Trichomoniasis
- definition
- etiopathogenesis
- infection (vulvovaginitis) caused by trichomonas vaginalis –> 90% urethral infection
- trichomonas enters through vagina or urethra
Trichomoniasis
-clinical features
females
- asymptomatic course 50%
- foul smelling, yellow-green, frothy, purulent discharge
- 2% - strawberry cervix - erythematous with petechia
-pruritus, burning sensation, redness of external genitalia, dyspareunia, frequent and painful urination
males
- asymptomatic
- urethritis
Trichomoniasis
- diagnosis
- treatment
-direct microscopy, culture, pH of vaginal discharge >4.5
- metronidazole - first choice
- treatment of partners
- avoid sexual intercourse during treatment
Bacterial vaginosis - not an STI
- definition
- etiopathogenesis
- risk factors
- vulvovaginitis
- normal vaginal flora has changed –> lactobacilli are replaced by anaerobes and aerobes –> vaginal pH increased
- pregnancy, contraception, frequent sexual intercourse, multiple sexual partners, immunosuppression, acquired immunodeficiency, smoking
Bacterial vaginosis
-clinical features
- asymptomatic 50%
- grayish - whitish homogeneous discharge
- unpleasant “fishy smell”
- probably itching, but usually no pain or pruritus
Bacterial vaginosis
- diagnosis
- treatment
- direct microscopy: absence of lactobacilli, presence of clue cells
- 3 of 4 Amsel’s classification: whiff test, vaginal pH >4.5, no leukocytes, clue cells
- first choice: metronidazole
- oral probiotics
Gonorrhea
- definition
- etiopathogenesis
-sexually transmitted infection caused by Neisseria gonorrhoeae
- facultative intracellular microorganism, survives only in host cells using its energy
- invades cylindrical epithelium - detected in: cervix, urethra, rectum, conjunctiva, pharynx
Gonorrhea
- epidemiology
- risk factors
- most common STI, 15-24 y.o
- multiple sexual partners, low socioeconomic status, lack of protection
Gonorrhea
- diagnosis
- treatment
- anamnesis, molecular diagnostics, discharge microscopy (PMN leukocytes with gonorrhea diplococci), culture
- third generation cephalosporins: ceftriaxone
Gonorrhea
-clinical features
-polyuria, dysuria, dyspareunia, purulent (yellow) odorless discharge
women:
-cervicitis, urethritis, pelvic inflammatory disease, bartolinitis (vulval edema, pain, discharge)
men:
-urethritis, epididymitis, proctitis
complications: pharyngitis, conjunctivitis (usually in newborns)
Urogenital chlamydiosis
- epidemiology
- risk factors
- most common STI among adolescent up to 25 y.o
- multiple sexual partners, low socioeconomic status, lack of protection
Urogenital chlamydiosis
- diagnosis
- treatment
- anamnesis, molecular diagnostics, discharge microscopy (non-specific findings, leukocytes increased but usually normal!)
- Doxycycline or Azithromycin (pregnant women)
Urogenital chlamydiosis
-clinical features
-polyuria, dysuria, dyspareunia, purulent odorless vaginal discharge
women:
-cervicitis, urethritis, pelvic inflammatory disease, peri hepatitis, pregnancy complications,
men:
-urethritis, epididymitis, prostatitis, proctitis
Syphilis
- definition
- infected through:
-systemic disease caused by Treponema pallidum
- sexual contact, blood transfusion, direct contact with the pathogen in saliva/mothers milk/ semen/vaginal discharge, transmitted through the placenta 12-16 week
- sweat, tears, urine –> not contagious
Syphilis
- epidemiology
- risk factors
- male more than female
- unprotected sex
Syphilis
- diagnosis
- treatment
- history, symptoms, direct T. pallidum identification, T. Pallidum Ab detection, biopsy
- non-treponemal tests, treponemal tests, dark field microscopy, PCR, CSF examination
- penicillin G
- VDRL test every 3 months after therapy
Syphilis
-classification
Acquired - early and late
- stages: primary, secondary, early latent, late latent, tertiary
- tertiary - gummatous, cardiovascular, neurosyphilis
Congenital
Syphilis
-classification
Acquired - early and late
- stages: primary, secondary, early latent, late latent, tertiary
- tertiary - gummatous, cardiovascular, neurosyphilis
Congenital
Syphilis - clinical features
-Primary stage (6)
- infection site papule –> painless ulcus durum (fluid is rich in spirochetes)
- resolves within 3-6 weeks, 10-14 days when treated
- ulcus/ erosion with elevated border and cartilage with surrounding erythema and local lymphadenopathy
- males - glands, foreskin
- females - rarely detected - cervix, labia minora and majora, periurethral
- oral mucosa, lips, rectum, nipples, ears, fingers
Syphilis - clinical features
-Secondary stage
- due to spirchetal multiplication and dissemination in the blood
- asymmetric flat pink macula (roseola)
- fever, headache, tonsilitis, nocturnal arthralgia, malaise
- non- pruritic, copper red, symmetric rash –> in face, palms, soles, trunk, skin folds
- around 3 months –> lesions become papular –> most infectious stage
- condylomata lata - smooth, white, painless lesions - highly contagious
- syphilitic alopecia
- oral and genital mucosal involvement
- generalized lymphadenopathy
Syphilis - clinical features
-Secondary stage
- due to spirchetal multiplication and dissemination in the blood
- asymmetric flat pink macula (roseola)
- fever, headache, tonsilitis, nocturnal arthralgia, malaise
- non- pruritic, copper red, symmetric rash –> in face, palms, soles, trunk, skin folds
- around 3 months –> lesions become papular –> most infectious stage
- condylomata lata - smooth, white, painless lesions - highly contagious
- syphilitic alopecia
- oral and genital mucosal involvement
- generalized lymphadenopathy
Syphilis - clinical features
- early latent stage
- late latent stage
- no clinical signs, serological positive
- dormant, asymptomatic
- no clinical signs, serological positive
- can last a long time
- spirochetes stays in organs and tissues
- dormant, asymptomatic
Syphilis - clinical features
-Tertiary stage (6)
- symptoms can manifest up to 20 years following the infection
- skin involvement - superficial (kidney shaped lesion) or deep (syphilitic gumma - round/oval painless, develops into deep ulcers)
- cardiovascular involvement - asymptomatic murmur, aortitis, aneurysm
- bone, muscle, internal organ (esophagus, stomach, liver) involvement
- heals with scarring
- neurosyphilis
Syphilis - clinical features
-neurosyphilis
asymptomatic
symptomatic
- acute meningeal syphilis
- meningovascular syphilis - subacute stroke, cranial neuropathies
- late neurosyphilis - general paresis, Argyll Robertson pupil, syphilis myelopathy
