2nd century A.D Gonorrhea
means…
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Flow of Seed”
“
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Coined A.D. 130 by Greek
Physician
Claudius
GALEN
Mistook pus as a excess
semen
2
Also called
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“clap”
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From the French word
clapori meaning
brothel
a treatment that used to clear the
blockage in the urethra from gonorrhea
pus, where the penis would be
'clapped' on both sides .
3
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Also called
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“tulo”
(tagalog) or
“ The drip”
(continuous
flow)
4
Mid- 13th century when it was
recognized as a specific
disease,
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1879 causative agent,
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Neisseria gonorrhoea
Described by German physician,
discovered leprosy as well
ALBERT NEISSER
- Gram
negative, spherical
oval diplococcus with
flattened adjacent sides that
resemble pair of coffee beans
facing each other.
5
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STRAINS OF NEISSERIA
6
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N. gonorrhoeae (also
called the
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gonococcus), which
causes gonorrhoea.
7
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Neisseria meningitis (also
called the
meningococcus), one of
the most common causes
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of bacterial
meningitis and the
causative agent of
meningococcal
septicaemia.
8
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Neisseria cinerea
Neisseria elongata
Neisseria flavescens
Neisseria lactamica
Neisseria mucosa
Neisseria polysaccharea
Neisseria sicca
Neisseria subflava
Neisseria bacilliformis
Neisseria macacae
9
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MAJOR DIFFERENCE OF THE
2 PATHOLOGIC STRAINS
10
sets of sugars
only glucose,
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N. gonorrheae makes acid from
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from which they will produce acid.
N. meningitidis produces acid
from both
glucose and
maltose.
11
12
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VIRULENCE FACTORS
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PATHOGEN AND
Neiisseria gonorrhoea is
pathogen that cause
gonorrhea.
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gonococcus is the
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also known as
13
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Cocci protect themselves from immune system by
secreting aprotease enzyme that cleaves IgA in
mucus.
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Gram –negative bacterium usually forms pairs of
cells that have fimbrae, a polysaccharide capsules
and major cell wall antigen called
lipoligosaccharide composed of lipid A and sugar
molecules.
14
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PILI (FIMBRAE) ATTACH TO EPITHELIAL CELLS
IN THE URINARY TRACT SO THAT THEY ARE
NOT SWEPT OUT IN THE PASSAGE OF URINE.
15
cannot
attach to cell lining of
vagina but it commonly
Neisseria gonorrhea
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affects the cervix of
the uterus .
16
Squamous epithelium, which lines the
adult vagina, is not susceptible to
keratinized under the influence of estrogen, may
be
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prepubertal vaginal
epithelium, which has not been
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infection by the gonococcus. However, the
infected
17
(pain on urination,
Vulvar and perianal
soreness, discomfort on
defacation)
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is the term used for
gonorrhea in young
girls between 1puberty. Due to
sexual abuse
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VULVOVAGINITIS
18
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anorectal
gonorrhea as
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Both boys and
girls can
develop a pus
filled anal
discharge
indicative of
a result of
sexual abuse.
19
NEISSERIA GONORRHEA
CAN ALSO USE THEIR
PILI/ fimbrae TO
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INTO UPPER PART OF
THE REPRODUCTIVE
TRACT .
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ATTACH TO SPERM
CELLS AND CLIMB
RESULTS IN AN
INFECTION PELVIC
INFLAMMATORY DISEASE
UPPER REPRODUCTIVE
SYSTEM….
20
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Some new strains of
gonorrhea without the
pili are non -virulent
21
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Neisseria cinerea
Neisseria elongata
Neisseria flavescens
Neisseria lactamica
Neisseria mucosa
Neisseria polysaccharea
Neisseria sicca
Neisseria subflava
Neisseria bacilliformis
Neisseria macacae
22
Gonococci produce endotoxins
that damages the mucosal cells of
tubes so it releases
phospholipases that is important
in
pathogenesis.
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proteases and
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the fallopian
23
Produce
extracellular protease that
neutrophils and are phagocytized by
multiply in polymorphonuclear
leukocytes.
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them. Some bacterias are killed and survivors
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cleaves IgA , they adhere to
24
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Gonococci gets their
IRON for their
metabolic needs on
iron-transport protein,
TRANSFERRIN.
25
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EPIDEMIOLOGY
26
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GONORRHEA is the SECOND
MOST commonly reported disease
in the UNITED STATES..
(CHLAMYDIA is the first.)
27
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An estimated 650,000 cases of gonorrhea occur each year in the
United States
The reported gonorrhea rate in the United States remains the
highest of any industrialized country and is roughly 50 times that
of Sweden and eight times that of Canada.
28
More common in
homosexuals….
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More common in
blacks than
whites….
More common on
males than
females…
29
chance of
getting the
infection…
20% chance
for men.
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women
have 50%
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During a single
encounter,
30
In the
Statistics,
253,652
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September 2009,
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Philippine
cases of
Gonorrhea
out of
86,241,697
population
(http://www.cureresear
ch.com/g/gonorrhea/st
ats-country.htm)
31
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the ONLY
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HUMANS are
NATURAL
HOST for
gonococci.
32
ASYMPTOMATIC
carriers for
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FEMALE , 40%
male, remains
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60-80% of
about 5-15
years.
33
intrauterine device is
WOMEN using CONTRACEPTIVE PILL
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Men decreased using condoms and soermicides
that lead to their SEXUAL FREEDOM.
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In 1960, contraceptive pill and
introduced in the WESTERN WORLD.
98% suceptible to
gonorrhea because pill alters vaginal
becomes suceptible for gonococcal growth.
pH and now
Desired pH
of bacteria
:7.2- 7.6
34
WOMEN using IUDs makes
gonorrheal infection spread
bacteria to enter the
circulatory system cause
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EXPOSURE OF BLOOD VESSELS
during menstruation alllows
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FASTER,
BACTEREMIA.
Gonorrheal lesions makes
infection with HIV
easier.
35
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INCUBATION PERIOD
36
sometimes until
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1-14 days or
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Neisseria gonorrhoea can
incubate after the
exposure to the
pathogen from
30
days prior to exposure.
37
38
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GONORRHEA
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TRANSMISSION OF
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A person can transmit
the organism even
without having
symptoms.
39
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40
Transfer of organisms by
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can result
to eye infection of gonorrhea. ( scarring of
cornea may lead to blindness)
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contaminated hands
41
Fomites like
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also cause
gonorrhea
infection on
eyes if the
towel is
contaminated
and was
placed on eyes.
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infected
towels may
42
Transmission may also
occur from failure of
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sheets correctly.
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a hospital to
launder infected
An outbreak of
vulvovaginitis in
female pediatric
patients who
acquired the
disease from
sitting on the
unclean sheets.
43
on
the birth canal.
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the passage
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Infected mother
may cause
opthalmia
neonatorum during
44
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Sharing of
SEX TOYS
without
cleaning it
after use.
45
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Ejaculation is
not needed
for the
disease to be
passed on or
caught.
46
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SIGNS &SYMPTOMS
47
up to thirty
days.
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People are
considered
contagious until
they have been
treated
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Symptoms are often within one to
fourteen days after exposure, but can take
48
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• painful urination
• anal itching or
bleeding
• sore throat
• greenish yellow or
whitish discharge from
the urethra.
• painful or swollen
testicles
49
Gonorrhea Symptoms in Women
•abnormal vaginal bleeding
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•irritation or discharge from the anus
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•strong smelling vaginal discharge that may be
thin & watery or thick & yellow/green
•possibly some low abdominal or pelvic
tenderness
•pain or a burning sensation when passing urine
•low abdominal pain sometimes with nausea
50
Gonorrhea Symptoms in Men
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•inflammation of the testicles &
prostate gland
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•white, yellow or green thick
discharge from the tip of the penis
•irritation or discharge from the anus
•urethral itch & pain or burning
sensation when passing urine
51
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DIAGNOSIS
52
The presence of
PUS
from an
inflammed penis is
sufficient for a
symptomatic
gonorrhea in men.
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yellow, creamy
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gram negative
diplococci in
53
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•giving a sample of urine
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A urine test & a swab test - collecting
fluid from the penis or vagina by
placing a swab in the opening of the
urethra; this causes brief discomfort.
•a genital examination by a doctor or nurse
•taking swabs from the cervix (entrance to
the womb), urethra (tube where the urine
comes out), throat or rectum
54
•women may have an internal examination
confirmatory test
should still be
done.
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gonorrhea, a
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There are many species of
neisseria so a positive results
on a screening test does
not necessarily mean of
55
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IF YOU HAD BEEN POSITIVE FOR GONORRHEA…
CONSIDER HAVING TESTED FOR…
56
Urethra is the
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most common
site of
gonorrhea
infections in
males.
57
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Most
common site
of infection in
the female
is the cervix
58
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-Urethra
-Anal canal
-Pharynx
-Skene’s gland in urethra
and Bartholin’s glands near
vaginal outlet
59
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-Infection spreads
throughout the pelvic
cavity
- The infection
becomes systemic
60
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Sterility often
follows PID
because of tubal
occlusion by
scarring.
61
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May also cause ectopic pregnancy Mild pelvic
infections can destroy the delicate hair-like cells
lining the fallopian tubes. Severe infections can
scar the tubes, causing them to become blocked.
Women who have had pelvic infections have a
five times greater risk of ectopic pregnancy.
62
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63
Most common infection in
Gonococcal arthritis occurs
when the infection reaches the
joints.
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Scarring produces tight,
inflexible tissue that immobilizes
pelvic organs into the
condition “frozen pelvis.”
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people 16-50 yrs old
64
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COMPLICATIONS OF NEISSERIA
GONORRHEA ON THE OTHER PARTS OF
THE BODY
65
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66
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•Common in woman and
homosexual men
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•Developed in 5% of those
exposed to ORAL SEX
•May develop a sore throat
•Usually pharyngeal cases
are asymptomatic
67
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68
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•Occurs in 5-10 cm of the rectum
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• common in homosexual men
•Either be asymptomatic or painful
•With constipation, pus and rectal
bleeding
•Women w/ vaginal gonorrhea may also
have anorectal infection (contamination
of organism laden vaginal discharge)
69
MEDICAL PRACTIONERS
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who does
INTERNAL PELVIC EXAMINATIONS should use
different gloved finger for examination of
anal and vagina so not to spread the
infection.
70
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common
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PHARYNGEAL
and
ANORECTAL
infections are
to VICTIMS OF
SEXUAL ABUSE.
71
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ophthalmia neonatorum
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The baby's eyes are contaminated during
passage through the birth canal from a mother
infected with Neisseria gonorrhoeae
Treatments intravenous dose of
benzylpenicillin or cefotaxime.
72
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TREATMENT
73
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Women;
-Pelvic inflammatory disease
-Ectopic pregnancy
-Sterility
-- death due to complications
-Male:
-- inflammation of testes
-- sterility
-- heart problems
-Septicemia
-They can also affect the heart and
brain for male and female.
74
Historically it has been suggested that
for gonorrhea.
English warship the Mary Rose
included a syringe that, according to
some, was used to inject the mercury via
the urinary meatus into any unfortunate
crewman suffering from gonorrhea. The
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Surgeons tools on board the recovered
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mercury was used as a treatment
"the clap", i
name
n reference to
the disease, is recorded as early as the
sixteenth century
75
Sulfonamides are the first
agents to
treat gonorrhea
become sulfonamide resistant
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Some strains of gonococci are resistant to Pencillin
because they produce B-lactamase that breaks
down the antibiotic.
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PENICILLIN came when some strains
CEFTRIAXONE
(cephalosphorin)
AZITHROMYCIN
plus
is now used.
Others:
(Ciprofloxacin, ofloxacin,levofloxacin)
76
SPECTINOMYCIN.
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Those allergic to
cephalosporin are given
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77
DURATION OF TREATMENT:
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about
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in the early stages, when only the cervix
(in a woman) or the urethra (in a man)
has been infected, it will clear up in
two days -- although,
continue to
take your oral
medication for the full time
again, you must
prescribed.
78
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IMMUNITY
79
NO LONG – TERM SPECIFIC
IMMUNITY
( there are different new strains
has prevented an effective
vaccine. )
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Immunity to one strain does not
provide protection to other
strains
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PEOPLE CAN HAVE GONORRHEA
FOR MULTIPLE TIMES
80
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PREVENTION
81
-Sexual abstinence
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-100% consistent and
proper use of condoms (
though condoms cannot
really prevent, but can
help)
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- monogamy with
monogamous partner
-Early detection / diagnosis
82
If you're pregnant, you'll
typically be tested for
gonorrhea during your first
infection and prevent
and other problems in your
newborn.
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gonococcal ophthalmia
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trimester to diagnose a silent
If you're considering having sex
with a new partner, both of you
should first be tested for STDs,
83
Wash sex toys
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Don't share towels or
other
personal items that
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(including vibrators) after
every use; some studies show
that the virus can be spread
by them if they're shared.
could harbor the bacteria.
84
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GOVERNMENT PROGRAMS
85
ADOLESCENT AND YOUTH HEALTH AND
DEVELOPMENT PROGRAM (AYHDP)
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•mainly focus on addressing the
following health concerns regardless
of their sex, race and socioeconomic
background
•Growth and Development concerns
Nutrition Physical, mental and
emotional status
•Reproductive Health Sexuality
Reproductive Tract Infection (STD,
HIV/AIDS) Responsible Parenthood
Maternal & Child Health
86
every two years and is a forum for the
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occurs
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International Pathogenic Neisseria
Conference (IPNC)
presentation of cutting-edge research on all
aspects of the genus Neisseria. This includes
immunology, vaccinology and physiology
and metabolism of Neisseria meningitidis, Neisseria
gonorrhoeae and the commensal species. The first IPNC took place in
1978 and the most recent one was in September 2008.
Normally the location of the conference switches between North
America and Europe but took place in Australasia for the first time in
2006, where the venue was located in Cairns, Australia
87
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#33 REGANIT, CITIZEN MOSES
#34 RODRIGUEZ , ROJEAN BIANCA C.
SEPTEMBER 2009
SUBMITTED TO:
MS. MARILYN NGO, MS PHAR
88
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89