Sexually Transmitted Disease(STDs)

What is STD: Sexually transmitted disease (STDs) are agroup of communicable diseases that are transmitted predominantly by sexual contact and caused by a wide range of bacterial,viral,protozoal & fungal agents & ectoparasite.

Classification of STDs:

1.Disease manifested by discharge-

• Gonorrhea(N.gonorrhoae)
• Non gonococcal urethritis

2.Disease manifested by ulcer-

• Syphilis(T.pallidum)
• Herpes and cervical cancer(HHV-2 & HHV-1)
• Chancroid (H.ducreyi)
• Granuloma inguinale

3.Disease manifested by lumps-

• Lymphogranuloma venereum(Chlamydia trachomatis)
• Molluscum contagiosum(one of the pox virus)
• Genital warts(Papilloma virus)

4.Vaginitis-

• Trichomoniasis(T.vaginalis)
• Vaginal thrush(Candida albicans)
• Bacterial vaginitis(Gardnerella vaginalis)

5.Infestation with parasite-

• pediculosis pubis
• Genital scabies(Sarcoptes scabei hominis)

6.AIDS- HIV-I,HIV-II


7.Hepatitis virus- HBV,HCV,CMV

8.PID,Nonspecific urethritis,Proctitis,Cervicitis- Bacterial infection (Chlamydia,Mycoplasma, hominis,urea plasma)

9.Additional infection in homosexual man-

• Bacterial: Shigella,Salmonella,Campylobacter jejuni
• Viral: HIV-I,HIV-II,HBV,HDV,HCV,HAV,CMV
• Protozoal: Giardia,E.histolytica,Cryptosporidium and Microsporidium.
• Helminthic: Enterobius vermicularis,Trichuris trichuria,Strongyloides stercoralis.

Investigation of STD:

1.Material collection
a.urethral specimen or swab in urethritis
b.Vaginal swab in vaginitis
c.Cervical swab in women with or without puerperal sepsis
d.Fluid and pus from genital ulcer

2.Laboratory examinations:
Examinations are to be planned on clinical diagnosis-

A.First day-

• Microscopic examination of the specimen,Gram stain of the smear
• Culture of the specimen

B.Second day & onwards-

Serology:

1.Test for detection of HIV:

• ELISA-screening test
• Western blot-confirmatory test

2.Test for detection of HBsAg-(ELISA) ,Haemagglutination test.

3.Test for syphilis:

• VDRL test
• Complement fixation test
• Kahn test

4.Antitreponemal  antibody tests:

• TPHA
• FIA-ABS test

5.Other tests:

• Gonococcal CFT
• Herpes CFT
• Chlamydia CFT

Lymphogranuloma Venerum

It is a STD caused by Chlamydia tracomatis(L1,2,3)

Clinical features:

Primary lesions are 2 to 3mm vesicles or erosions over genitalia
Secondary-inguinal lymphadenopathy occurs after 2 weeks become swollen and tender
Bubo-ulcerated
Groove sign-due to swollen inguinal and femoral lymphnode(Inguinal ligament become tight-due to involvement of femoral and inguinal lymphnode)

Lymphogranuloma Venerum pictures:

Diagnosis:

1. Giemsa stain-lymphnode aspirate isolation of LGV agent
2. LGV-CFT
3. Microhemoagglutination test-confirm species and strain (L1,2,3)

Treatment:

Doxycycline 100mg for 21 days or Eryrhromycin
500mg q.d.s for 21 days

Chancroid

It is a STD caused by Hemophilus ducreyi
Incubation Period:3 to 10 days.

Clinical features:

• Ulcer is acutely inflamed
• Painful
• Tender
• Extends into the dermis and is yellowish red colour
• Covered by dirty exudates and
• Bleeds on touch

Inguinal lymphnode inflammed called bubo,glands may ulcerated
Multiple ulcers extends into each other
New ulcer formed by auto in oculation

Diagnosis:

1. Gram stain-school of fish appearance of ducreyi bacillus(H.ducreyi)
2. Culture-selective medium

Treatment:

1. Azithromycin-1gm single dose
2. Erythromycin-500mg q.d.s for days
3. Injection Ceftriaxone-250mg I.M single dose