Sexually Transmitted Diseases (STDs)

Presented by:

Dr. Vrish Dhwaj Ashwlayan,

Professor, Department of

Pharmaceutical Technology, MIET, Meerut

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 Learning Objectives
1. Identify the five most common STDs affecting HIV-infected women

2. Discuss clinical presentations associated with the five common STDs

3. Recall methods for diagnosing the five common STDs

 Chlamydia

 Gonorrhea

 Syphilis

 Trichomoniasis

 Herpes Simplex Virus (HSV) 2

 What is an STD?
Infection transmitted through sexual contact with an infected
individual. Sexually transmitted infection or STI and can
develop into a sexually transmitted disease or STD.

FIVE MODES OF TRANSMISSION

1. Vaginal sex
2. Anal sex
3. Oral sex
4. Skin-to-skin contact
5. Infected Mother to child
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Why is This Important About STI/STDs?
Often NO signs or symptoms
20 million new
infections every year
UNAWARE of infection, and don’t in the U.S.
receive treatment.

More than 50% of

LONG-TERM damage all people will have
an STI at some
May have PASSED infection to others point in their
lifetime.
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 Are STDs Curable?
Antibiotics can cure Treatment can improve the
bacterial STDs, but cannot lives of many people living
reverse the long-term with viral STDs, but there is
damage: NO cure:

• Chlamydia • HIV
• Gonorrhea • Herpes
• Syphilis • HPV
• Trichomoniasis*
• Hepatitis B
*parasitic protozoan
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 Most Bacterial STDs
Antibiotics can cure most bacterial STDs
but not always the long-term damage.

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Chlamydia The “Silent” Disease
In the U.S.
• Most frequently reported STD
• Estimated 1.76 million new cases in 2018
(Could fill the OU Football Stadium 20x)

How is it Spread?
1. Vaginal, anal, or oral sex with someone who has chlamydia.

2. Infected pregnant women can pass it to her baby during

pregnancy or childbirth.
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 Chlamydia
Symptoms:
Abnormal vaginal/penile discharge Burning sensation when urinating
Rectal pain, discharge, or bleeding Pain/swollen in one or both testicles

Can lead to:

Sterility or infertility Infection of tube that carries sperm
Pelvic Inflammatory Disease (PID) to/from the testicles (pain, fever)
• Long-term abdominal/pelvic pain
• Scar tissue formation in fallopian tubes
• Ectopic pregnancy
Oklahoma State Department of Health | STI 101 | 2022 8
Chlamydia:
Diagnosis Treatment Considerations

Chlamydia culture  Antibiotics

• Azithromycin
 New tests include:
 Evaluate and treat sexual partners
 Avoid sex for seven days after
• Direct immunofluorescence assays completion of treatment
(DFA)

• Enzyme immunoassay (EIA)

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 Gonorrhea
In the U.S.
• 2nd most common disease reported
• Estimated 583,405 new cases in 2018

How is it Spread?
1. Vaginal, anal, or oral sex with someone who has gonorrhea.

2. Infected pregnant woman can pass it to her baby during

childbirth.
Oklahoma State Department of Health | STI 101 | 2022 10
 Gonorrhea
Symptoms:
Abnormal vaginal/penile discharge Burning sensation when urinating
(white, yellow or green) Vaginal bleeding between periods
Rectal discharge, itching or bleeding Pain/swollen in one or both testicles

Can lead to:

Sterility or infertility Disseminated infection (rash, fever,
Painful infection tubes attached testicles arthritis, meningitis, etc.)
Pelvic Inflammatory Disease (PID)
Long-term abdominal/pelvic pain Ectopic pregnancy
Scar tissue form in fallopian tubes Inability to get pregnant
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 Gonorrhea

Diagnosis Treatment Considerations

 Clinical exam
 Intramuscular Ceftriaxone
 Cervical culture
 Polymerase chain reaction  For pregnant women only:
(PCR) or ligase chain reaction
• Ceftriaxone single dose but
(LCR)
 Gram stain– substitute Quinolones with
polymorphonucleocytes with Erythromycin
gram negative intracellular
diplococci • Do not treat with Quinolones or
Tetracyclines
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Primary & Secondary “The Great
Syphilis Imitator”
In the U.S.
Estimated 35,063 new cases in 2018

How is it Spread?
1. Direct contact with a syphilis sore (chancre) during vaginal,
anal, or oral sex.
2. Can be spread from an infected mother to her unborn baby.
Primary Secondary Tertiary/Late
Syphilis Syphilis Syphilis

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Primary Syphilis
Chancre (primary syphilis sore)
• painless ulcer with a hard edge and a clean base
• Firm, round, and painless or open and wet
• Appears within 2-6 weeks after exposure usually but possibly up to 3
months
• Found on the part of the body exposed to the infection such as penis,
vagina, anus, lips, in rectum, or in mouth
• Disappears after a few weeks without treatment and still progresses to
next stage of Secondary Syphilis 14
 Secondary Syphilis
Appears about 4 weeks after chancre heals.
Disappears after a few weeks without treatment and still progresses to next
stage Late (Tertiary) Syphilis

non-itchy RASH with Alopecia or Mucous Patches

rough red or patchy hair loss usually in the mouth,
Reddish-brown spots vagina, or anus

Condylomata lata (C. lata) or “fleshy warts” in anogenital region 15

 Latent Syphilis
• The period of time when there are
no signs or symptoms
but syphilis is still present in the body.

• If left untreated, you can continue to have syphilis

in your body for years
without any signs or symptoms.

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 Late (Tertiary) Syphilis
Typically Occurs 10-30 years after infection begins!
• Can damage almost any part of the body including the heart, brain, spinal cord, eyes and bones
• Can result in mental illness, blindness, deafness, heart disease and death
• Gumma: soft, gummy tumor

Types:
• Cardiovascular Syphilis: Aortic valve disease, aneurysms
• Late Benign Syphilis:
• Neurosyphilis Syphilis: Meningitis, encephalitis, tabes dorsalis, dementia
 Gumma formation: Deep cutaneous granulomatous pockets
 Orthopedic: Charcot’s joints, osteomyelitis
 Renal: Membranous Glomerulonephritis

(Occurs sooner among People Living with HIV.)

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 Neurosyphilis Syphilis
Usually occurs during late syphilis but can occur
at anytime during the infection.
Symptoms:
• Difficulty coordinating muscle movements
• Paralysis (not able to move certain parts of your body)
• Numbness
• Blindness
• Dementia (mental disorder)
• Damage to internal organs
• Can result in death
More likely to occur early in the disease process if HIV infection is also present.

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 Congenital Syphilis
40% will be stillborn or die in the hospital.

Transmission can occur during any stage of syphilis and

during any trimester of pregnancy.

Can cause:
• Prematurity
• Birth defects
• Hutchinson’s teeth
• Osteochondritis
• Developmental delays
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 Syphilis: Diagnosis
• Requires demonstration of:
• Organisms on microscopy using dark field
• Positive serology on blood or cerebrospinal fluid (CSF)
Non-Specific Treponemal Tests:
1. Venereal Disease Research Laboratory
(VDRL)
2. Rapid Plasma Reagin (RPR)
 Positive serology on blood or CSF
• Specific Treponemal Test:
1. Fluorescent Treponemal Antibody Absorption
(FTA-ABS)
2. Microhemagglutination-Treponema pallidum (MHA-TP)
 Organism may not be cultured but diagnosis cannot be determined by 20
clinical findings only
 Syphilis: Treatment Considerations

Primary/ secondary/ latent stage: Benzathine penicillin

Neurosyphilis: Penicillin G

Ask about penicillin allergy before treatment

Jarisch-Herxheimer reaction may occur

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 Trichomoniasis
In the U.S.
Estimated 3.7 million new cases in 2018
How is it Spread?
Parasite passed during vaginal sex.
70% of infected people have NO signs/symptoms

Symptoms:
Abnormal thin vaginal/penile discharge Burning urinating and ejaculation
white, yellow or green with foul odor Genitals itching, sore, red, burning

Site:
Lower genital tract (vulva, vagina, penis or urethra)
Greatly increases the risk of getting/spreading other STIs.
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 Pelvic Inflammatory Disease (PID)
Serious infection of woman’s reproductive organs
Often untreated STDs like chlamydia and gonorrhea
Symptoms
Pain in your lower abdomen Unable to undo damage
Pain & bleeding when you have sex Fallopian tube scar tissue
Burning sensation with urination Ectopic pregnancy
Vaginal discharge with a bad odor Infertility
Bleeding between period Long-term pelvic/
Fever abdominal pain
May have Mild or No symptoms
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 Trichomoniasis

Diagnosis Treatment Considerations

 Flagellated, motile  For HIV-infected women: same
trichomonads on wet mount treatment as non-HIV infected
 Vaginal pH > 4.5 women
 Diagnosis confirmed by  Metronidazole or Tinidazole
microscopy
 Other FDA approved tests:  Sex partners have to be treated
• OSOM Trichomonas Rapid
 Evaluate and treat all sexual partners
Test
• Affirm VP III

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 Genital Herpes (HSV-1 and HSV-2)
1 in 8 people 14-49 years old have genital herpes.
Many infected people have NO signs/symptoms.

How is it Spread?
Vaginal, Oral, or Anal sex OR Skin-to-Skin Contact
with someone who has genital herpes.

Symptoms (“Having an outbreak”):

• One or more blisters on or around the genitals, rectum, or mouth.
• Blisters break & leave painful sores that take weeks to heal.

Usually characterized by NO or very mild symptoms AND NO cure.

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 HIV

Diagnosis Treatment Considerations

 Clinical presentation Antivirals
 Viral culture  Lesions may be bathed in mild soap
 Tzanck smear/Giemsa smear and water
 Skin biopsy  Sitz baths may provide some relief
 Sex partners may benefit from
evaluation and counseling
• Transmission is possible when
lesions not present due to viral
shedding

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 Human Papillomavirus (HPV)
HPV is VERY common.
Estimated 80% sexually-active men and women will get at least one type of
HPV at some point in their lives.

How is it Spread?
Mainly transmitted through vaginal & anal sex and can also occur through oral
sex and skin-to-skin contact.

Most people with HPV do not know they are infected and never develop
symptoms or health problems.

There is No treatment for HPV, but there are treatments for the
health problems that HPV causes:
Cervical pre-cancer Genital warts Other HPV-related cancers
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 “Inflammation
Hepatitis of the liver”
Hepatitis A Hepatitis B Hepatitis C
How is it Person ingests infected Blood, semen, or other Blood from a person
spread? fecal matter—even in body fluids from a infected with the virus -
very small amounts— person with the virus - even in very small
from contact with even in very small amounts - enters the
contaminated objects, amounts - enters the body of a non-infected
food, drinks. body of a non-infected person.
person.

How long A few weeks to several Mild illness (a few Mild illness (a few
does it months. weeks) but Lifelong or weeks) but Lifelong.
last? chronic condition.

How Most recover from mild 15-20% develop chronic 75-85% develop chronic
serious is illness with no lasting liver disease including liver disease, 5-20%
it? liver damage, cirrhosis, liver failure, or develop cirrhosis and
but death can occur liver cancer. 1-5% will die.
(although rare).
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 Reducing the Risk
NO RISK
Abstinence from Sex
Abstinence from Injection Drugs
Mutual Monogamy w/STD Negative Partner

REDUCED RISK
Protected Sex “Correctly and Consistently”
Fewer Sexual Partners
Never Sharing Needles or “Works”
Regular HIV/STD Testing
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 Get Tested!
HIV Syphilis
Everyone aged 13 through 64 should If you are pregnant
get tested at least once Man who has sex with other men
People who have occasional exposure Have sex for drugs or money
to HIV risks at least once a year Have HIV or another STD
Had sex with someone who tested
People who are at high risk for HIV
positive for syphilis
infection 3-6 months
Chlamydia & Gonorrhea
• Age 24 or younger having sex get tested once every year
• Age 25 or older and more than one sex partner or with a new sex partner
• Talk with a doctor about getting tested if you have had sex with someone who tested
positive for chlamydia or gonorrhea.
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