections)
5. Diseases Characterized by Vaginal Discharge
6. Ectoparasitic Infections

Some STDs begin as localized infections, others are

primary systemic ( AIDS, syphilis, HSV)
 
Common Venereal Infections (STDs)

Bacterial
• Gonorrhea Neisseria gonorrhoeae
• Syphilis Treponema pallidum
• Chlamydial Infections Chlamydia trachomatis
• Chancroid Haemophilus ducreyi
• Ureaplasma Infection Ureaplasma urealyticum
• Granuloma inguinale Calymatobacterium
granulomatous
 Common Venereal Infections (STDs)
Viral

• Genital herpes simplex HSV

• Papilloma virus infections HPV
• AIDS HIV
• Hepatitis HBV
• Molluscum contagiosum virus

Protozoa
• Trichomoniasis Trichomonas vaginalis

Fungi
• Vulvovaginal candidiasis Candida albicans

Ectoparasites
• Scabies Sarcopties scabiei
• Phthirus pubis Pubic louse infestation
STD : Clinical Features
Symptoms that Suggest STD
• Abnormal discharge from vagina or penis
• Pain or burning sensation with urination
• Ulcer or blister on genitals
• Swellings in the groin
• Abnormal vaginal bleeding
• Unusual severe menstrual cramps
• Pain in the lower abdomen in women
• Painful sexual intercourse
 Vaginal Discharge
• Neisseria gonorrheae Purrulent

• Trichomonas vaginalis Frothy, foul-smelling,

yellowish green

• Gardnerella vaginalis Grey–white,

unpleasant fishy odor

• Candida albicans Thick-white, curd-like

• Chlamydia trachomatis Thin grey-white

 Ulcers on External Genitalia
Occurrence Number and Tenderness Ulcer Appearance Adenopathy
Diseases Location

HSV Most common Clusters of Tender Uniform size clean base Tender inguinal nodes
ulcers on labia erythematous border
and penis

Syphilis Less common than One or two on Little to no Clean base indurated border Rubbery, mildly
HSV. vagina and tenderness tender
penis

Chancroid Less common than One or two, Painful Can be large, ragged and Very tender,
HSV. lesions may necrotic base, undermined fluctuant inguinal
coalesce, On edge nodes
labia and penis

LGV Rare Ulcer lasts 2-3 Painless Ulcer spontaneously heals at Fluctuant inguinal
weeks, labia time of fluctuant adenopathy nodes
and penis

Granuloma Very Rare: Kissing lesions Painless Clean, beefy read base, stark Nodes usually firm
Inguinale labia and penis white heaped-up ulcer edges can mimic LGV.
Herps vesicles
in female
Herps vesicles in male

Herpes
 H. Ducre (Chanroid

Granuloma
inguinale

Gonorrhea
LGV LGV
 Genital warts

• Caused by HPV (condyloma accminatum),types 16, 18,

and 31 are the predominate cause, Soft, fleshy,
cauliflower-like lesions lesions on the skin, genitalia,
perineum, and perianal regions.

• Or by Treponema pallidum (condlyloma latum), these

are painless mucosal warty erosions in the genitals
and perineum
condyloma lata condyloma acuminata
 Lab Diagnosis
Specimens
• Urethral swab
N. gonorrheae, C. trachomatis, Ureaplasma
• Cervical swab
N. gonorrheae, C. trachomatis, HSV
• High vaginal swab
& Vaginal discharge
T. vaginalis, Candida, G. vaginalis
• Genital Ulcer Specimens
T. pallidum, H. ducreyi, C. trachomatis, HSV
 Lab Diagnosis
Microscopy
 Gonorrhea : Intra & extracellular Gram-ve diplococci
 Syphilis : Motile spirochaetes by
dark field microscopy
 Trichomoniasis : Motile T. vaginalis trophozoites

 Candidiasis: : Yeast cells by wet & Gram-smear

 Bacterial Vaginosis : Clue cells

 Granuloma : Intracellular bipolar

inguinale stained cocco-bacilli
Gonococci Gonococci
 Chlamydial inclusion bodies

Granuloma inguinale them Donovan bodies.

Eosinophilic intra nuclear inclusion

Treponema bodies (HSV)
 Lab Diagnosis

Culture

• N. gonorrhoeae, H. ducreyi

Other Methods
Gonoccocci
• Tissue culture, ELISA culture
o C. trachomatis
o LGV
o Genital herpes
 SYPHILIS
Source of Infection
• Patient with Primary or Secondary syphilis
Modes of Transmission
1. Venereal : Sexual contact
2. Non-venereal
A) Direct Contact
• With mucous membranes (kissing)
• Blood Transfusion
B) Mother to Child – Congenital syphilis
• Hard painless chancre
 SYPHILIS : Lab Diagnosis

Dark-field Microscopy of discharge from chancre

Serodiagnosis
Non-specific tests : To detect non-specific Abs
VDRL & RPR Tests
• Are positive in majority of Pri syphilis
• Almost always positive in Sec syphilis
• Have good prognostic value
Specific tests : To detect specific Abs
• FTA-Abs
(Fluorescent treponemal antibody Absorption) Test
• MHA-TP
(MicroHaemAgglutination test for T. pallidum, is an indirect hemagglutination test
using T. pallidum antigens absorbed to erthrocytes)
 GONORRHEA
Source
• Usually asymptomatic females : 50% asymptomatic
Males
• Purulent urethral discharge & dysuria
• Stricture formation

Females
• Vaginal discharge and dysuria
• Pelvic inflammatory disease - leads to sterility

Treatment
• Penicillin
• Ceftriaxone for penicillin-resistant
 CHLAMYDIA TRACHOAMATIS
INFECTIONS

 Non-gonococcal urethritis in men

• Mucopurrulent urethral discharge
• May progress to epidydmitis & orchitis

 Cervicitis & Vaginitis

• Mucopurrulent vaginal discharge

 Pelvic Inflammatory Disease (PID)

• May lead to secondary infertility

 Lymphogranuloma Venereum (LGV)

• Caused by serotypes L1, L2 & L3
• A STD with lesions on genitalia & LNs (buboes)
 GRANULOMA INGUINALE
• Caused by Calymmatobacterium granulomatous
• Base of ulcer is “BEEFY”
• Spreads by contact so is known as
“KISSING ulcers”
• LN may enlarge
Treatment : Tetracycline

CHANCROID
• Caused by Haemophilus ducreyi
° Produce soft ulcers on external genitalia
° Local lymphadenitis (bubo)
• Treatment:
° Ceftriaxone or ciprofloxacin
 Scabies - mite infestation

• The predominant symptom of scabies is pruritus.

Scabies in adults often is sexually acquired,
although scabies in children usually is not.
• Causes itching
• Diagnosis
– Grossly or microscopically demonstrate mite, its eggs,
larvae, or feces.
– Demonstrate lesion pruritic, erythematous, papular
eruptions.
Sarcoptes scabiei
Sarcoptes scabiei, the scabies or
itch mite
 Pediculosis (crabs)
• Caused by lice (pediculosis pubis )

• Patients who have pediculosis pubis (i.e., pubic

lice) usually seek medical attention because of
pruritus or because they notice lice or nits on
their pubic hair. Pediculosis pubis is usually
transmitted by sexual contact.

Diagnosis
– Finding lice or nits attached to genital hairs (definitive
Diagnosis)
pediculosis pubis,
Finding lice or nits attached to
genital hairs (definitive Dx)
Treatment
• Permethrin 1% creme rinse applied to
affected areas and washed off after 10
minutes.

• Bedding and clothing should be

decontaminated (i.e., machine-washed,
machine-dried using the heat cycle, or dry-
cleaned) or removed from body contact for at
least 72 hours.
 Prevention

Based on the following five major concepts: 

• Education and counseling of persons at risk on ways to
adopt safer sexual behavior; 
• Identification of asymptomatically infected persons
and of symptomatic persons unlikely to seek
diagnostic and treatment services;
• Effective diagnosis and treatment of infected
persons, evaluation, treatment, and counseling of sex
partners of persons who are infected with an STD 
• Preexposure vaccination of persons at risk for
vaccine-preventable STDs (Hep A and B)
• Prevention of STD begins with changing the sexual
behaviors that place persons at risk for infection.
 Case presentation

A 24-year-old women went to her

gynecologist for routine pelvic
examination. The patient had no
symptoms, but the physician collected
routine screening tests for gonorrhea,
chlyamydiosis, HIV, and syphilis. All
laboratory test results came back
negative except for the chlamydia test
which was positive
 Case presentation

A 25-year-old woman presented with genital

ulceration. This was accompanied by malaise
and low grade fever. The patient complained
of considerable local discomfort with a
burning sensation of the external genitalia
which preceded the development of genital
ulceration. On questioning she gave no history
of previous episodes of genital ulceration. An
association inguinal lymphadenopathy was
noted on clinical examination
 Questions

• What is your clinical diagnosis?

• How is this disease transmitted?
• What complication may be associated
with this clinical condition?
• How would you confirm your clinical
diagnosis in the laboratory?
• What is your differential diagnosis?
 Differential Characteristics of Genital Ulcer Diseases

Occurrence Number and Tenderness Ulcer Appearance Adenopathy

Diseases Location

HSV Most common Clusters of Tender Uniform size clean base Tender inguinal
ulcers on labia erythematous border nodes
and penis

Syphilis Less common than One or two on Little to no Clean base indurated border Rubbery, mildly
HSV. vagina and tenderness tender
penis

Chancroid Less common than One or two, Painful Can be large, ragged and Very tender,
HSV. lesions may necrotic base, undermined fluctuant inguinal
coalesce, On edge nodes
labia and penis

LGV Rare Ulcer lasts 2- Painless Ulcer spontaneously heals at Fluctuant inguinal
3 weeks, labia time of fluctuant nodes
and penis adenopathy

Granuloma Very Rare: Kissing lesions Painless Clean, beefy read base, Nodes usually firm
Inguinale labia and penis stark white heaped-up ulcer can mimic LGV.
edges
MOTHER TO CHILD
TRANSMISSION OF
INFECTIONS
Intrapartum Transmission
• Streptococcus agalactiae
• Neisseria gonorrhoeae
• Listeria monocytogenes
• Chlamydia trachomatis
• Escherichia coli
• CMV, HSV, HBV, HIV
Perinatal Transmission (infection is
often include a period from 20-28 weeks to 7-28
days after birth)
• CMV
• HSV
• HBV
• HIV
• VZV
Transplacental Transmission

• T : Toxoplasma gondii
• O: Other

TORCH
• R : Rubella virus
• C : Cytomegalovirus
• H : Herpes simplex
Other iclude
• Listeria monocytoges
• HBS, EBV,HIV, varicella zoster
• Malaria
• Syphilis