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Below is vital information on leading Sexually Transmitted
Diseases.
Click on the name of the diseases below to learn more or contact
us today for more information.
List of leading Sexually Transmitted Diseases.
The information below originally created and presented by Dr.
Alean Zeiler.
Sexually Transmitted Diseases (STD)
/ Sexually Transmitted Infections (STI)
Syphilis
Gonorrhea
Chlamydia
Pelvic Inflamatory Disease (PID)
Human Papilloma Virus (HPV)
HIV/AIDS
AIDS
HAART
Post Exposure Prophylaxis
Trichomonas Vaginalis
Herpes
Hepatitis
Hepatitis B - DNA Virus
Hepatitis C - RNA Virus
Chancroid - Hemoplilies Ducreyi
Lymphogranuloma Venereum
Granuloma Inguinale (Donovanosis)
Ureaplasma Urealyticum - Mycoplasm Genitalium
Pharyngitis
Anorectal
Contraceptive Update
Sexually Transmitted Diseases (STD) /
Sexually Transmitted Infections (STI)
- One in four sexually active teens will contract an STI every
year.
- Half of new HIV diagnosed in those under 25.
- 15 million new sexually transmitted infections in US annually.
- Re-screen infected teens every six months - 50-70% re-infection
- Annual screening recommended for all sexually active
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SYPHILIS
- Serious Bacterial Infection Requiring Immediate Treatment
- Caused by Spirochete - Treponema Pallidum
- Primary, Secondary and Tertiary Stages
- Treated with antibiotics - usually Penicillin
- Sporadic outbreaks
- Tests
- VDRL or RPR - take months to become positive
- FTA - confirmatory test - will stay positive
- Newborns exposed to Syphilis in utero have multiple abnormalities
including bone deformities and Meningitis
- Test for other STD's, retest and treat contacts.
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GONORRHEA
- Caused by gram negative bacteria
- Second most frequently reported STD - 600,000 new cases per
year
- 90% of men develop symptoms within 5 days - less than 50 % of
women develop symptoms.
- Pain on urination, yellow green vaginal or urethral discharge
- In females may progress to PID - Pelvic Inflammatory Disease
- which can cause infertility
- Diagnosed by screening or culture on special media
- Treatable with antibiotics although there are some resistant
strains so patients must return for re-culture after treatment.
- If newborn exposed to GC through the birth canal and eyes not
treated can result in blindness
- Disseminated Gonorrhea
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CHLAMYDIA - Most frequently
reported STD
- 10-25% of sexually active adolescents are infected
- 75% of these are asymptomatic
- 25% of untreated females develop infection in fallopian tubes
especially if recurrent infections
- Recommended yearly screening for all adolescent sexually active
females
- Symptoms include Cervicitis with Mucopurulent discharge, Urethritis,
Epididymitis, Proctitis, Pharyngitis, Conjunctivitis
- Cause of Reiter's Syndrome (SARA) sexually acquired reactive
arthritis - involving knees, ankles, back and uveitis
- Cause of Fitz-Hugh-Curtis Syndrome Infection around liver giving
right upper abdominal pain and fever
- Same long term consequences of infertility and ecotpic pregnancy
as GC
- Treated with antibiotics - no definite evidence of benefit of
empirically treating both GC and Chlamydia
- Diagnosed by screening or special culture
- Newborns born to mothers with Chlamydia can develop eye infections
and pneumonia
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PELVIC INFLAMATORY DISEASE (PID)
Spread of infection to female upper genital structures
- Less than 50% culture positive for Chlamydia or Gonococcus
- Often accompanied by abdominal and pelvic pain and fever, infection
of endometrium ovaries fallopian tubes and perihepatic area (Fitz-Hugh-Curtis
Syndrome), fever, purulent discharge, abnormal bleeding
- Ultrasound or MRI used to show tubal abscesses, thickened fluid
filled fallopian tubes or free fluid in peritoneum
- May need laproscopy
- Frequently requires hospitalization for IV antibiotics and control
of pain
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HUMAN PAPILLOMA VIRUS (HPV)
- Incubation 3-8 months
- Adolescents more susceptible due to cervical ectopy and increased
columnar epithelium - now in question (more sex partners more
mature epithelium)
- 90% of cervical cancer caused by 18 high risk stereotypes of
HPV
- Cervical abnormalities associated with types 16, 18, 31, 33,
and 45
- Cause of laryngeal papillomas in newborns C-section not protective
- RRP - Recurrent Respiratory Papillomatosis - adults 1.1/100,000
- Increasing cause of oral cancer
- 70% of sexually active females positive - most no actual warts
- Abnormal pap in adolescent population spontaneously resolves
without intervention - generally 8 years from persistent infection
to cancer in situ
- 5-10% become carriers, most resolve spontaneously
- Incidence of cervical cancer in 15-19 year olds is zero and
1.7/100,000 for 20-24 year olds if immunocompetent
- New recommendation for pap smears and routine pelvic exams is
now 3 years after initiation of sexual activity of 21 year old
(urine screening for Chlamydia still recommended at least yearly)
- No evidence condoms prevent but may decrease cancer by decreasing
co-factors, HIV and Chlamydia
- Increased risk with progesterones, other infections, immune
deficiency, smoking, pregnancy and diabetes
- Vaccine for HPV 16 clinically effective in trials - now bivalent
and quadrivalent, safe but unknown duration of effect - 88-100%
in preventing lesions
- Treatments for warts
- 5-10% carriers - cancer late in life
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HIV / AIDS
- 43,000 new cases in US in 2002 - 50% of new cases in 2004 in
13-24 year olds
- CDC only reports method of transmission as heterosexual if no
other source - so could be more than shown
- 30% of women with HIV have no risk factors - sole sexual partner
- Retrovirus replicates in CD4 cells, HSV recruits CD4 cells to
mucosa
- Most patients asymptomatic for up to 10 years but still infectious
- Most at risk least likely to be tested and 40% in HIV clinic
admit to non - disclosure
- Takes 3 weeks to 6 months usually for tests to become positive
after exposure
- Transmission
- Nonoxyl 9 and other STD's with ulceration increase transmission
- Prevention
- Testing
- ELISA - Enzyme Immunoabsorbant Assay done twice, if positive
confirm with Western Blot
- Rapid Tests - Urine, saliva caution with sensitivity of result
- Viral Load - Used to assess course and treatment, most predictive
of risk of transmission
- Treatment, Not Cure
- Drug regimens expensive, difficult
- Many side effects
- Diarrhea, anemia, Lactic acidosis, allergy, neuropathy,
pancreatitis
- Coronary artery disease, cholesterol elevation
- Lipodystrophy and weight gain
- Resistance
- 10-15% of children are out of options
- T20, only recent new drug is injectable only
- HIV Stages
- A - Asymptomatic (or N)
- B - Symptomatic - fever, diarrhea, weight loss, rashes, candidiasis,
abnormal pap, PID, Herpes Zoster, listerosis
- C - Full blown AIDS
- Acute Symptoms - Within 2-6 weeks of exposure
- Flu or mono-like illness
- Fever, adenopathy, pharyngitis, rash or ulcerations, myalgia,
arthralgia headache, diarrhea, occasional meningoencephalitis
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AIDS
- CD4 Count <200 <14%
- Yeast Infections, Herpes breakouts, and spread, Zoster, Pneumocystis
Carinii Pneumonia, Crytococcocis, Histoplasmosis, Toxoplasmosis,
Mycobacterium Avium, Aspergillus, Tuberculosis, Wasting, Diarrhea,
Visual Problems, Kaposi Sarcoma
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HAART - Highly Active Antiretroviral
Therapy
3 Drugs Decrease Mortality by 85%
- Nucleoside Reverse Transcriptase
- Non Nucleoside Reverse Transcriptase
- Protease Inhibitors
- Reduce Transmission to Newborn by 2.6%
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POST EXPOSURE PROPHYLAXIS
- Cost $1,000
- Avoid Secondary Transmission
- Use 3 drug Combination
- Treat Within 72 Hours for One month
- Sexual Contacts - How many times?
- Occupational exposure to blood, CSF, Synovial, Pericardial,
Peritoneal and Amniotic Fluids, Unfixed Tissues (low risk with
exposure to blood free saliva), Urine, Feces (including diarrhea)
and vomiting
- Depends also on amount of exposure and timing
- No evidence of infection from discarded needles
- Transmission by human bites reported but rare 0.1% or less
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TRICHOMONAS VAGINALIS
- Protozoan
- Incubation 4 days to 4 weeks
- Infection of Vagina, Urethra, Cervix, and Prostate
- Malodorous profuse frothy vaginal discharge, itching and pain
- 50% Asymptomatic
- Punctate Hemorrhages "Strawberry Spots" on cervix and vagina
- Flagellated Organisms found on wet Prep, Pap or in urine
- Treatment Metranidazole 2 grams
- Test for other STDs
- Treat Partners
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HERPES
Most Adults have had at Least One Type of Herpes Virus - Zoster
- Chicken Pox
- Labial and Genital Herpes are Simplex
- 25% of adults are infected and only 25% of these are symptomatic
- Originally divided into Type I (above the waist) and Type II
( Below the waist) - Now mixed
- Incubation 2-10 days. But may not have symptoms, especially
if already HSV1 positive
- Herpes Viruses live in nerve cells ascend along the Sensory
Nerve Roots and recur with Stress, Fever, Etc.
- First episode most likely to have more severe symptoms, burning
pain with blister like Vesicular Lesions which progress to Pustules
and Ulcers, Crust and Heal within 15-20 days - May extend to thighs,
buttocks, perianal area
- Usually shed virus 10-12 days
- More constitutional symptoms with first infection - pain on
urination, Inguinal Lymphaenopathy, Headache, Fever, Muscle Aches,
Hyperesthesia, may lead to Encephalitis
- Can be diagnosed by fluorescent antibody, PCR, EIA, NAAT or
Serology
- Asymptomatic contact probably responsible for 70% of new cases,
asymptomatic shedding 1-3% to 28% of days
- Antivirals only decrease transmission by 48% in one study
- Condom effectiveness - unknown vs. 60% more likely to be infected
in males
- Vaccine - 75% effective for women, HSV1 negative
- Pre-nataly Infected Newborn may have disseminated infection
which can be neurologically devastating or fatal
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HEPATITIS
• Liver infection caused by many different viruses,
some of them sexually transmitted
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HEPATITIS B - DNA VIRUS
- 5-10% develop chronic carrier state
- Transmitted to 90% of newborns at birth if not treated
- Can develop cirrhosis or Hepatocellar Carcinoma
- Risk Factors - Multiple sex partners, blood transfusion, intravenous
drug use, rarer household spread, only breast feed baby actively
and passively immunized
- 50% Sexually Transmitted in US more early household infections
in other areas
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HEPATITIS C - RNA VIRUS
- Leading cause of infectious chronic liver disease in US and
most frequent cause of Liver transplants
- Leading cause of liver transplant
- 20% sexually transmitted per CDC
- Chronic infection leads to Cirrhosis and Cancer
- Transmitted by blood, organ transplant, IV drugs, intranasal
cocaine use, sexual activity and prenatal exposure
- Rare household spread
- 1.8% risk after accidental needle stick
- 5% prenatal transmission - more with higher viral titers and
Co infection HIV
- Treatment - Interferon Ribavirin - No Cure
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CHANCROID - Hemoplilies Ducreyi
- Ulcers all cofactor for HIV transmission
- Gram negative rods, anaerobic, rare, often co-infection
- Incubation 4-7 days
- Papules, ulcers with Inguinal Lymphadenopathy called Buboes
progress to deep, painful ulcers and fistulas
- Ulcers produce purulent and hemorrhagic discharge
- Diagnose by culture (60%) or PCR
- Treated with Azithromycin
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LYMPHOGRANULOMA VENEREUM
- Rare in US, 4 recent reports from San Francisco
- Incubation 3-12 days
- Caused by Chlamydia Trachomatis
- Transient Ulceration with regional swollen Lymph nodes, Inguinal
or Femoral
- Proctocolitis, leading to fistulas and strictures
- Cultures only 30% - PCR Rising titers
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GRANULOMA INGUINALE (Donovanosis)
- Rare in US
- Caused by gram negative bacillus Calymmatobacterium Granulomatis
with dark staining Donovan bodies
- Granulating Ulcers without Lymphadenopathy
- Ulcers are painless and progressive
- May need biopsy to diagnose (not able to culture)
- Treat with TMPS or Doxycycline for 3 weeks
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UREAPLASMA UREALYTICUM - MYCOPLASM
GENITALIUM
- Non specific or non Gonococcal Urethritis
- Can cause Chorioamnionitis, Septic Arthritis and Neonatal Pneumonia,
Meningitis and Abscesses, PID, Pyelonephritis
- Diagnosed by culture (difficult) PCR or Serology
- Treated with Tetracycline or Erythromycin
- Treated as non-specific
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PHARYNGITIS - Rare but
possible
- Gonorrhea - Asymptomatic or mild sore throat
- HSV 1 and 2 - sore throat, swollen nodes, Myalgias
- Syphilis Chancres anywhere mouth or lips or throat
- HPV
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ANORECTAL
- HSV 1 and 2
- Syphilis
- Lymphogranuloma Venerum
- Granuloma Inguinale
- Anogenital Warts
- Procitis - GC, Chlamydia - Pain and discharge
- Prostatitis - Chlamydia, GC, Ureaplasma, Mycoplasma, Trichomonas
- Needs prolonged treatment with antibiotics due to poor penetration
into tissue
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CONTRACEPTIVE UPDATE
- Depo-Provera
- Black box warning - calcium
- Depression
- Weight gain
- 3 fold increase in GC and Chlamydia - behavior or thinning
vaginal lining
- Ortho-Evra - cardiovascular risks - patches
- Nonoxyl 9 - abrasions
- One in four teens don't know OCP no protection from STD
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