Sexually transmitted

infections(STIs)
 DERMATOLOGY
Sexually transmitted
infections(STIs)

Group 4
..…By
1. Asma adam
2.Nahid Mahjoub
3. Ahmed Al-Sadiq
4.Sahar Muhammad
 -:The objective
1. Introduction.
2. Gonorrhea.
3. Chlamydia.
4. Syphilis.
5. Trichomoniasis.
6. Genital Herpes.
7. Genital warts.
Definition:
Infections that are most
commonly passed on from one
person to another through
sexual contact.
Transmission
It needs:
1- A body fluid with the germ in it.
2- A way of spreading the germ from one person to another.

Body fluid:
Semen
Vaginal fluid
Blood
Saliva
Tears
Urine
Method of transmission
• Sexual intercourse: vaginal, anal or oral.

• Blood to blood contact.

• Sharing needles or other drug use equipment.

• Infected mother to her baby.

Classification
Viral:
Genital herpes, genital warts.
Bacterial:
Gonorrhea, chlamydia and syphillis.
Parasitic:
Trichomoniasis.
 Gonorrhea

• is a curable sexually transmitted infection caused

by the bacterium Neisseria gonorrhoeae.

• IP 2-5 days.

• Previous infection does not confer immunity, and

a person who has been infected can become
infected again.
• Gonorrhea if left untreated may last for
weeks or months with higher risks of
complications.

Neisseria gonorrhoeae
 Signs &
symptoms: • In Women:
In Men: • No symptoms 50%.
• Burning sensation • vaginal discharge
during urination. (purulent).
• purulent discharge • lower abdominal pain.
from the penis. • pain with sexual
• inflammation of the intercourse.
penile urethra. • Inflammation of the
uterine cervix.
• vaginal bleeding between
Urethral periods, or pelvic pain.
discharge
 Diagnosis:
Urine or Swapping urethral discharge is
collected then:
• Gram stain.
• Culture.
• PCR.
Treatment:
Ceftriaxone.
+ doxycycline or azithromycin
In 2015 CDC recommends both ceftriaxone and
azithromycin.
 Complications:
• Systemic dissemination (skin pustules or petechia, septic arthritis, meningitis, or
endocarditis).

• In men, inflammation of the epididymis, prostate gland, and urethra (Infertility).

• In women, the most common result of untreated gonorrhea is pelvic

inflammatory disease (Infertility).

• Neonatal or adult blindness from conjunctivitis

• Other complications include inflammation of the tissue surrounding the liver, a

rare complication associated with Fitz-Hugh–Curtis syndrome; septic arthritis,
septic abortion; chorioamnionitis during pregnancy.

• Men who have had a gonorrhea infection have an increased risk of getting
prostate cancer.
Chlamydi
a

Definition:-
chlamydia, is a sexually transmitted
infection caused by the bacterium
Chlamydia trachomatis.
 Clinical features:-
In men:-
infection is asymptomatic
in up to 50%.
Symptoms include :-
• white, cloudy or watery
discharge from the tip of
the penis.
In women:-
the most common
site of infection is
the endocervix.
up to 80% of
infection in women
is asmptomatic.
Symptoms include :-

• inflammation of the cervix in a female characterized by

mucopurulent cervical discharge, redness, and inflammation.
• Vaginal discharge
• post-coital or intermenstrual bleeding .
• lower abdominal pain.
• Ascending infection causes acute salpingitis
Neonatal infection:-

•Acquired from the birth canal.

•result in mucopurulent conjunctivitis and
pneumonia.
 Diagnosis:-
Diagnosis is often by screening which is recommended
yearly in sexually active women under the age of twenty
five, others at higher risk, and at the first prenatal visit.
Testing can be done on the urine or a swab of the cervix,
vagina, or urethra. Rectal or mouth swabs are required to
diagnose infections in those areas.

Treatment:-
Chlamydia can be cured by antibiotics with
typically either azithromycin or doxycycline being
used. Erythromycin or azithromycin is
recommended in babies and during pregnancy.
Syphilis
• Sexually acquired infection
• Etiologic agent: caused by spirocheteTreponema
pallidum
• Disease progresses in stages
• May become chronic without treatment

Treponema pallidum
Pathology
•Penetration:
• T. pallidum enters the body via skin and
mucous membranes through abrasions during
sexual contact
• Also transmitted transplacentally
•Dissemination:
• Travels via the lymphatic system to regional
lymph nodes and then throughout the body
via the blood stream
Treponema pallidum on
darkfield microscopy
Primary Syphilis
• Incubation period:9 to 90 days
• Primary lesion or "chancre" develops at the site of
inoculation

• Chancre:
• Progresses from macule to papule to ulcer
• Typically painless, indurated, and has a clean base
• Highly infectious
• Heals spontaneously within 1 to 6 weeks
• 25% present with multiple lesions

• Regional lymphadenopathy: classically rubbery, painless,

bilateral

Primary Syphilis-
Penile Chancre
Secondary Syphilis
• Incubation period:6weeks to 6month
• Mucocutaneous lesions most common
• Manifestations:
• Rash (75%-100%)
• Lymphadenopathy (50%-86%)
• Malaise
• Mucous patches (6%-30%)
• Condylomata lata (10%-20%)
• Alopecia (5%)
• Serologic tests are usually highest in titer
during this stage
 Secondary Syphilis:
Palmar/Plantar Rash

Secondary Syphilis -
Condylomata lata
 Latent Syphilis
• Host suppresses the infection enough so that no
lesions are clinically apparent
• Only evidence is positive serologic test for syphilis
• May occur between primary and secondary
stages, between secondary relapses, and after
secondary stage
• Categories:
• Early latent: <1 year duration
• Late latent: 1 year duration
 Neurosyphilis
• Occurs when T. pallidum invades the CNS
• May occur at any stage of syphilis
• Can be asymptomatic
• Early neurosyphilis occurs a few months to a few
years after infection
• Clinical manifestations include acute syphilitic meningitis,
meningovascular syphilis, ocular involvement
• Late neurosyphilis occurs decades after infection and
is rarely seen
• Clinical manifestations include general paresis, tabes
dorsalis, ocular involvement
Tertiary (Late) Syphilis
• Incubation period:occurs months or years after
initial infection

• Approximately 30% of untreated patients

progress to the tertiary stage within 1 to 20
years

• Manifestations
• Gummatous lesions
• Cardiovascular syphilis
Late Syphilis -
Ulcerating Gumma
 Congenital
Syphilis
• Occurs when T. pallidum is transmitted from a
pregnant woman with syphilis to her fetus

• May lead to stillbirth, neonatal death, and infant

disorders such as deafness, neurologic impairment,
and bone deformities

• Transmission to the fetus in pregnancy can occur

during any stage of syphilis; risk is much higher during
primary and secondary syphilis

• Fetal infection can occur during any trimester of

pregnan
 Syphilis Diagnosis

•Identification of Treponema pallidum

in lesions
•Darkfield microscopy
•Direct fluorescent antibody - T. pallidum
(DFA-TP)
•Serologic tests
•Nontreponemal tests
•Treponemal tests
Management
Therapy for Primary, Secondary, and Early
Latent Syphilis

• Benzathine penicillin G 2.4 million units IM in a

single dose
• If penicillin allergic:
• Doxycycline 100 mg orally twice daily for 14 days,
or
• Tetracycline 500 mg orally 4 times daily for 14 days
 Therapy for Late Latent Syphilis or
Latent Syphilis of Unknown Duration
•Benzathine penicillin G 7.2 million units
total, administered as 3 doses of 2.4
million units IM each at 1-week intervals
•If penicillin allergic:
•Doxycycline 100 mg orally twice daily
for 28 days OR
•Tetracycline 500 mg orally 4 times daily
for 28 days
Therapy for Tertiary Syphilis without
Neurologic Involvement
• Benzathine penicillin G 7.2 million units
total, administered as 3 doses of 2.4 million
units IM each at 1-week intervals
• Penicillin allergic:
• Doxycycline 100 mg orally twice daily for
28 days OR
• Tetracycline 500 mg orally 4 times daily
for 28 days
 Therapy for Neurosyphilis

• Aqueous crystalline penicillin G 18-24 million

units per day, administered as 3-4 million units IV
every 4 hours or continuous infusion for 10-14
days IV

• Alternative regimen (if compliance can be

ensured):
• Procaine penicillin 2.4 million units IM once daily PLUS
Probenecid 500 mg orally 4 times a day, both for 10-14
days
Therapy for Syphilis in Pregnancy
• Treat with penicillin according to stage of
infection.

• Erythromycin is no longer an acceptable

alternative drug in penicillin-allergic patients.

• Patients who are skin-test-reactive to penicillin

should be desensitized in the hospital and
treated with penicillin.
 trichomoniasis

Definition
•is an infectious disease caused by the
parasite Trichomonas vaginalis
•About 70% of women and men do
not have symptoms .
•it occurs more often in women than
men
•Having trichomoniasis increases the
risk of getting HIV/AIDS.
 Signs and symptoms
•Symptoms experienced include pain, burning
or itching in the penis, urethra or vagina
.Discomfort for both sexes may increase
during intercourse and urination. For women
there may also be a yellow-green, itchy,
frothy, foul-smelling ( vaginal discharge. In
rare cases, lower abdominal pain can occur.
Symptoms usually appear within 5 to 28 days
of exposure
Diagnosis
The first is known as saline microscopy
The second diagnostic method is culture
The third method includes the nucleic acid
amplification tests (NAATs)

•Treatment
• Trichomoniasis can be cured with antibiotics, either 
metronidazole or tinidazole. Sexual partners should also be
treated.[1] About 20% of people get infected again within three
months of treatment
Genital herpes

•What is genital herpes?

• Is a common STD that any sexually active
person can get.

caused by two types of viruses.

• Herpes simplex type 1
• Herpes simplex type 2
• How common is herpes simplex?
• It is a common infection in many countries with
prevalence in some regions such as sub-Saharan
Africa.
• Prevalence in adult range from 30 - 80% in women.
And from 10 - 50% in men.

• How is genital herpes spread?

• vaginal, anal, or oral sex with someone have the
disease.
• Fluids found in a herpes sore carry the virus.
• Also virus can be released through skin and spread
to the sex partner.
Signs and symptoms:
Blisters Sores

• Others
• Flu-like symptoms
• Smelly discharge
• Burning micturition
• For women bleeding between period
Diagnosis
Clinically
Taking sample from the sores and testing it

• Can herpes be cured?

• There is no cure for herpes. But there are
medicines that can prevent or shorten the
outbreaks. These drugs can also reduce severity
and duration of symptoms.
• Acyclovir
• Famciclovir
• valacyclovir
Genital warts

Definition:-
• Genital warts are symptoms of a contagious
sexually transmitted disease caused by some
types of human papillomavirus (HPV). it can
affect both skin and mucosa .
• incubation period : 1-6 months
Classification:
Many types of Human papilloma virus(HPV) some of which
infected the genital area
over hundred HPV types are identified ,more than 30 types
infect the genital tract,.
can infect men ,women ,and newborn
Most genital warts are caused by the type HPV-6 and HPV-11.
16, 18 ,31 and 32 are associated with squamous cell carcnoma
 
•genital HPV two types :
•depending on whether they can cause genital cancer or not
•low- risk-type can cause genital warts
•high -risk -type can cause cervical cancer and anther genital
cancers
 
Signs and symptoms:-

• Many people with low risk types have no

symptom
• Other HPV type may cause ;  
• Itching
• Discharge
• Anal pain
• rectal bleeding
Diagnosis:-

• Diagnosis is often base on finding from the

history and appearance of the genital warts
1-infections are usually diagnosed clinically.
2-cytology
PCR
immunofurescence
electron microscopy
 COMPLICATION
• CANCER
• cervical cancer
• vulvar cancer
• anal cancer

Treatment:-
• Treatments can be classified as either removal of visible
warts,or topical agents like.
• Electrical removal by cautery
• chemical ttt
• Podophyllin
• laser therapy
Preventing STIs
• Only sure-fire way is abstinence, or monogamous
relationship btwn 2 uninfected people
• Get tested for STIs, insist that your partner do too
• May want to wait for results before engaging in sexual
activity that can put you at risk
• Communicate w/partners about safe sex
• Get to know potential sexual partners well enough to
develop trust and communication
• Inform a partner if you have an STI
• Avoid sex w/multiple partners or
w/individuals at high risk for STIs
• Use condoms or oral dams
• If you use injected drugs, do not share needles
Condoms
• Latex condoms are highly effective in preventing
transmission of HIV chlamydia, gonorrhea, NGU,
bacterial vaginosis, and trichomoniasis
• Condoms are less effective in preventing infections
transmitted by skin-to-skin contact, such as syphilis, herpes,
HPV, and are ineffective in preventing pubic lice and scabies
• Condoms from sheep’s membrane contain small pores that
may permit passage of viruses (HIV, HSV, hepatitis)
• Studies on couples where one partner is infected show that
with consistent condom use, HIV infection rates for the
uninfected partner are below 1% per year.
• CDC recommends against using condoms containing
nonoxynol-9 (N-9), which can cause genital lesions that
create an entry point for HIV and other STI pathogens
 Proper use of condoms
!Condoms must be used correctly every time
 Proper use of condoms
• Store condoms in a cool, dry place away from direct sunlight
• Throw away condoms past expiration date or condoms in
damaged packages
• Put on a condom before any genita contact occurs
• Be sure that the condom is adequately lubricated--if you
add lube, use only water-based lube (oil-based lubes deteriorate
latex)
• Unroll condom directly onto erect penis; if penis is
uncircumcised, pull back foreskin before putting on condom
• After ejaculation, hold base of condom before withdrawal
so condom does not slip off
• Note: rates of condom slippage and breakage are higher
during anal intercourse than vaginal intercourse, so be extra
careful during anal penetration
Thank you for attention

Any questions ?