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Pubic Lice
Pubic Lice
chancroid tx:
Human Papilloma Virus
Haemophilus ducreyi causes:
lymphogranuloma venereum tx:
patient given penicillin throughout
-both partners must be treated at the same time
-discharge from urethra
-frequent urination
-discomfort while urinating
-vaginal discharge
-abnormal periods
-discomfort an anal and rectum
-pain, swelling, redness of eyes
-fever, tiredness
-weight loss
-white patches in mouth
-dry cough
-bruise-like spots on skin thay won't leave
-swollen glands for many months
Herpes Simplex Virus II
Syphillus causes__________which increases the likelihood of sexual HIV transmission 3-5 fold.
genital ulcers
chlamydia Tx:
azithromycin or doxycycline
Pubic Lice
-bathe throughlly
-apply permethrin liquid
-comb pubic hair w/ a fine tooth comb
-wash all clothing and towels/sheets uesd in the past 2 days
recurrent persistent urethritis/cervicitis Tx:
metronidazole + Erythromycin
Non-gonococcal urethritis =
chlamydia trachomatis (20-40%)genital mycoplasms (20-30%)
syphilis Dx:
1. darkfield microscopy2. serology3. Microhemagglutination- Treponoma pallidum
granuloma inguinale
painless progressive ulcerative lesion without regional lymphadenopathy VERY RARE IN US
Pubic Lice
-intense itching in the affected area
-blood specks in underwear
-actually seeing nits (eggs) or lice
How it's spread
any type of sexual intercourse
Secondary stage syphilis

oEven without treatment, rashes clear up on their own.  Because the disease can involve different organs and tissues, symptoms can be varied and include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness.
What percent of women with untreated chlamydial or gonococcoal cervicity develop PID?
painful genital ulcer is:
HSV or chancroid(Haemophilus ducreyi)
condylomata lata:
skin lesion specific to secondary syphilis
gonococcal cervicitis sx:
1. 50% asymptomatic2. purulent cervical discharge3. increased menses4. dysuria
neurosyphilis tx:
aqueous crystaline penicillin G larger dose and IV
Tertiary (late) stage

oAs the second stage resolves, about 33% of those infected are spontaneously cured; while in the other 67%, the organisms remain latent for years or decades without symptoms, and 50% of those will eventually develop tertiary syphilis.
oTertiary syphilis results in tissue destruction, and may result in damage to the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.

oLate stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. This damage may be serious enough to cause death
What are acute STD manifestations?

oMucopurulent cervicitis and urethritis
(gonorrhea and chlamydia)
oGenital ulcer disease
(syphilis, chancroid, genital herpes)
oDysplasia and cancer
(genital warts, cervical cancer)
what is the most common consequence of STDs affecting women?
what percent of women with PID become infertile?
friable cervix with frank ulcers or necrosis:
HSV cervicitis
which test can differ btwn HSV 1&2?
immunofluorescent staining
which test has the best sensitivity and specificity for chlamydia?
tissue culture
most common cause of genital ulcer dz in north america and europe:
key words: beefy red lesion that bleeds on contact
granuloma inguinale
lymphogranuloma venereum dx:
serology or by eliminating other causes of inguinal adenopathy
Human Papilloma Virus
How it's spread
any type of sexual intercourse
Human Papilloma Virus
-depends on size and shape of warts
-medication applied to the skin
-larger warts require surgery
What are Chronic STD Consequences?

oPelvic inflammatory disease (PID) – an ascending infection of the uterus and fallopian tubes caused by N. gonorrhea and Chlamydia.
oAnogenital and cervical cancer – caused by some human papilloma viruses (HPVs).
oSecondary and tertiary syphilis

oRecurrent herpes virus (HV) infection
What can untreated PID lead to?
-infertility, ectopic pregnancy, abscess formation, and chronic pelvic pain.
Is there a vaccine for HPV infection?
yes there is
What is pubic lice cause by?
Phthirus pubic
-treated by pesticide preparations.
HSV-1 occurs primarily where?
above the waist-mouth and lips-fever blisters.
most common presenting sx for lymphogranuloma venereum:
unilateral tender inguinal/femoral lymphadenopathy
gram negative rod STD common in Africa, carribean & SW Asia
Haemophilus ducreyi (chancroid)
How it's spread
-sexual contact with the first sore or the rash that develops later
-mothers give it to their babies during pregnancy
Herpes Simplex Virus II
-no cure
-new drugs are help, but don't heal
Second stage of syphilis?

o3-6 weeks after the ulcer heals, the secondary form of the disease occurs in about 50% of infected individuals.
oThe second stage represents the systemic spread of the disease and signifies reproduction of the treponemes in the lymph nodes, the liver, joints, muscles, skin, and mucus membranes. 
oThe second stage is evident when one or more areas of the skin break into a rash that usually does not itch. Rashes can appear as the chancre is fading or can be delayed for weeks.
In men with chlamydia signs or symptoms might include:
penile discharge
-burning sensation when urinating.
clinical presentation of chancroid:
multiple or single painful lesions w painful lymphadenopathy
When the chlamydia trachomatis infection spreads from the cervix to the fallopian tubes some women still have no signs and symptoms others have:
abdominal pain, low back pain, nausea, fever, pain during intercourse, and bleeding between menstrual periods.
Where does Neisseria gonorrhoeae easily grow and multiply?
in the mucous membranes of the body
What is pelvic inflammatory disease?
an ascending infection of the uterus, fallopian tubes, ovaries and adjacent peritoneal linigns.
Tertitary (late stage) syphilis
A single dose of penicillin will cure a person who has had syphilis for less than  a year.  Larger doses are needed for people who have had it longer.
patient presents with HSV-2 outbreak and are shown to have a titer: Is this a primary or secondary outbreak?
secondary; primary outbreaks will not have an antibody titer yet
location and Sx for gonorrhea in females:
endocervical canal, 50% asymptomatic, may have discharge, dysuria, labial/abd pain
what is shown on the Tzank smear in HSV-2?
multinucleated giant cells
Where can gonorrhea bacteria grow?
in the warm, moist areas of the reproductive tract.
 including: the cervix, uterus, fallopian tubes and the urethra in men and women.
Are problems associated with STDs more severe in women or men?
Women because of the asymptomatic nature of some of the infections.
When infected with gonorrhea most men have:
a burning sensation when urinating and a yellowish white discharge from the penis.
Do STDs survive well in the environment?
No, They survive very poorly in the environment.
is chlamydia easy or hard to treat?
It can be easily treated and cured with antibiotics.
How it's spread
Human Papilloma Virus
-loss of apetite
donovanosis =
granuloma inguinale
HPV transmission:
skin contact
genital herpes Tx:
-no treatment
-just supported care
Herpes Simplex Virus II
gram negative intracellular diplococcus:
How it's spread
-contaminated blood transfusions
-contact with body fluids (saliva, blood, semen)
Pubic lice is also called?
safetypin shaped donovin bodies
granuloma inguinale
which HPV causes cervical infection/neoplasm?
HPV 16,18,45&56
2 ulcer causing STDs
herpes and syphilis
what kind of bacteria is syphilis?
4 "discharge" STDs
1. Gonorrhea2. Chlamydia3. nongonococcal urethritis4. mucopurulent cervicitis
Herpes Simplex Virus II
-itching burning, soreness
-small blisters in genital area
-small ulcers
-enlarged lymphnotes in groin
-headache, fever, red eyes, cold sores, fever blisters
Herpes Simplex Virus II
How it's spread
-sexual contact
How it's spread
-sexual contact
-contact of infected needles
-babies get it from mothers during pregnancy
What is syphilis also know as?
veneral pox
whenever chlamydia trachomatis infection spread past the cervix into the upper reproductive system, what can occur?
permanent and irreversible damage.
Ryder's syndrome
1. conjunctivitis2. pain on urination 3. joint painCan't see Can't pee Can't climb a tree
HPV tx:
1. removal of symptomatic warts2. podofilox solution3. cryotherapy
painless genital ulcer is:
1. syphilis2. lymphogranuloma venereum3. granuloma inguinale
which HPV causes anogenital warts?
HPV types 6&11
What is Gonorrhea caused by?
Neisseira gonorrheoeae, a bacterium.
What can Chlamydia trachomatis damage?
a woman's reproductive organs.
What is Chlamydia also termed as?
non-gonoccoal urethritis, (NGO)
What is Chlamydia caused by?
Chlamydia trachomatis, a bacterium.
What is the leading cause of early infeant pneumonia and conjunctivities in newborns?
which test detects gonorrhea and chlamydia from one swab?
nucleic acid hybridization
20-70% have normal appearing cervix & nonspecific abd pain, maybe mucopurulent discharge:
chlamydial cervicitis
triad of Sx from disseminated gonococcal infection:
1. dermatitis2. polyarthralgia/polyarthritis3. tenosynovitis
what is the second most common cause of genital ulcer dz?
serology for syphilis:
RPR - Rapid Plasma Reagin Antibody
lymphogranuloma venereum is caused by:
chlamydia trachomatis serotypes L1L2L3
Pubic Lice
How it's Spread
-close body contact
-using an infected person's towels, sheets, or clothes
What is trichomoniasis also know as?
the ping pong disease.
HSV-2 occurs primarily where?
below the waist.
-one or more blisters on or around the genitals or rectum.
there is a very strong link between genital warts and what?
cervical cancer.
What is syphillis caused by?
the bacterial spirochete, Treponema pallidum
When can symptoms develop?
symptoms can delop in 7-14 days.
What is syphilis often called because so many of the signs are indistinguishable from those of other diseases?
the great imitator
Tx for gonorrhea:
Cefixime or ceftriaxone + Tx for chlamydia of it is not ruled out
Dx of cervicitis:
1. gram stain of endocervical mucus2. cervical cytology3. virla culture HSV4. multinucleated giant cells = HSV
Human Papilloma Virus
-genital warts in the vaginal area and rectum
-small, flat, flesh-colored bumps
-burning, itching, pain, tenderness
Wome  who have symptoms of PID most commonly have?
lower abdomical pain
If left untreated what can syphilis lead to?
cardiovascualr and neurological disease, blindess and death.
Genital herpes is caused by?
-herpes simplex viruses types 1 and 2.
What does chlamydia trachomatis bacteria initially attack?
the cervix and the urethra.
-The few women with symptoms might have ab abmorla vaginal discharge or a burnig sensation when urinating.
if chlamydia is untreated in males what can it cause?
urethral infection, can cause  infertility if spreads to the epididymis.
clinical manifestations of secondary syphilis:
1. rash (whole body including palms)2. generalized lymphadenopathy3. malaise4. alopecia (hair loss)5. mucous patches6. condylomata lata
cervicitis is primarily caused by (4)
1. N. gonorrhea2. C. trachomatis3. HSV4. HPV
What is the primary stage in sypilis?

oThe time between infection with syphilis and the start of the first symptom can range from 10-90 days (average 21 days).

oThe primary stage of syphilis is usually marked by the appearance of a single sore or ulcer (called a chancre), but there may be multiple sores. The chancre is usually firm, round, small, and painless.
oIt appears at the spot where syphilis entered the body. The chancre lasts 3-6 weeks, and it will heal on its own. If adequate treatment is not administered, the infection progresses to the secondary stage.
Syphilis is usually seen in what situations?
situations where there are multiple opportunities for large numbers of anonymous sex partners, such as situations where sex is exchanged for drugs.
Hepatitis B Virus can cause what?
severe liver disease and death (there is a vaccine but not cure.)
-It damages the liver and may cause cirrhosis and liver cancer.
CDC criteria for dx of chancroid:
1. >1 painful genital ulcer2. tender inguinal lymphadenopathy3. negative syphilis4. negative HSV
When do gonorrhea symptoms usually occur?
2-5 days after infection, but can take as long as 30 days.
what are PAP smears screaning for?
HPV DNA; over 99% of cervical cancers have HPV DNA detected in the tumor
What are genital warts caused by?
up to 30 different types of the human papillomavirus.
how do you monitor neurosyphilis tx?
CSF q 6mo; CSF VDRL & protein should decrease, if cell count not down in 6mo then retreat
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