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Medical Microbiology

Medical Microbiology. Department of Microbiology, HMU. 微生物学教研室 付英梅. SEXUALLY TRANSMITTED DISEASES. STD 的定义. 性传播疾病 (sexually transmitted diseases) 是指主要通过性行为或类似性行为而传染的一组疾病，简称性病，过去民间称“花柳病”。 性病不仅仅发生在性器官上，也可侵犯附属淋巴器官及全身重要器官组织。. Sexually Transmitted Diseases(STDs). Objectives:

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Medical Microbiology

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  1. Medical Microbiology Department of Microbiology, HMU 微生物学教研室 付英梅

  2. SEXUALLY TRANSMITTED DISEASES

  3. STD的定义 • 性传播疾病(sexually transmitted diseases)是指主要通过性行为或类似性行为而传染的一组疾病，简称性病，过去民间称“花柳病”。 • 性病不仅仅发生在性器官上，也可侵犯附属淋巴器官及全身重要器官组织。

  4. Sexually Transmitted Diseases(STDs) Objectives: Know the type of causative agent, main symptoms, laboratory diagnosis, treatment, prevention 1. Gonorrhea 2. Syphilis 3. Soft chancre 4. LGV: Chlamydia 5.Genital Herpes 6. AIDS 7. condyloma acuminatum 8. nongonococcal urethritis

  5. Pathogens of STDs • Bacterial • Gonorrhea • Chlamydia • Syphilis • Viral • Genital Herpes Simplex (HSV-2) • Papillomavirus (HPV) • AIDS (HIV) • Protozoal • Trichomoniasis

  6. 流行概况及特征 • 2000年，WHO，感染 >100万人/天，新增4亿/年 • 其中 • 梅毒1200万 • 淋病6200万 • 衣原体感染8900万 • 滴虫病1.7亿 • 尖锐湿疣3000万 • 生殖器疱疹2000万

  7. 1995年不同地区15～49岁成人4种STD的估计患病率（%）1995年不同地区15～49岁成人4种STD的估计患病率（%）

  8. 1981－2000年全国主要性病发病情况

  9. 我国性病流行趋势 • 增长迅速 • 1980年全国仅报告48例, 至1988年全国各省市均有性病报告, 1981-1988年均增长124.31%. 1989-1997年均增长10%-25%. 1998年以来年均增长30%. • 梅毒增长幅度最大 • 1998年全国梅毒报告数为53768例, 是1993年的26.7倍. 在某些地区如福州和厦门市, 梅毒发病率超过150/10万人, 近年东北地区增长迅速

  10. 淋病一直为我国报告性病中的优势病种。 • 但有资料显示：天津, 广东, 广西和海南4个省市的NGU的报病数超过淋病, 居第一位。 • 性病报告存在大量的漏诊和漏报 • 专家估计, 实际性病数是报告数的6-10倍

  11. 地区分布特点 • 各省性病发病均呈上升趋势 • 沿海开放省份高于内地, 经济发达地区高于经济落后地区 • 城市高于农村, 90%以上的性病病人集中在城市, 尤其大中城市和经济发展较快, 交通便利的城市

  12. 我国性病地区分布图

  13. 人群分布的特点 • 发病率不断上升，发病人群广泛 • 多数STD的发病率以男性为多，不同病种男女患者性别比例不同。 • 近年女性病例逐年升高，男女比例差距逐渐减小，可能与女性主动就诊人数增加，诊断水平提高有关。 • 性活跃的人群为感染性病的危险人群。20-49岁青壮年占全部性病病例数的90%以上

  14. 2000年我国人群STD的年龄分布图

  15. STD的流行过程 • 传染源 ----主要传染源：性病病人及病原携带者。 ----感染和传播性病的“高危人群”：卖淫嫖娼者和吸毒人员 ----嫖客等“桥梁人群”：STD向普通人群传播

  16. 传播途径 • 性接触传播 • 血源性传播 • 母婴传播 • 医源性传播 • 日常生活接触传播

  17. 易感人群 • 人群对性病包括艾滋病普遍易感，尚无有效的疫苗 • 因此，可反复感染，也可久延不愈，时隐时现 • 易感性与患者接触部位的状态（有无破损），感染病原体的种类和数量、感染的方式、次数以及自身非特异性免疫功能的高低等有关

  18. 流行因素--1 • 对外开放和经济发展导致价值观和道德观发生变化, 婚外性生活和多个性伴增多 • 贫富差距加大, 导致卖淫现象增加 • 人口流动增加

  19. 流行因素--2 • 性教育薄弱 • 性病临床医疗服务水平低, 就诊环境差, 性病诊治不规范 • 性病医疗市场混乱, 大量耐药病原体出现，如我国各地的耐青霉素淋菌株率高达52.5%-78%

  20. 流行因素--3 • 艾滋病的出现, 非淋菌性尿道炎急剧增加, 性病性盆腔炎增多 • 由于性行为方式的多样化，病变的发生部位也成多样性，除生殖器外，肛门、直肠、口咽部等也可发病

  21. STD的预防针对传播的三个环节，采取综合性措施 STD的预防针对传播的三个环节，采取综合性措施 (一)管理传染源 性病患者早发现、早诊断、早隔离、早报告、早治疗。 • 加强性病知识宣传教育，使患病者及时、主动就医。 • 高危人群定期检查，入境人员卫生检疫。按《中华人民共和国传染病法》及时报告疫情，并对病人进行治疗。 (二)切断传播途径 1．性接触传染 (1) 性道德，洁身自爱，不性乱。遵守法律法规，杜绝卖淫嫖娼。 (2)正确使用安全套，预防蔓延。

  22. 2．非性接触传染 (1)公共环境，旅馆、游泳池、理发店、美容场所等设备与器械严格消毒。 (2)个人自我保护，淋浴冲澡，不用浴盆；自带洁具(桶、盆等) 3．血液传播 (1) 严格控制血液制品 (2)不以任何方式吸毒，尤其是不静脉吸毒。 (3)医疗单位一次性器械用品，强调一人一针一管。 (4)理发店、美容院等器械严格消毒。 (5)个人用品决不互用，牙刷、剃须刀等。 4．母婴传播 性病及时治疗，一旦妊娠应及时终止。 (三)保护易感人群 无疫苗。生活方式，卫生习惯，体育锻炼，提高抗病能力。

  23. Neisseria gonorrhea Gonococcus

  24. 内容要点 • 淋病奈瑟菌的生物学性状、致病物质及所致疾病

  25. Gonorrhea • Leading cause of sterility in women • Caused by bacteria Neisseria gonorrhoea • One million cases/yr • Treated with antibiotics • May cause arthritis and endocarditis (inflammation of heart) • Diagnosed by a smear of the discharge

  26. Morphology • 0.8μm, Gram negative, diplococci (pairs of cocci) • most in neutrophil cells

  27. Cultivation • Culture • Obligatory aerobic • grow best on chocolate agar, containing heated blood, brown in color • Thayer Martin Chocolate Agar • A modified (selective) chocolate agar • Biological reactions • Glucose fermentation only • Can not use other sugars

  28. Surface Antigens • Pili • Adherence factor, weak antigenic • LPS • Out membrane protein (OP) • PI: major OP, 18 serotypes • based on PI • PII: adherence factor

  29. Resistance • Extremely sensitive to environmental conditions, e.g., heat and cold • Sensitive to penicillin • Drug resistance is quite common • Penicillin doesn’t work well • New beta-lactam drugs are recommended • R plasmid

  30. Virulent Substances • Pili • Involved in the initial adhesion of the organism to genital epithelium • LPS (Endotoxin) • IgA1 proteinase • Exotoxins are not believed to be of importance in pathogenesis

  31. Pathogenesis • The only natural host is human • Gonococci attack mucous membranes of the genitourinary tract, eye, and rectum • Cause acute suppuration that lead to tissue invasion • Followed by chronic inflammation and fibrosis • Exclusive pathogenic • Diseases result from exogenous infection

  32. Diseases • Adult • Gonorrhea • STD,The second most common venereal disease • Skin lesions • Results of gonococcal bacteremia • Neonate • Gonococcal Ophthalmia Neonatorum • Gonococcal conjunctivitis • Blindness

  33. Gonorrhea • Women • 80% of women asymptomatic carriers • May cause Pelvic Inflammatory Disease (PID) • Men • Develop a drip, pus exudate 3-8 days after exposure • Painful urination • If newborn has contact with the bacteria during birth may cause blindness • Silver nitrate is put into the newborns eyes to prevent blindness

  34. 淋病 人类是淋球菌唯一的天然宿主 成人淋病绝大多数通过性接触感染，是重要的性传播疾病（sexually transmitted disease，STD） 新生儿淋球菌性结膜炎：经产道传播 “脓漏眼” 所致疾病

  35. Gonorrhea In Males • Usually urethritis, with yellow, creamy pus and painful urination, but may be asymptomatic • As suppuration subsides in untreated infection, fibrosis occurs, sometimes leading to urethral strictures

  36. Gonorrhea In Females • Primary infection is in the endocervix and extends to the urethra and vagina, giving rise to mucopurulent discharge • Chronic gonococcal cervicitis is often asymptomatic • It may progress to the uterine tubes, causing salpingitis, fibrosis of the tubes • Infertility occurs in 20% of women with gonococcal salpingitis

  37. Gonococcal Ophthalmia Neonatorum • Also, gonococcal conjunctivitis • An infection of the eye of the newborn • acquired during passage through an infected birth canal • The initial conjunctivitis rapidly progresses and, if untreated, results in blindness • To prevent • Instillation of tetracycline, erythromycin, or silver nitrate into the conjunctival sac of the newborn is compulsory in most countries

  38. Gonococcal Bacteremia • A common feature of disseminated gonoccocal disease is arthritis • Commonly considered a form of septic arthritis • In many cases gonococci cannot be isolated from the joint (i.e. they are "reactive" in nature) • Dermatitis (skin lesion) is also common

  39. Immunity • Can be infected repeatedly • due to the variations of antigenecities of gonococci proteins

  40. Diagnosis • Specimens • Pus and secretions taken from the urethra, cervix, rectum, conjunctiva • Smear and microscopy exam • A smear may show the presence of G- cocci present in polymorphonuclear cells • Cultivation and isolation • Culture is essential for definitive diagnosis • Special care is needed to keep the temperature and moisture to preserve the bacteria • Bacterial antigen detection • Nucleic acid detection

  41. Prevention and Treatment • There is no vaccine • since strains are highly variable in their external antigens (both outer membrane and pili) • Social management, surveillance, and prevention are more effective than drug • Instillation for neonates

  42. Antibiotic Therapy • Penicillin therapy is still usually effective • Because of the problems with antimicrobial resistance in N gonorrhoeae, it is recommends that uncomplicated genital infections be treated with ceftriaxone given intramuscularly as a single dose • Additional therapy • doxycycline orally twice a day for 7 days, is recommended for the possible concomitant chlamydial infection • Erythromycin base orally four times a day for 7 days, is substituted for doxycycline in pregnant women • ceftriaxone • A beta-lactamase-resistant cephalosporin

  43. 标本 保暖、保湿、立即送检 直接涂片镜检 分离培养与鉴定 巧克力色培养基及生化反应 快速诊断法 抗原检测：ELISA法、 核酸检测：杂交、PCR技术 微生物学检查法

  44. Syphilis& Treponema pallidum

  45. 8种性病发病率均在上升，但以梅毒为甚，有些地区呈现高速增长势头。 • 梅毒过去与麻风、结核并列称为世界三大慢性传染病。 • 梅毒危害严重，传染性大，症状多样，易误诊漏诊。特别是梅毒患者感染艾滋病的危险性比常人增加4～5倍，从而会促进艾滋病的传播。

  46. 1985～2006年全国梅毒发病流行趋势(说明 ：1991～2004年为全国性病病例报告系统数据，2005与2006年为全国网络报告数据)

  47. 2006年全国梅毒发病年龄与性别分布

  48. 2006年全国梅毒病例分期/类

  49. Syphilis • Caused by bacteria treponema pallidum • Found in the remains of American natives 5000 years old • AIDS of the 16th century • Columbus, Beethoven, Goya, Keats, James Joyce, Oscar Wilde, Peter the Great, Napoleon, and a few popes all had syphilis • Bacteria enters through the mucous membranes of mouth, genital tract, rectum

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