Sexually Transmitted Diseases

1. Sexually TransmittedDiseases

2. What is a Sexually Transmitted Disease? • STD’s are infections that are spread from person to person through intimate sexual contact. • STD’s are dangerous because they are easily spread and it is hard to tell just by looking who has an STD. • 1 in 4 teenagers has an STD. www.sareh-abdollahi.ir

3. Pregnant teen girls are carrying on average 2.3 sexually transmitted diseases. • Each day 33, 000 Americans become infected with an STD. • Today 12 thousand teenagers will contract a sexually transmitted disease www.sareh-abdollahi.ir

4. In l980, four million people were reported to have been infected with an STD.  By 1990 that number tripled with 12 million people reported to have a new STD infection that year.  • Today, one in every five Americans between ages 15 and 55 is infected with at least one sexually transmitted disease.  • The Centers for Disease Control reports there are now more than 50 known STDs. Some STDs can make you sterile. Some are incurable. www.sareh-abdollahi.ir

5. Common STDs • Chlamydia • Gonorrhea • Genital Herpes (HSV-2) • Genital Warts (HPV) • Hepatitis B • HIV and AIDS • Pubic Lice • Syphilis • Trichomoniasis www.sareh-abdollahi.ir

6. Syphilis • Caused by bacteria called Trepenomapallidum. • If not treated Syphilis can be very dangerous and can cause brain damage and other serious health problems. • If you are diagnosed as having the disease you can be treated with antibiotics. • Anyone with whom you’ve had sex will also need to be treated www.sareh-abdollahi.ir

7. Syphilis • A multistage systemic disease. • A bacterial infection caused by the spirochaete Treponema Pallidum • Under a microscope the spirochaete is corkscrew shaped with 6-18 spirals • The incubation period is stated as 6-90 days

8. Treponema pallidum Pathogenesis www.sareh-abdollahi.ir Electron photomicrograph, 36,000 x. Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

9. Pathogenesis Treponema pallidum on darkfield microscopy www.sareh-abdollahi.ir Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

10. Stages of disease process Primary Syphilis Early (Infectious) Secondary Syphilis Early latent Syphilis Late (low level infectivity) Late latent Syphilis Tertiary Syphilis

11. Primary Syphilis –The chancre, a painless, usually solitary ulcer appears 9-90 days after sexual contact at the site of initial infection. • Secondary Syphilis– Approx 90% present with a rash, it is generalized with the trunk being affected in 80% and the palms and soles in 50%. 75% also have lymphadenopathy. Other clinical manifestations include mouth ulcers, patchy alopecia, meningitis and hepatitis. These features are caused by a systemic vasculitis caused by high levels of treponema in the blood and associated immunological response.

12. Sites of primary syphilis • EXTRAGENITAL • Lip • Tongue • Mouth, tonsil, pharynx • Fingers • Eyelid • Nipple • Any pat of the skin or mucous membranes. GENITAL • Shaft of Penis • Coronal sulcus • Glans Penis • Prepuce • Urethral Meatus • Anal Margin and Canal • Rectum • Labia minora, labia majora • Fourchette • Clitoris • Vaginal Wall • Cervix

13. Latent Syphilis – (Early) A-symptomatic with positive serology up to 2 years. • (late) A-symptomatic with positive serology over two years after acquisition. • Tertiary Syphilis - Gumma - Cardiovascular - Neurological

14. Transmission • Sexual contact • Previously blood transfusion (now blood tested) • Mother to foetus via placenta or during birth • Not contracted from toilet seats, swimming pools or saunas

15. Testing • Serological testing (Preferred choice) • Treponema pallidum enzyme immunoassay (EIA) is recommended as it tends to be more sensitive in primary infection. • Direct detection of T.pallidum in primary and secondary syphilis. Dark ground microscopy. (ltd to specialist areas, not suitable for oral lesions) • Lymph node aspiration • Follow up monitoring at 3, 6 and 12 months.

16. Treatment Early Syphilis • Procaine PenicillinG (IM) 600-750mg daily 10 days • BenzathinePenicillin 2.4g IM twice, a week apart. • Doxycycline 100mg bd 14 days Latent Syphilis • Procaine penicillin G (IM) 600-750mg daily 17 days • Benzathine Penicillin 2.4g IM x3, a week apart. • Doxycycline 200mg bd 28 days • Neurosyphilis – specialist care.

17. Statistics • Between 2001-2011 there has been a 1954% increase in diagnosis of infectious syphilis. • Since the outbreak in 2001 – 2011, 4090 cases. • In 2011 829 new cases 68% among msm.

18. Diagnoses of infectious syphilis (primary, secondary and early latent) by sex and sexual orientation, London enhanced syphilis surveillance: April 2001 - December 2011 Data source: London Enhanced Syphilis Surveillance

19. Clinical Manifestations Primary Syphilis • Primary lesion or "chancre" develops at the site of inoculation • Chancre: • Progresses from macule to papule to ulcer • Typically painless, indurated, and has a clean base • Highly infectious • Heals spontaneously within 1 to 6 weeks • 25% present with multiple lesions • Regional lymphadenopathy: classically rubbery, painless, bilateral • Serologic tests for syphilis may not be positive during early primary syphilis www.sareh-abdollahi.ir

20. Clinical Manifestations Primary Syphilis- Penile Chancre www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

21. Clinical Manifestations Primary Syphilis – Labial Chancre www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

22. Clinical Manifestations Primary Syphilis – Perianal Chancre www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

23. Clinical Manifestations Syphilis Lesion - Tongue www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention /STD Clinical Slides

24. Clinical Manifestations Secondary Syphilis • Secondary lesions occur 3 to 6 weeks after the primary chancre appears; may persist for weeks to months • Primary and secondary stages may overlap • Mucocutaneous lesions most common • Manifestations: • Rash (75%-100%) • Lymphadenopathy (50%-86%) • Malaise • Mucous patches (6%-30%) • Condylomatalata (10%-20%) • Alopecia (5%) • Serologic tests are usually highest in titer during this stage www.sareh-abdollahi.ir

25. Clinical Manifestations Secondary Syphilis - Papulosquamous Rash www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

26. Clinical Manifestations Secondary Syphilis: Palmar/Plantar Rash www.sareh-abdollahi.ir Source: Seattle STD/HIV Prevention Training Center at the University of Washington, UW HSCER Slide Bank Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

27. Clinical Manifestations Secondary Syphilis: Generalized Body Rash www.sareh-abdollahi.ir Source: Cincinnati STD/HIV Prevention Training Center Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

28. Clinical Manifestations Secondary Syphilis – Papulo-pustular Rash www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

29. Clinical Manifestations Secondary Syphilis - Condylomata lata www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

30. Clinical Manifestations Secondary Syphilis – Nickel/Dime Lesions www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

31. Clinical Manifestations Secondary Syphilis - Alopecia www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

32. Clinical Manifestations Latent Syphilis • Host suppresses the infection enough so that no lesions are clinically apparent • Only evidence is positive serologic test for syphilis • May occur between primary and secondary stages, between secondary relapses, and after secondary stage • Categories: • Early latent: <1 year duration • Late latent: 1 year duration www.sareh-abdollahi.ir

33. Clinical Manifestations Neurosyphilis • Occurs when T. pallidum invades the CNS • May occur at any stage of syphilis • Can be asymptomatic • Early neurosyphilis occurs a few months to a few years after infection • Clinical manifestations include acute syphilitic meningitis, meningovascular syphilis, ocular involvement • Late neurosyphilis occurs decades after infection and is rarely seen • Clinical manifestations include general paresis, tabes dorsalis, ocular involvement www.sareh-abdollahi.ir

34. Clinical Manifestations Neurosyphilis - Spirochetes in Neural Tissue www.sareh-abdollahi.ir Silver stain, 950x Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

35. Clinical Manifestations Tertiary (Late) Syphilis • Approximately 30% of untreated patients progress to the tertiary stage within 1 to 20 years • Rare because of the widespread availability and use of antibiotics • Manifestations • Gummatous lesions • Cardiovascular syphilis www.sareh-abdollahi.ir

36. Clinical Manifestations Late Syphilis - Serpiginous Gummata of Forearm www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

37. Clinical Manifestations Late Syphilis - Ulcerating Gumma www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

38. Clinical Manifestations Late Syphilis--Cardiovascular www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

39. Clinical Manifestations Congenital Syphilis • Occurs when T. pallidum is transmitted from a pregnant woman with syphilis to her fetus • May lead to stillbirth, neonatal death, and infant disorders such as deafness, neurologic impairment, and bone deformities • Transmission to the fetus in pregnancy can occur during any stage of syphilis; risk is much higher during primary and secondary syphilis • Fetal infection can occur during any trimester of pregnancy • Wide spectrum of severity exists; only severe cases are clinically apparent at birth • Early lesions (most common): Infants <2 years old; usually inflammatory • Late lesions: Children >2 years old; tend to be immunologic and destructive www.sareh-abdollahi.ir

40. Clinical Manifestations Congenital Syphilis - Mucous Patches www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

41. Clinical Manifestations Congenital Syphilis - Hutchinson’s Teeth www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

42. Clinical Manifestations Congenital Syphilis - Perforation of Palate www.sareh-abdollahi.ir Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

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45. Chlamydia • Caused by bacteriacalled Chlamydia Trachomatis. • Chlamydia is one of the most common sexually transmitted infections. • Chlamydia is curable. • Your healthcare provider will give you antibiotics for treatment. • Anyone with whom you’ve had sex will also need to be treated www.sareh-abdollahi.ir

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47. Bacteria: Chlamydia Source: Seattle STD/HIV Prevention Training Center

48. One attack of Chlamydia leaves you with a 35% chance of infertility (never being able to have children) A second attack of Chlamydia raises that percentage to close to 50%. A third attack of Chlamydia, and there is a very good chance you will never have children. www.sareh-abdollahi.ir

49. Untreated chlamydia infections in women may lead to: • Pelvic Inflammatory Disease (PID). PID is a serious infection of a woman's reproductive organs. Left untreated, PID can cause infertility. • Cystitis (inflammation of the urinary bladder) • Mucopurulent (muke-o-PURE-you-lent) cervicitis, characterized by a yellow discharge from the cervix www.sareh-abdollahi.ir

50. Untreated chlamydia in men may lead to: • Prostatitis (inflammation of the prostate gland) • Urethral scarring • Infertility • Epididymitis (inflammation of the epididymis, which are the elongated, cord-like structure that runs along the back of the testes) www.sareh-abdollahi.ir