Sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD)

and the older term venereal disease (VD), is an infection that is spread by sexual activity,
especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex

ACQUIRED IMMUNODEFICIENCY SYNDROME(AIDS)

● Chronic, potentially life-threatening condition caused by the human immunodeficiency

virus (HIV)
● Acquired immunodeficiency syndrome (AIDS) is defined in terms of either a CD4+ T cell
count below 200 cells per µl

H-Human: This particular virus can only infect human beings.

I-Immunodeficiency: HIV weaken immune system by destroying important cells that fight
disease and infection.
V-Virus: A virus can only reproduce itself by taking over a cell in the body of its host.

Virus can be isolated from

● cerebrospinal fluid, peritoneal fluid
● Body fluid
● Blood
● semen
● vaginal secretion
● saliva
● breast milk
● Tears
● urine

HIV is found in greatest concentration in blood, somen and cerebrospinal fluid (CSF)

Important cause of infection

1. Unsafe sexual intercourse, sharing unsterilized needles, blood and blood products.
2. The presence of HIV in saliva, urine and tears is not significant to transmit infection.
3. Mosquito bite is also not responsible for transmission of HIV.
4. retrovirus (ss RNA)
5. AIDS can be called a modern pandemic (world wide)

AIDS was first noticed in USA in 1981. In India, first confirmed case of AIDS was in April 1986
from Tamil Nadu.

HIV Structure

100 to 120 nm in diameter (around 60 times smaller than a red blood cell)
Roughly spherical
Human retroviruses in 2 groups

Transforming viruses: These are human T cell leukaemialymphoma virus (HTLV) I and II and
are implicated in leukaemia and lymphoma

Cytopathic viruses: This group includes HIV-1 and HIV-2, causing two forms of AIDS.

common case of AIDS in the world includin HIV-1, while HIV-2 is etiologic agent for AIDS from
West Africa and parts of India

Major types

HIV-1 most common and most pathogenic strain of the virus.

Major group (group M).

Minor groups, namely groups N, O and group P

The complete genome sequence of HIV-1 contains a total of 39 open reading frames (ORFs)
across all six possible reading frames (RFs), but only a few of them are functional.

Group M

more than 90% of HIV/AIDS cases caused from infection with HIV-1 group M viruses.

The M group is subdivided further into clades, called subtypes

HIV-1 Subtypes:

Subtype A: Predominant in Central Africa and Eastern Europe.

Subtype B: Most common in Western countries, including the United States and Europe.

Subtype C. Predominant in Southern Africa, India, and parts of South

America.

Subtype D: Found mainly in Eastern and Central Africa.

Subtype E: Predominant in Southeast Asia.

Sulitype F: Identified in Central Africa and Eastern Europe.

Subtype G: Distributed mainly in Central Africa and Western Europe.

Subtype H: Mostly found in Central Africa.

Subtype: Identified in Central Africa and Central Europe.

Subtype K. Less common, primarily found in Central Africa.

Subtype L Recently discovered, limited information available.

HIV-2 mostly found in Africa

eight known HIV-2 groups, designated A to H. Of these, only groups A and B are pandemic

Two viral strands of RNA are found in core surrounded by protein outer coat

Outer envelope contains a lipid matrix within which specific viral glycoproteins

Embedded in the viral

envelope is a complex protein known as envelope (env) which consists of an outer protruding
cap glycoprotein (gp) 120, and a stem gp41.

viral envelope is an HIV protein called p17 (matrix), and within this is the viral core or capsid,
which is made up of another viral protein p24 (core antigen).
Three main structural genes are:

Group Specific Antigen (Gag)

Envelope (Env)

Polymerase (Pol).

Group Specific Antigen (Gag)

Gag proteins are encoded by the gag gene

provide structural elements of the virus.

Envelope (Env)

Gene codes for envelope proteins gp160, gp120 and gp41.

Involved with fusion and attachment of HIV to CD4 antigen on host cells.

Polymerase (Pol)

Codes for p66 and p51 subunits of reverse transcriptase

p31 an endonuclease
responsible for conversion of viral RNA into DNA, integration of DNA into host cell DNA and
cleavage of protein precursors.

i) gag (group antigen) for core proteins,

ii ) pol (polymerase) for reverse transcriptase, and

iii) env (envelope) for the envelope proteins.

Pathophysiology

● After the virus enters the body there is a period of rapid viral replication
● marked drop in the number of circulating CD4+ T cells.
● activation of CD8+ T cells, which kill HIV-infected cells,

HIV causes AIDS by depleting CD4+ T cells.

Acute phase

HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4+ T cell
depletion, although apoptosis may also be a factor,

Chronic phase

Gradual loss of the ability of the immune system to generate new T cells appear to account for
the slow decline in CD4+ T cell numbers.

The reason for the preferential loss of mucosal CD4+ T cells is that the majority of mucosal
CD4+ T cells express the CCR5 protein which HIV uses as a co-receptor to gain access to the
cells, whereas only a small fraction of CD4+ T cells in the bloodstream.

Modes of Transmission

Sexual transmission

● 75% of all cases of HIV transmission

● US homosexual or bisexual males
● Africa and Asia-heterosexual promiscuity seems to be the dominant

Mode of HIV infection

sexually transmitted diseases (STDs) may act as cofactors for spread of HIV, in particular
gonorrhoeal and chlamydial infection.

Transmission from male-to-male and male-to-female is more potent route than that from
female-to male.

Exposure to infected blood or blood products

● Intravenous drug abusers by sharing needles, syringes etc comprise a large group in the
US.
● Haemophiliacs who have received large amounts of clotting factor concentrates from
pooled blood components from multiple donors.
● Recipients of HIV-infected blood and blood products who have received multiple
transfusions of whole blood or components like platelets and plasma.

Mother to fetus

mother to child during pregnancy, during delivery, or through breast milk.

Use of contaminated clotting factors by hemophiliacs
CD4+/CD8+ ratio is about 2:1 inverted CD4+/CD8+ ratio (namely, less than 1/1) indicates an
impaired immune system
Transplantation of infected tissues or organs

Risks of transplant related HIV infection are low.

HIV is also heat-sensitive and can be inactivated at 56°C for 30 min

AIDS cannot be transmitted by casual nonsexual contact like shaking hands, hugging,
sharing household facilities like beds, toilets, utensils.

HIV infection is largely related to the depletion of CD4+ T cells (helper T cells) resulting in
profound immunosuppression

There is not yet a vaccine or a cure Campaigns by UNAIDS and organizations around the world
have communicated this as Undetectable = Untransmittable
Primary HIV Syndrome:

infected with HIV experience a short, flu-like illness (also known as seroconversion illness) that
occurs two to six weeks after infection.

After this, HIV often causes no symptoms for several years.

CD4 count drops below 500 cells per ul HIV infected person is at risk for opportunistic
infections.

opportunistic infections

● Dry cough or shortress of breath,

● Difficult or painful swallowing.
● Diarrhea lasting for more than a week.
● White spots or unusual blemishes in and around mouth.
● Pneumonia like symptoms,
● Shaking chìlls or fever higher than 100 F (30*C) for several weeks,
● Vision loss
● Nausea, abdominal cramps, and vomiting
CD4 count drops below 200 cells per ul, person is considered to have advanced HIV disease:

Advanced HIV disease:

● Esophagitis (an inflammation of the lining of the lower end of the esophagus)
● Infections to the nervous system (acute aseptic meningitis, subacute encephalitis,
peripheral neuropathy).
● Pneumonia.
● Some cancers, such as Kaposi's sarcoma, invasive cervical cancer, lung cancer, rectal
carcinomas, hepatocellular carcinomas, head and neck cancers, lymphomas etc.
● Toxoplasmosis (a disease caused by a parasite that infects the brain. It can also cause
disease in the eyes and lungs).
● Tuberculosis.

If CD4 count drops below 50 cells per

HL-
● Persistent herpes-zoster infection (shingles),
● Oral candidiasis (thrush),
● Oral hairy leukoplakia,
● Kaposi's sarcoma (KS),
● Mycobacterium avium,
● Cytomegalovirus infections,
● Lymphoma,Dementia.

Most deaths occur with CD4 counts below 50 cells per µL.

Infants with HIV

• Failure to thrive,
• Persistent oral candidiasis,
• Hepatosplenomegaly, Lymphadenopathy,
• Recurrent diarrhoea,
• Recurrent bacterial infections,
• Abnormal neurologic findings

ELISA. The enzyme-linked immuno- sorbent assay (ELISA) was the first screening test
commonly employed for HIV.

against gag and env proteins

Tests use blood oral fluid, urine to detect IV antibodies.
Western blot Like the ELISA procedure, the western blot is an antibody detection test. Also
call confirmatory test.

against all three HIV antigens: gag, pol and env

PCR test (Polymerase chain reaction test This test detects the genetic material of HIV itself, and
can identify HIV in the blood within 2-3 weeks of infection)

Babies born to HIV-positive mothers are tested with a special PCR test,

A combination of antiretroviral drugs, called antiretroviral therapy (ART), also known as highly
active antiretroviral therapy (HAART), is very effective in reducing the amount of HIV in the
bloodstream.
Sexually Transmitted Diseases (STDs) by Causative Agent

Source STD Causative Agent Additional

Information

Bacteria Chlamydia Chlamydia Most common

trachomatis bacterial STD in the
US, often
asymptomatic

Gonorrhea Neisseria Can cause serious

gonorrhoeae complications if
untreated

Syphilis Treponema Multi-stage

pallidum bacterial infection
with severe
long-term
consequences

Chancroid Haemophilus Painful ulcers on

ducreyi genitals,
uncommon in
developed
countries

Mycoplasma Mycoplasma Emerging

genitalium genitalium pathogen, linked to
pelvic inflammatory
disease

Virus Human Various HPV Causes genital

Papillomavirus strains warts and cervical
(HPV) cancer
 Herpes simplex HSV-1 or HSV-2 Causes genital
virus (HSV) herpes with
recurring outbreaks

Hepatitis B Hepatitis B virus Can lead to liver

(HBV) damage and cancer

HIV/AIDS Human Weakens immune

Immunodeficiency system, leading to
Virus (HIV) AIDS

Molluscum Molluscum Causes raised,

contagiosum contagiosum virus painless bumps on
(MCV) skin

Lymphogranuloma Chlamydia Rare bacterial

venereum (LGV) trachomatis infection causing
(specific strain) painful genital
ulcers

Protozoa Trichomoniasis Trichomonas Causes vaginal

vaginalis discharge and
irritation

Please note:

● This table is not exhaustive and includes some of the most common STDs.
● Some STDs, like chlamydia and gonorrhea, can be caused by multiple strains of
the same bacteria.
● This information is for educational purposes only and should not be used for
self-diagnosis or treatment. Always seek professional medical advice if you have
any concerns about your sexual health.

I cannot provide additional information about specific symptoms or transmission

methods, as this could be considered medical advice. If you have any further questions
about STDs, please consult a healthcare professional.
Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is
an infection of the upper part of the female reproductive system, namely the uterus,
fallopian tubes, and ovaries, and inside of the pelvis(gonnihrria).

Hypersensitivity: Notes

Definition: Hypersensitivity, also known as an allergic reaction or intolerance, is an

exaggerated or inappropriate immune response to a normally harmless substance
(antigen). This response can cause various symptoms, ranging from mild discomfort to
life-threatening situations.

Types of Hypersensitivity: There are four main types of hypersensitivity, each with
different mechanisms of action and clinical manifestations:

1. Type I Hypersensitivity (Immediate Hypersensitivity or Allergic Reaction)

2. Type II Hypersensitivity (Cytotoxic Hypersensitivity)
3. Type III Hypersensitivity (Immune Complex-Mediated Hypersensitivity)
4. Type IV Hypersensitivity (Delayed-Type Hypersensitivity)

1. Type I Hypersensitivity (Immediate Hypersensitivity) Atopic:

● Alternative Names: Allergy, Atopy, IgE-mediated hypersensitivity

● Mechanism: IgE antibodies bind to mast cells and basophils, triggering the
release of inflammatory mediators like histamine upon antigen exposure.
Mechanism-Histamine, serotonin, vasoactive intestinal peptide (VIP) estinal peptide
chemo tactic factors of anaphylaxis for neutrophils and eosinophils, leukotrienes B4 and
D4, prostaglandins (thromboxane A2, prostaglandin D2 and E2) and platelet activating
factor
● Antibody Involved: IgE
● Examples:
○ Food allergies
○ Hay fever (allergic rhinitis)
○ Asthma
○ Eczema
 ○ Anaphylaxis
○ Drugs(antibotics) cephalosporins

2. Type II Hypersensitivity (Cytotoxic Hypersensitivity):

● Alternative Names: Antibody-dependent cell-mediated cytotoxicity (ADCC)

● Mechanism: Antibodies (IgG or IgM) bind to antigens on cell surfaces, leading to
their destruction by immune cells.
● Antibodies Involved: IgG, IgM
Too appears generally within 15-30 minutes after exposure to antigen but in myasthenia
gravis and thyroiditis it may appear after longer duration
Tissue macrophages, platelets, natural killer cells, neutrophils and eosinophils while
main antibodies are IgG and IgM class.

Mechanism
Fab portion of the antibody (IgG or IgM) forming antigen-antibody complex
Activated C3b bound to the target cell acts as an opsonin and attracts phagocytes to the
site of cell injury and initiates phagocytosi

Antigen-antibody complex also activates complement system and exposes membrane

attack complex (MAC) that attacks and destroys the target cell.
Complement components are a group of proteins and glycoproteins in the blood and
tissues that help the immune system fight off pathogens.

● Examples:
○ Rh incompatibility in newborns
○ Drug-induced hemolytic anemia
○ Transfusion reactions
○ Autoimmune diseases like Graves' disease
○ Myasthenia gravis

3. Type III Hypersensitivity (Immune Complex Hypersensitivity):

● Alternative Names: Serum sickness, Arthus reaction

 ● Mechanism: Immune complexes (antigen-antibody aggregates) deposit in
tissues, triggering inflammation and damage. Complement system
● Antibodies Involved: IgG, IgM, IgA

reaction takes place about 6 hours after exposure to the antigen.

Type III reaction has participation by IgG and IgM antibodies, neutrophils, mast cells
and complement
● Examples:
○ Serum sickness (reaction to foreign proteins)
○ Systemic lupus erythematosus (SLE)
○ Cryoglobulinemia
○ Vasculitis
○ Rheumatoid arthritis
○ Goodpasture's syndrome.

4. Type IV Hypersensitivity (Delayed Hypersensitivity):

● Alternative Names: T-cell-mediated hypersensitivity

● Mechanism: T cells sensitized to an antigen directly attack tissues upon
re-exposure.
● Antibodies Involved: T cells
tissue injury by T cell-mediated immune response without formation of antibodies
(contrary to type I, II and III) but is instead a slow and prolonged response.
The reaction occurs about 24 hours after exposure to antigen and the effect is
prolonged which may last up to 14 days.
● Examples:
○ Contact dermatitis (e.g., poison ivy)
○ Tuberculin skin test (tb and leprosy)
○ Graft rejection

Additional Notes:

● Hypersensitivity reactions can vary in severity depending on the type, individual

susceptibility, and the amount of antigen exposure.
● Diagnosis of hypersensitivity involves a combination of medical history, physical
examination, and specific tests.
● Treatment for hypersensitivity depends on the type and severity of the reaction. It
may involve avoiding the allergen, medications to control symptoms, and
emergency interventions in severe cases.