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Sexually Transmitted Diseases
Outline
A. Major Sexually Transmitted Diseases
| STD | Causative Agent | Remarks |
| Gonorrhea | Neisseria gonorrhea | CDC recommends that females with gonococcal PID be treated for chlamydial infection as well.
Gonococcal conjunctivitis in newborns |
| Syphillis | Treponema pallidum | Primary- chancre, secondary- condylomata lata, tertiary - gummas. Can cross placenta- congenital syphillis in fetus |
| Genital Herpes | Herpes simplex, Type 2 (mostly), occasionally HSV-1 | Recurrent infections, Up to 50% of newborns will die if they contract HSV during delivery |
| Genital Warts | human papilloma virus (HPV), (more than 60 types) | Carries increased risk for penile, vulvar and cervical cancers |
| Granuloma Inguinale | Calymmatobacterim donovani | obstucts lymphatics and can lead to elephantoid external genitalia |
| Chlamydial Infections | C. trachamotis (Types D-K) | May cause ocular diseae in newborns. TypesA1, B1, Ba, C cause eye infections.Symptoms similar to those of gonorrhea |
| Lymphogranuloma venereum | C. trachamotis (Types L-I and L-III) | Causes large tender inguinal lymph nodes called bubos |
| Chancroid | Hemophilus ducreyi | Causes large tender inguinal lymph nodes called bubos |
| HIV/AIDS | Human Immunodeficiency virus (HIV) | HIV/AIDS |
B. Minor Sexually Transmitted Diseases
1. Candidiasis
a. caused by Candida albicans
b. can be transmitted sexually but normally present in healthy people, only causes problem when it overgrows as a result of
1. antibiotic therapy
2. high hormone levels due to pregnancy or use of oral contraceptives
3. high sugar intake or Diabetes
2. Trichomonas
a. caused by Trichomonas vaginales (protozoa that is tranmitted sexually
b. can cause spotty reddening and edema of affected mucosa with small blisters or granules called strawberry mucosa
3. Bacterial Vaginitis (Nonspecific vaginitis)
a. often caused by Gardnarella vaginales
b.produces a typical fishy or ammonia smelling discharge, but does not produce an inflammatory response.
Discussion
Sexually transmitted diseases (STD) are the major cause of preventable sterility in American men and women. Gonorrhea and chlamydia are a major cause of PID. In turn, PID has tripled the rate of ectopic pregnancies in the last few years. Other STD related complications include miscarriage, premature delivery and post partem infection of the uterus. STD's also increase the risk for cancers. The presence of an STD increases the risk of transmission of HIV. An STD caused by a bacteria, fungus or protozoa can be treated with antibiotics (although resistant forms are occurring). An STD caused by a virus basically cannot be eliminated from the body. In the case of genital herpes it becomes dormant in the dorsal root ganglia where it can cause periodic flareups. A person with genital herpes is infectious during these flareups. Some new data indicates that infectivity may even be present when the herpes virus is apparently dormant.Genital warts (also called condylomata acuminatum) is the fastest growing STD in the US and is now even more common than genital herpes. There are more than 60 ytpes of HPV. Infection with certain types increases the risk for penile, vulvar and cervical cancers. Persons with HIV experience more frequent and severe recrrences of herpes and genital warts.
Clinically
T. pallidum elicits a humoral reponse that causes the body to produce two types of antibodies: nonspecific and specific. The nonspecific antibodies are detected by means of non treponemal serological tests that include VDRL, Wasserman and RPR (Rapid plasma reagin). Diseases, other than syphillis, may cause a false positive reading. These tests are good for screening for syphillis and the RPR is good for monitoring disease activity by quantitating the amount of antibody. Anyone with a positve nonspecifc test should be confirmed for syphillis with a specifc serological test. These tests are very sensitive for T pallidum. They include FTA-ABS (fluorescent treponemal antibody absorption).