1 / 30

Sexually Transmitted Diseases

Sexually Transmitted Diseases. Seema Izfar, MD 2/15/12. Sexually Transmitted Diseases. there are more than 25 diseases spread primarily by sexual means distal anoderm, perinanal skin, anoderm - can either be from anal intercourse or contiguous spread from other genitalia.

moke
Download Presentation

Sexually Transmitted Diseases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Sexually Transmitted Diseases • Seema Izfar, MD • 2/15/12

  2. Sexually Transmitted Diseases • there are more than 25 diseases spread primarily by sexual means • distal anoderm, perinanal skin, anoderm - can either be from anal intercourse or contiguous spread from other genitalia

  3. Sexually Transmitted Diseases • hard to diagnose • usually symptom of an organ rather than organism • often presence of more than one organism • true pathogen vs colonizing organism • lack of rapid sensitive diagnostic tests

  4. Anorectal Immunology • anal health requires integrity of skin and mucosa • immunoglobulin A (rectal mucosa) • cell-mediated immunity: Langherhan cells, T cells • HPV invades and increases Langherhan cells • HIV destroys LCs • HPV and HSV invade cell and destroy nm surveillance • HIV, HAART, +/- HSV may increase HPV-related dysplasia

  5. Gonorrhea • gram-negative diplococci • most common bacterial STD involving anorectum • occurs in columnar, cuboidal epithelium • frequently asymptomatic - incubation 3d - 2wks • 35-50% of women with cervical gonorrhea have rectal gonorrhea (contiguous spread)

  6. Gonorrhea

  7. Gonorrhea • symptoms: pruritus, tenesmus, bloody or mucopurulent discharge, pain • can have external erythema or superficial ulceration • anoscopy/proctoscopy with thick purulent discharge or nonspecific proctitis • lube may decrease yield of cxs • treat: cephalosporin or quinolone (penicillin G resistance high)

  8. Chlamydia/Lymphogranuloma Venereum • obligate intracellular organism • simultaneous infection with gonorrhea common - treat both • LGV serovars - more aggressive infection with perianal, anal, and rectal ulceration • anoscopy/proctoscopy with friable rectal mucosa - can be difficult to distinguish from Crohn’s • rectal gram stain - PMN’s without visible diplococci

  9. Chlamydia/Lymphogranuloma Venereum • can do direct fluroescent Ab detection or ELISA • or treat empirically - azithromycin one dose 1g orally, or doxy 100mg BID x 7days • LGV - doxy for 21 days • HIV and LGV may require longer therapy

  10. Syphilis • spirochete Treponema pallidum • primary (chancre or proctitis), secondary (condyloma lata) or tertiary • anal chancre - small papule that ulcerates - painful (differs from genital chancre) • can be difficult to distinguish from anal fissure

  11. Anal Syphilis

  12. Syphilis • primary within 2-10 wks exposure, secondary 4-10wks after primary lesion • secondary - hematogenous dissemination: fever, malaise, arthralgias, wt loss • findings: maculopapular rash, condyloma lata • symptoms resolve 3-12 wks rather, 25 % relapse (early latent syphilis)

  13. Syphilis • diagnosis: visualization of spirochetes on dark-field microscopy • also may be demonstrable on Warthin-Starry silver stain • RPR, VDRL - false neg 25% • treatment: penicillin G 2.4 million units IM, pen-allergic treated w doxy 100 BID x 14d • failure treated with re-dose pen G x 3 wks • f/u serology (RPR or VDRL) at 6 mos, re-check at 3mos for HIV positive pts

  14. Syphilis

  15. Haemophilus Ducreyi • gram-neg facultative anaerobe - causes ulcerating STD • more common in developing countries (only 6million global incidence) • tender papules with erythema --> pustules --> erosions • painful LAD - more common in males • facilitates transfer of HIV (ulcerations, open sores)

  16. Haemophilus Ducreyi • diagnosis by GS - nonmotile GNRs in groups • difficult to culture • PCR more sensitive • treatment - single-dose azithromycin 1g or ceftriaxone 250mg IM

  17. Danovanosis Inguinale • ulcerating lesion of genitalia - sexual and nonsexual transmission - C. granulomatosis or Donovania granulomatosis • more common in Africa, SA, Australia • subsequent sclerotic lesions can cause anal stenosis • cannot be cxed but can see macrophage inclusions on smear (Donovan bodies) • doxy 100 BID x 7 days or 3 wks azithro, cipro, or erythro

  18. Herpes Simplex Virus • DNA virus - same family as EBV, CMV, VZV • 20% population seropositive (50% in black females) • increasing HSV-1 genital transmission (30%) • clinical: systemic (fevers, HA, malaise), pina, vesicles, coalescence, healing

  19. Herpes Simplex Virus • HSV second most common cause of proctitis in homosexual males • distal 10cm - friable • sacral radiculopathy, urinary retention, constipation, impotence • tender LAD in 1/2 of pts • latency in host cell nuclei (sensory ganglia)

  20. Herpes Simplex Virus • diagnosis by clinical picture • pap smear or Tzank prep: multi-nucleated giant cells with inclusion bodies - ground glass • cxs from swabs or biopsies • direct immunofluorescence

  21. Herpes Simplex Virus • treatment of symptoms • can have shortened course of herpes proctitis with 10d acyclovir • IV acyclovir for severe symptoms • >five recurrences/yr considered for suppressive treatment - valyclovir, acylovir • daily valcyclovir suppression has show to lower transmission rate

  22. HPV • DNA papovirus - most common STD • 80 subtypes - 16 and 18 have highest risk of anal dysplasia • anoscopy - involvement above dentate line rare • destruction and fulguration of all gross disease - recurrence 20-30% • burn superficial condyloma without intruding on deep dermis or fat

  23. HPV • topical agents like podofilox or imiquimod not approved for us inside anal canal • podofilox - BID x 3 days, off 4 days - cycle one month • clearance 35-80% with recurrence 10-20% • imiquimod - increases local interferon production - 3x/wk x 16 wks • response in 50%, recurrence in 11%

  24. HPV • Bushke-Lowenstein tumor - giant condyloma, risk for underlying squamous or in situ SCC, excise with 1cm margins • chemorads for poor surgical candidates • can do APR if involving the sphincters

  25. Molluscum Contagiosum • poxvirus - benign papular condition • 2 to 6mm umbilicated papules • excisional bx with enlarged epithelial cells with intracytoplasmic molluscum bodies • treatment with eradication, can also use podophyllin or imiquimod

  26. HIV • ~5% pt with anorectal complaints HIV pos • several studies with poor wound healing and increased morbidity after anorectal procedures in HIV pts • assoc with presence of AIDS, dec. leukocytes, dec. CD4 • Morandi et al - 50% AIDS pts p hemorrhoidectomy with nonhealing wounds at 32 wks

  27. HIV • HIV anal fissures and ulcers - need to distinguish from STD ulceration like HSV or syphilis • HIV-related ulcers more proximal in anal canal (above dentate line) - surgical debridement, bx, cx, can inject with steroids to help w pain

More Related