Sexually Transmitted Diseases

(STD)

 Introduction.
 Important facts
 Important STDs
 Discussion about common & important STDs.

Guide: Dr. Mrs. Sumitra Yadav

Introduction

 STDs, once called venereal diseases, also

known as Sexually transmitted infections or
STI.
 Defined as the infections that can be
transferred from one person to another
through sexual contact
 More than 20 STDs have now been identified.
Important facts about STDs.

1. They affect men & women of all backgrounds &

economic levels, being most prevalent among
teenagers & young adults, nearly two-thirds
occur in people <25 yrs.
2. The incidence is rising- young people become
sexually active earlier, have multiple sex partners.
3. STDs may be asymptomatic, even then infected
person is capable of transmitting the disease to
partner.
Facts (contd...)
4. Some STD can spread into
the uterus, tubes & ovaries
to cause PID,which in turn
is a major cause of
infertility & ectopic
pregnancy.
5. In female some STD may
be associated with cervical
cancer. e.g.HPV 16,18,31
6. STD can be transmitted
vertically from mother to
baby before, during or
immediately after birth.
7. When diagnosed & treated
early, many STD can be
treated effectively.
8. Having STD increases the
risk for infection with HIV.
Signs and Symptoms

See a Medical Professional if These

Symptoms are Present

IN WOMEN:
 Unusual discharge or odor from the vagina

 Burning or itching around the vagina

 Bleeding from vagina not associated with period

 Pelvic pain during sexual intercourse

 Persistent unexplained pain in pelvic area

IN MEN:
 Pus or other discharge from the penis
Signs and Symptoms

IN BOTH WOMEN AND MEN:

 Sores, bumps or blisters on or near the sex

organs, mouth or anus

 Burning or pain during urination or bowel

movement
 Flu-like symptoms, with fever, chills, body

aches
Key Points to Remember

 Many STD’S have no signs or symptoms

 At times, symptoms may go away even though
the STD is still present
 You may believe your medical provider is
checking you for STD’s during a regular
physical check up, when, in fact they are not.
During most visits you will need to specifically
ask for these tests and discuss your risk with
your provider.
Transmission

Most STD’s are spread by:

 Vaginal sex
 Oral sex
 Anal sex
 Sharing needles when injecting drugs,
performing body piercing, or tattooing
 Infected mother to newborn
Complications / Consequences
If left untreated, some STD’s can:
 Be serious and painful
 Cause permanent damage to reproductive organs
 Lead to infertility in both men and women
 Spread to other sex partners or needle sharing
partners
 Infect newborns possibly leading to serious
complications or even death of the infant
 Cause heart disease, blindness, arthritis, brain
damage, or death
 Many STD’s increase susceptibility to HIV/AIDS
Important STDs

1. Chlamydial infection 9. Chancroid

2. Gonorrhea 10. Bacterial vaginosis
11. Granuloma inguinale
3. Genital Herpes. (donovanosis).
4. HPV & genital warts. 12. Lymphogranuloma
5. Syphilis venereum
13. Molluscum contagiosum
6. HIV/AIDS.
14. Pubic lice
7. Trichomoniasis 15. Scabies
8. Hepatitis B 16. Vaginal candidiasis.
Chlamydial infection
 Now the most common  Causative org.-Chlamydia
of all bacterial STD. trachomatisobligatory
intracellular Gm-ve bacteria.
 Dangerous because  Infection mostly localised in
usually asymptomatic. the urethra, Bartholin’s gland
75% of infected women & cervix. Can ascend
& 25% of infected men upwards to cause PID, can
are asymptomatic. lead to ectopic pregnancy,
infertility or chronic pelvic
pain
 More risk of getting HIV
Chlamydial infections (contd...)
 Clinical features-  Diagnosis-tissue culture,
abnormal mucopurulent Antigen detection (ELISA),
discharge, burning serology for antibody titre.
micturition pain in lower  Treatment-Azithromycin 1 gm
abdomen.Findings- single dose,Doxycycline
Cervical edema, (100mg) BD or Erythromycin
discharge. (500mg) QID for 7 days .
 Treat the partner also with the
 Can cause premature
same regime, even if
delivery, neonatal eye asymptomatic.
infections & pneumonia  Latex condoms can reduce
risk of infection.
Gonorrhea
 Causative org-Neissaria
gonorrheae-a Gm-ve
diplococcus.
 Clinical features- may be
asymptomatic- abnormal
purulent vaginal discharge,
dysuriaPID with its
consequences. Untreated can
infect the joints, heart valves
&/or the brain.
 Findings- purulent discharge,
swollen inflamed labia with
tenderness, congested cervix
etc.
 Can cause blindness,
meningitis, septic arthritis in
infants.
 Diagnosis-Swab from urethra,
endocervix for Gm stain & c/s,
VDRL
Gonorrhea (contd...)
 Treatment-CDC  Latex condom can
guidelines reduce but not eliminate
 Aqueous procaine the risk of contracting
penicillin- 2.4 mega units the disease during
IM or Tab ciprofloxacin sexual contact.
500 mg single dose or
Cefixime 400 mg single
dose or Inj. Ceftriaxone 1
gm IM single dose.
 Treat the partner also
Genital Herpes.
 Caused by Herpes simplex
virus type 2.
 Symptoms- itching or burning
sensation, painful blisters or
open sores in the genital
area. May be preceded by a
tingling or burning sensation
in the legs, buttocks or genital
region.Multiple
vesiclesshallow ulcers on
clitoris, labia & vestibule
 Sores usually disappear
within 2-3 weeks, but the
virus remains in the body for
life & lesions may recur form
time to time.
 Diagnosis-smear for vesicles-
intranuclear inclusion bodies
in multinucleated giant cell,
tissue culture, antibody titre.
 Sores provide an entry point
for HIV.
Genital Herpes
 Increased risk of  Treatment- Antiviral
premature delivery. drugs help control the
Infection to neonate may symptoms but do not
result in possible death eliminate the virus from
the body.Acyclovir
or serious brain damage. 200mg 5 times a day for
Active infection during 7 days.Topical acyclovir
labor indicate the need as 5% ointment.
for cesarean section.  Condom can reduce the
risk.
Genital warts
 Caused by Human  Association with malignancy
Papilloma Virus type 6 , of cervix , vagina &
vulva,HPV 16,18,31
11.Also called venereal  Infants can develop warts in
warts or condylomata the throat which can obstruct
acuminata the airway.
 Symptoms: Painless  Treatment: no known cure.
fleshy, cauliflower-like Warts can be suppressed by
chemicals, cryotherapy, laser
warts on & inside the
or surgery. 20% podophyllin
genitals, anus & throat. can be used.
Syphilis
 Caused by Treponema
pallidum.
 Initial symptom- painless
sores or Chancres on genitals
may go undetected. Heal
spontaneously in 1-8 wks.If
untreated more advanced
stages with transient rash,
fever with sore throat, hair
loss, condyloma lata in vulva-
coarse, moist & necrotic.
 May cause serious damage
to heart, brain, eyes, nervous
system, bones, joints etc.
 Still birth, NND, damage to
infant’s heart, brain & eyes.
 Diagnosis: smear from the
lesion-dark ground
illumination microscopy,
VDRL, TPHA test, Antibody
test.
Syphilis (contd...)
 Treatment-Penicillin  Tetracycline or
remains the most erythromycin 500mg QID
effective drug. for 14 days is also
 Benzathine penicillin G effective in penicillin
2.4 megaunits IM in a allergic cases.
single dose half in each  Condom can reduce the
buttock. risk of transmission.
HIV/AIDS
 Caused by Human
immunodeficiency virus.
 Destroys the body’s ability to
fight off infections.
susceptible to life-threatening
oppotunistic infections and to
certain forms of cancer.
 No known cure. Eventually
develop AIDS & die of AIDS
related complications.
 20-30% of newborns born to
infected mother are infected &
develop AIDS within one
year .
 Symptoms: may be
asymptomatic at first.Flu-like
symptoms with fever, loss of
appetite, weight loss, fatigue
& enlarged lymph nodes.
HIV/AIDS (contd...)
 Initial symptoms  Treatment- no known cure.
disappear within a wk or Antiviral drugs used to
a month, virus remaining prolong the life & improve the
dormant for many years, health. Other drugs used to
but continues to weaken treat opportunistic infections.
the immune system.  Zidovudine 150-500mg in
divided doses.
 Diagnosis: ELISA-
 Condoms can reduce but not
screening procedure,
eliminate the risk of
Westernblot test- highly transmission.
specific- confirmatory.
Trichomoniasis
 Caused by a protozoan  Increase the chance of
Trichomonas vaginalis HIV infection
 Most common curable  Risk of preterm delivery.
STD.
 Treatment with
 May be
asymptomatic.Excessive metronizole or tinidazole.
, foamy diffuse, yellow-  Treat the partner also.
green discharge,
dysuria, pain in vagina
with itching.
Bacterial Vaginosis
 Caused by Gardnerella  Diagnosis- wet saline
vaginalis, Bacteroides, smear- Clue cells-
Mycoplasma hominis, epithelial cells
Ureaplasma urealyticum surrounded by
& Mobiluncus sps. coccobacilli all over the
 Creamy vaginal surface.
discharge with fishy  Treatment with
smell metronidazole.
Chancroid
 Caused by Hemophilus  Treatment- Tetracycline
ducreyi. 500mg QID for 2 weeks,
 Multiple vesicopustules Azithromycin 1 gm single
over vulva, vagina, dose or Ceftriaxone 250
cervix. shallow ulcer. mg IM single dose.
Inguinal lymphadenitis
may occur.
 Syphilis to be excluded.
Granuloma inguinale
 Caused by Donovania  Diagnosis- Donovan
granulomatis. bodies (safety pin
 Painless ulcers at appearance)within the
external mononuclear cells in
genitalia.Inguinal lymph material from the ulcer.
nodes enlarge.  Treatment- Doxycycline
100 mg BD for 3 weeks
or Tetracycline or
ampicillin.
Lymphogranuloma venereum
 Caused by Chlamydia  Diagnosis- Intradermal
trachomatis. Frei test, complement
 Painless papule, pustule fixation test.
or ulcer in vulva  Treatment- Doxycycline
 Inguinal glands feel 100 mg BD for 3 weeks
rubbery, necrosed &
or Tetracycline,
form abscesses.
Aspiration of abscess.
 Healing with intense
fibrosis & lymphatic
obstruction.
Molluscum contagiosum
 Caused by a pox virus.  Treatment- removal of
 Smooth, shiny lesions lesion by diathermy or
often umbilicated. cryosurgery. Application
Multiple & can occur of phenol.
anywhere in the skin.
 Microscopically-
numerous inclusion
bodies in cytoplasm
Prevention of STD
1. Have a mutually
monogamous sexual
relationship with an
uninfected partner.
2. Correct & consistent use
of condom.
3. Delay having sexual
relations as long as
possible. Younger the age
of first sexual contact, the
more susceptible they are
to STD.
4. Sexually active
persons should have
regular checkups
even in the absence
of symptoms.
5. Immediate treatment
when diagnosed.
6. Notify all recent sex
partners & urge them
to have checkup.
Prevention (contd...)

7. Always treat the partner also.

8. Follow the instructions & complete the full
course of medications.
9. A follow-up test may be needed to ensure
that infection has been cured.
10. Avoid all sexual activity while being
treated for STD.
Syndromic management: