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Std

Uploaded by

samy.abusenbl
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Sexually transmitted

diseases
Syphilis
The spirochete, Treponema pallidum
Acquired syphilis Congenital syphilis
• Early • Early congenital
• Primary (I Stage)
• Secondary (II Stage) • Late congenital
• Latent
• Early latent
• Late latent
• Late (Tertiary)(III
Stage)
Primary syphilis

• Characterized by the development of a


painless chancre at the site of
transmission after an incubation period
of 3-6 weeks

• The lesion has a punched-out base and


rolled edges and is highly infectious
Chancre

• Genital area (95%)


• Lips
• Tongue
• Oral comissure
• Palate
• Tonsille
• Eyelid
• Finger
Primary syphilis-chancre
Oral chancre
Primary syphilis

• The chancre: Mononuclear leukocytic


infiltration, macrophages, and lymphocytes
(=obliterative endarteritis)

• The spirochete can be isolated from the


surface of the ulceration or the overlying
exudate of the chancre

• Healing : 3-12 weeks, with fibrosis.


Syphilis - Treponema pallidum on
darkfield
.
Secondary syphilis

• Secondary syphilis develops in 4-10 weeks


• Spirochetes multiply and spread
throughout the body
• Secondary syphilis lesions are quite
variable in their manifestations
• Systemic manifestations include malaise,
fever, myalgias, arthralgias,
lymphadenopathy, and rash
Clinical manifestations of secondary
syphilis
Rash
Condyloma latum in intertriginous areas
Lymphadenopathy
Hepatitis (subclinical)
Systemic: fever, malaise, weight loss
Neurologic: headache, meningismus, meningitis, cranial
nerve disorders (optic neuritis, deafness, otitis),
cerebrovascular accident
Periostitis
Uvieitis, iritis
Glomerulonephritis
Arthritis
Alopecia
Syphilitic roseol
Condyloma lata
Secondary syphilis - alopecia
Latent Syphilis:Lesions of secondary SF
disappear
Serology (positive)

Tertiary Sf: Very rare


Noduloülcerative, ulcerating gumma
Tubercule
Organ involvement
(CNS, Bones, Cardiac, Ophtalmic, Pulmonary,
Testis)

Congenital Syphilis: Sf during pregnancy


Tertiary syphilis - ulcerating gumma
Congenital Syphilis
Placental pass of T. pallidum>14 week of
pregnancy
Earlier disease + Proper tx= Healthy child
possibility

Spontaneous abortus
Neuro-sceletal deformities
Prematurity
IU ex
Perinatal ex
Early cong sy: 0-2
Congenital Sy: years
(Onset of symptoms)
Late cong sy: > 2
years
Early Cong Sy
Nasal septum perforation
Purulan nasal discharge
Nasal deformity
Condilomata lata
Mucous patch
Chorioretinitis
Neurosyf
Anemia
Trombocytopenia
Leucopenia/leucocytosis
Late Cong Syp
Nasal deformity (saddle nose)
Retinitis
Keratitis
Bone deformities
Swollen knees (Clutton joints)
Teeth changes (Hutchinson incisors)
Congenital syphilis - mucous patches
Congenital syphilis –
Hutchinson’s teeth
Congenital syphilis –
perforation of palate
VDRL (diagnosis, follow-up)
FTA-ABS (most valuable test)

Treponemal tests: Spesific, conformative


 Enzyme immunoassay (EIA)
 Treponema pallidum haemagglutination (TPHA)
 Treponema pallidum particle agglutination assay (TPPA)
 Fluorescent treponemal antibody absorption test (FTA –
ABS)

Non treponemal tests: Routine screening, non-


specific
 Venereal disease research laboratory (VDRL)
 Rapid plasma reagin (RPR)
Periodic checks are carried out with
non-treponemal tests (VDRL titration)
• every 3 months (first year)
• every 6 months (second year)
• once a year for the following years
Treatment

Penicillin ***
Prokain penicillin: 800.000 Ü X 15 days (im)
Benzatin penicillin: 2.400.000 Ü (im) / week X
OR
Tetracyclin : 2gr/day X 15 days (po)
Seftriaxon : 1 gr/day X 5 days (im)

1 month for late


syphilis
Herxheimer reaction

First 12 hours of treatment


Endotoxins
High fever, artralgia, trembling, skin rash

Treatment of HRXHMR RXN: Aspirin


ULCUS MOLLE (CHANCROID)

• H. Ducreyi
• Incubation : 2-3 days

• Erythema, papul-pustul-ulcer : erytematous halo, soft base,


decoleted borders> 1
Rich in basil
• LAP( Bubo formation)

• Diagnosis: D. Microscopy (gram, giemsa)

• TX: Erythomycine 4x500 mg/day (7 days)


Ceftriaxon: 250 mg (one dose) im.
GONORRHEA

• Neisseria gonorrhea

• Incubation: 2-15 days


%20-50 asymptomatic

• Men: Burning sense- green yellow purulan discharge.


Periuretral erithema & edema
4- 8 weeks of mucoid urethal discharge
•
Women: asymptomatic BUT: prematur births, perinatal
mortality, neonatal conjuctivitis, perianal abcess, etc.
GONORRHEA

Skin findings;
• microabscesses
• macules
• papules
• pustules
• vesicles

• Haemorrhagic lesions, erythema nodosum, urticaria,


and erythema multiforme occur less frequently
GONORRHEA

• Diagnosis: D. microscopy =gram(-)


diploccocus

• TX: Procain penicliin: 4.8 m Ü(im) -


probenecid
Tetracycline: 4X 500 mg- 5 days
Genital herpes

• Clinically, about 60–70% of primary genital


infections are due to HSV-2 with the rest
due to HSV-1
• Recurrences are more frequent with type 2
genital herpes than with type 1
Genital herpes

• Painful, grouped (clustered) vesicles


Genital herpes

• Painful supeficial genital ulcers last for 2 to 3


weeks, if untreated
• The local lymph glands are enlarged and tender
• Treatment
• acyclovir 400 mg 3x1, valacyclovir (500 mg 2x1)
• 7-10 days for primary herpes and 5 days for
secondary herpes

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