OVERVIEW OF SEXUALLY
TRANSMITTED DISEASES
Assist Prof Dr.
Syed Yousaf Kazmi
OBJECTIVES
1. Describe the pathogenesis of genital infection.
2. Discuss the clinical manifestations of genital
infection.
3. Identify the common methods used in the diagnosis
of genital infection.
4. Discuss the management plan of genital infection.
5. Summarize appropriate preventive methods of
genital infection.
6. Describe the epidemiology, public health
importance, prevention and screening of genital
infection.
WHO WAS HE?
• He was the
Hollywood
celebrity
• It was because of
him that I first
heard the disease
HIV in 1980s
INTRODUCTION
 Definition: “An illness that has a
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significant probability of
transmission between humans or
animals by means of human sexual
behavior, including vaginal
intercourse, oral sex, and anal sex”
Some STIs can also be transmitted
via the use of IV drug needles,
through childbirth or breastfeeding
STIs is preferable term than STDs,
Venereal Diseases
Infection vs disease e.g.
“Venereal diseases” ''Veneris'' is the
Latin word from Venus–the Roman
goddess of love
LIST OF STDs (CDC)
1. Bacterial Vaginosis
(BV)
2. Chlamydia
3. Gonorrhea
4. Hepatitis, Viral
5. Herpes, Genital
6. HIV/AIDS
7. Human Papillomavirus
(HPV)
8. Pelvic Inflammatory
Disease (PID)
9. Syphilis
10. Trichomoniasis
11. Other STDs
a. Chancroid
b. Lymphogranuloma
Venereum (LGV)
c. Pubic Lice Infestation
d. Scabies
STIs VIDEO
PATHOGENESIS
• Many STDs are (more easily)
transmitted through the mucous
membranes of the penis, vulva,
rectum, mouth, throat etc.
• Pathogens -able to pass through
breaks/ abrasions of the skin, even
minute ones
• Probability of transmitting many
STIs is far higher from sex than by
more casual non-sexual means
e.g. touching, hugging, shaking
hands
• Some STIs can be transmitted by
direct skin contact e.g. Herpes
simplex and HPV
PATHOGENESIS
 Some STIs spread only during
active lesions e.g. HSV/ HPV
 Most other spread when infected
person is asymptomatic e.g. HIV,
gonorrhea, etc.
 All sexual activities between two
(or more) people - two-way route
for the transmission of STDs
 Most STIs infects local tissues e.g.
chlamydia, gonorrhea, HSV, HPV
 Many STIs disseminate to other
organs e.g. HIV, Syphilis
PATHOGENESIS
• STI org enter the abrasions
• Multiply locally-either
disseminate or produce
inflammation locally
• Usually urethritis, cervicitisdischarge
• Local skin lesions e.g. HSV, HPV,
Syphilis chancre
• Discharge/ local lesions-mean
of spread of inf
• Individual STI has peculiar
natural course of inf e.g. HIV,
Syphilis etc.
• Complications of primary inf
Urethral discharge in gonorrhea
Chancre on glans penis
CLINICAL PRESENTATION
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Usually asymptomatic in majority
Urethral discharge, dysuria in male
Vaginal discharge, dysuria,
Pruritus on external genitalia
Ulcerative lesions on external
genitalia
Edema, pus discharge from wound,
Warts on external genitalia
Gen symptoms fever, malaise, etc.
Specific symptoms of disease like
HBV, HCV etc.
Vulval warts
CLINICAL PRESENTATION
• Symptoms of local spread e.g.
PID, ectopic pregnancy,
infertility etc. in female &
• Prostatitis, epididymitis,
epididymo-orchitis in male
• Symptoms of distant
dissemination e.g. sepsis
syndrome, death
• Symptoms of peculiar
practices e.g. pharyngitis,
proctitis, etc.
Vulvo-vaginal Trichomoniasis
DIAGNOSIS OF STIs
• Thorough clinical
history
• Detailed clinical exam
• Appropriate samples
• Focused lab tests
• Proper technique
• Proper transportation
• Timely processed
• Reports
DIAGNOSIS OF STIs
• Direct Microscopy e.g. in Syphilis
(dark field microscopy of
chancre)
• Gram stain of discharge/ ulcer/
pus- Ns. gonorrheae, H. ducryei
etc.
• Culture and antimicrobial
sensitivity of discharge/ ulcer/
pus
• Serological tests (non specific &
specific tests of syphilis, HIV etc.)
• Nucleic acid amplification tests
e.g. PCR on appropriate sample
Dark field microscopy-Treponema pallidum
Neisseria gonorrheae colonies on CA
DIAGNOSIS OF GONORRHEA
Gram Staining of urethral
discharge smear
• Pus cells numerous
• Gram negative intra and extracellular
bean shaped diplococci
Culture of urethral discharge
• Freshly obtained urethral discharge
streaked on selective medium for
Neisseria gonorrheae (Modified
Thayer- Martin medium, Chocolate
agar) and incubated in 5% CO2 at 3537oC.
DIAGNOSIS OF GONORRHEA
Nucleic acid
amplification tests (PCR
test)
• More sensitive and rapid tests.
• Can be performed on urine
specimen
Serology
• Antibodies against pili and
outer membrane proteins
detected by ELISA/
Radioimmunoassay
MANAGEMENT OF STIs
• Depends upon type of STI
• Usually bacterial causes of STIs are treated by
antimicrobials
• E.g. case of gonococcal urethritis/ cervicitis is treated
by parenteral 3rd gen cephalosporins
• Additionally doxycycline is added for 7 days ???
• Syphilis is universally sensitive to Penicillin
• Genital herpes-Acyclovir 200 mg q5hrly for 7-10
days
• HIV infection-HAART
MANAGEMENT OF STIs
• Management of partnervery imp
• Follow up checkup for other
STIs e.g. HIV/ HPV/HSV etc.
• Counseling of partner and
patient
• Education of patient and
partner about STI
• Offer vaccination for
vaccine preventable STIs
PREVENTIVE METHODS
• Abstinence
• Reduction of number of Sex Partners
• Pre-exposure Vaccination
–
–
HPV(quadri-valent Gardasil, bivalent
Cervarix)
HBV, HAV
Male Condoms
Female Condoms, Diaphragm,
Topical Microbicides/ Spermicides
Male Circumcision
Post-exposure Prophylaxis (PEP) for
HIV and STD
• Partner management
• Education about “SAFE SEX”
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LIFE IS BEAUTIFUL
CONFINE TO YOUR LIFE PARTNER