SEXUALLY TRANSMITTED

DISEASES (3)
THOMAS RUTTO
BSC CLIN MED

1
VAGINITIS
Definition :
Clinical syndrome characterized by vaginal
discharge, vulval irritation or malodorous
discharge.
Types:
Infective vaginitis
Atrophic vaginitis

2
Infective vaginitis
1. Trichomonas vaginalis
2. Bacterial vaginosis
3. Candidiasis

3
Trichomoniasis
Causative organism
Trichomonas vaginalis is a flagellate
protozoa
Infects lower urinary tract in both male and
female.
Mode of transmission
 Sexual contact

4
Incubation period
3-28 days

Clinical features
Profuse offensive vaginal discharge
Vulval pruritus
Urinary symptoms – Dysuria, frequency

5
Examination findings
Thin, greenish yellow and frothy offensive
discharge p.v.
Inflamed vulva
Inflamed vaginal walls with hemorrhagic
spots ( strawberry spots).

6
Diagnosis
HVS microscopy- Motile flagellates
Culture

Treatment
Metronidazole ( flagyl) 500mg tds for 5 days.

Evaluate for other STDS

Treat partner

7
T. Vaginalis

8
T. Vaginalis

9
Candidiasis ( Moniliasis)
Causative agent:
Candida albicans
Pathology
Present in 20% of women without symptoms
Infection common in
 Diabetes mellitus
 Pregnancy
 Broad spectrum antibiotics

10
Clinical features
Vaginal discharge – White curd-like
Intense vulval pruritus
 Burning sensation following micturition due
to excoriation of the skin from scratching.

11
Examination findings
Thick whitish curd-like discharge often
adherent to vaginal walls.
Vulval may be red and swollen with evidence
of pruritus.
Removal of flakes may reveal multiple oozing
spots.

12
Diagnosis
Demonstration of candidal mycelia and a
normal vaginal PH =<4.5
Culture
Treatment
Imidazoles
Clotrimazole – Topical
- Pessaries
Ketoconazole/ fluconazole oral agents

13
Candida albicans

14
Bacterial vaginosis
Definition
BV refers to change of vaginal bacterial flora
with loss of lactobacilli, an increase in vaginal
PH >4.5 and an increase in multiple
anaerobic and aerobic bacteria.

Aetiology
Gadnerella vaginalis
Mode of transmission
Sexual contact
15
Clinical criteria for diagnosis
1. Homogenous white non inflammatory
discharge
2. Microscopic presence of clue cells
3. Vaginal discharge with PH >4.5
4. Fishy odor with or without addition of KOH

50% of infected women asymptomatic.

16
Complications
Prom
Preterm labor and delivery
Spontaneous abortions

17
Diagnosis
Clinical criteria
Microscopy- Clue cells
Culture
Clue cells
Exfoliated vaginal cells in a wet preparation
dusted with small dark particles- Gadnerella
vaginalis organisms

18
Clue cells in B. Vaginosis

19
Treatment
Metronidazole 400mg tds x 7 days
Tinidazole/ secnidazole 2gm stat.

20
Genital ulcer disease
Genital herpes, syphilis and Chancroid are the
commonest ulcerative lesions
HIV is a risk factor for genital ulcers

21
22
Herpes Genitalis
Herpes virus hominis is the commonest cause
of genital ulcer disease.
85% of primary infections are due to HSV
type 2
15% due to HSV type 1

Mode of transmission
Direct contact with secretions or mucosal
surface contaminated with the virus.

23
Virus enters the skin through cracks or other
lesions but can enter through an intact
mucosa.

Incubation period
2-7 days

24
Clinical presentation
[Link] symptoms
Symptoms that occur before vesicular
eruptions appear.
Burning sensation
Itching
[Link] then erode rapidly resulting in
painful ulcers distributed in small patches.
3. Bilateral inguinal adenopathy may be
present
4. Dysuria
25
5. Systemic manifestations
Occur in about 1/3 of patients
Fever, headache, myalgia
Lesions may persist for 2-6 weeks with no
subsequent scarring.

26
Herpes simplex vesicles

27
Diagnosis
Based on clinical presentation and laboratory
results.
Culture of the virus from the vesicle fluid in
acute phases
Antibody test IgM antibodies to type 2 virus
within 21 days of exposure.

Viral particles are transported along the

peripheral nerves to the dorsal root ganglion
where latent infection is established.
28
Activation is by exogenous factors including
Fever
Emotional stress
Menstruation
Immunosuppresion

50% of patients have recurrence within 6

months of the primary infection.

29
Treatment
Lesions are self limiting, they heal
spontaneously unless they get secondary
bacterial infection.
Symptomatic treatment
Good hygiene
Loose fitting undergarments
Oral analgesics
Sitz baths

30
Specific treatment
Antiviral
Acyclovir 400mg three times a day for 7 days

Prevention
Avoid direct contact with active lesions

31
Condylomata acuminata
Genital warts
Caused by human papilloma virus
Paillary growth coalesce and form large
cauliflowerlike masses.
Incubation period
3 months
Treatment
Imiquimode ( Aldara)
Surgical excision Cauterization

32
Vulval warts

33
Extensive vulval warts

34
In pregnancy: Elective c/ section

35
Chancroid
STD characterized by a painful genital ulcer.

Aetiology: H. ducreyi
Gram negative rod
Mode of transmission. Sexual contact.
Incubation period Short
3-5 days

36
Patients with Chancroid are at increased risk
of HIV transmission.
10% of patients with genital chancroid may
have coinfection with herpes or syphylis.

37
Clinical presentation
Saucer shaped ragged ulcer circumscribed
by an inflammatory wheal.
Very tender ulcer with foul discharge.
Cluster of ulcers may develop.
Lesions typically occur on the vulva, cervix
and perianal area in women.
Painful inguinal adenitis in over 50% of cases.
The buboes may become necrotic and drain
spontaneously.

38
Investigations/ Lab findings
Syphilis must be ruled out
Clinical diagnosis more reliable than culture
or smears because of the difficulty of isolating
this organism.
Culture- Aspirated pus from a bubo is the
best material for culture.
PCR

39
Differential diagnosis
Syphilis
Granuloma inguinale
Lymphogranuloma venereum
Herpes simplex

40
Prevention
Notifiable disease
Condoms

Treatment
Local treatment
Good personal hygiene
Clean with mild soap solution
Sitz baths

41
Antibiotic treatment
Azithromycin 1gm stat
or
Ceftriaxone 250mg im stat
Or
Erythromycin 500mg tds for 7 days

42
Prognosis
They should improve within 7 -10 days
If no improvementis noted then suspect the
following
1. Coinfection
2. HIV
3. Resistant strains
4. Non compliance

Untreated or poorly managed cases may persist and

secondary infection may develop.
Deep scarring in untreated cases.
43
Thank you

44