INFECTIOUS DISEASES SEXUALLY TRANSMITTED DISEASES[STDs]

INFECTIOUS DISEASES

SEXUALLY TRANSMITTED DISEASES[STDs] 

CHRISTY IMMACULATE - MDCCC - 112

In worldwide sexually transmitted diseases (STDs) is most commonly transmit from person through sexual contact.it is the important mode of transmission. In 16th century in India syphilis called as “portuguese disease (or) Firangi Roga. It may also caused by virus, bacteria, parasite and fungi.

Infection caused by viruses are AIDS (acquired immune deficiency virus).Genital Herpes simplex and genital warts. Infection caused by bacteria are syphilis, Gonorrhea, chancroid, Non-Specific vaginitis, Granuloma inguinale and by parasitic infections are scabies, pediculosis pubis and Trichomonas vaginitis and urethritis and by fungal infections are Balanitis, vulvovaginitis and vaginal Thrush.

• Germanzoologist Fritz Schaudinn and Dermatologist ErichHoffmann in 1905 discovered the causative organism of treponema pallidum.

ABOUT DISEASE:

SYPHILIS is the one of the Bacterial sexually transmitted disease.it is a disease caused by “TREPONEMA PALLIDUM”. In worldwide syphilis affecting the age group between 15-40. currently it was found to be increasing . It is curable.

EPIDEMIOLOGY: 

According to WHO the incidence of the disease increase in this recent years. On every year incidence rates increasing ranging from 5.4 per 100 person. On past Five years congenital syphilis increasing the ranges about 203 percent .

IMPORTANCE OF DISEASE:

1.It is a socioeconomic problem as well as behavioral problem. since it is linked with addiction, increasing age of marriage and also more number of sex partners who are infected with syphilis.

2.Increasing the incidence worldwide.

3.The cost and difficulties in the treatment of the disease and their complications.

ABOUT CAUSATIVE ORGANISM:

Syphilis is caused by TREPONEMA PALLIDUM Which comes under the category of Gram-Negative bacteria. It is a spiral shaped bacteria called as spirochetes. It is a motile and length is about 20um. It is invisible under light microscopy and it should be visible under dark field electron microscope.

HOW DO PEOPLE GET SYPHILIS?

1. pregnant mother with syphilis to fetus.

2. Person to person during foreplay even there is no penetrative sex.

3. It also transmitted via blood transfusion.

4. It is due to unsafe sexual practices.

5. It also spread through contaminated needles, infectious lesion.

6. In hospital, Indiscriminate handling of infectious lesion.

TYPES OF SYPHILIS:

PRIMARY SYPHILIS: It is the first stage of infection is characterized by syphilitic sore called as painless chancre. It is the primary stage of infection. The chancre occurs in lips or mouth, penis, vagina, rectum and anus.

SECONDARY SYPHILIS: It is the secondary stage of syphilis characterized by lesion appears throughout the body and mucocutaneous eruption results from widespread of Hematogenous and lymphatic spread of T.pallidum

LATENT SYPHILIS: Latent syphilis is divided into early latent and late latent.

Untreated primary and secondary syphilis may be a early latent syphilis.

• Late latency syphilis is not infectious; however, women in this stage can spread the disease in utero. Affected patients asymptomatic and the disease is detected only by serologic tests.

TERITARY SYPHILIS: After a latent period of appearance of secondary lesions and about 2-3 years following first exposure, tertiary lesions of syphilis appear. Lesions of tertiary syphilis are much less infective than the other two stages of spirochetes, can be demonstrated with great difficulty. These lesions are of two main types:

i. Syphilitic Gumma

ii. Diffused lesions of tertiary syphilis Appear.

CONGENITAL SYPHILIS: The risk of fetal infection greater in pregnant women with primary and secondary syphilis by vertical transmission . Symptoms can be seen during the first months of life (early congenital syphilis) or later in childhood or adolescence (late congenital syphilis).

CARDIOVASCULAR SYPHLIS:

This may present many years after initial infection. Aoritis, which may involve the aortic valve and or the coronary ostia. The condition typically affects the aortic arch and most commonly ascending aorta, rarely aneurysm of the descending aorta.

Clinical feature includes angina and aortic aneurysm , aortic incompetence.

NEUROSYPHILIS:

Asymptomatic infection is associated with CSF abnormalities in the absence of clinical feature. It most commonly affects the brain and spinal cord.

PATHOPHYSIOLOGY:

• T.Pallidum enters into the body ,multiplies and spreads via lymph to the blood.

• Within 2-10 weeks a hard painless ulcer (chancre forms).

• Upto 10 weeks later, secondary lesion appear. These consists of a red maculopapular rashes are present on the palms and soles.

• Both primary and secondary lesions are rich in T.Pallidum organism and are extremely infectious.

• Enter the third stage, Gummas develop

• Affect any organ system lead to dysfunction- Neurosyphilis

• Develop ataxic gait

DIAGNOSIS:

✓ Serologic testing

✓ Rapid plasma reagin (RPR)

Old test: Wassermann test, Hinton test

Present day test:

• Dark Field Microscopy

• Treponema palladium hemagglutination assay(TPHA)

• Microscopy of chancre fluid

• Micro hemagglutination assay

• Screening for pregnant women

• Cerebrospinal fluid test.

• HIV testing.

TREATMENT:

Initially there was no effective treatment

• Pencillin E, Benzathine pencillin G,2.4mv, IM inj was administered as first choice of treatment 

• Alternative- oral tetracycline 100 mg bid-14 days, Ceftriaxone 1g IM or iv 8-10 days
• Neurosyphilis - Crystalline penicillin G IV/day 18-24 MV
• Alternative-Ceftriaxone IM 2g -14 days

Early infections

• benzathine benzylpenicillin single dose in IM

• Doxycycline and tetracycline are alternative choices for those who are allergic to penicillin;

• Resistance to macrolides, rifampicin, and clindamycin is often present.

• Ceftriaxone, a third-generation cephalosporin antibiotic, may be as effective as penicillin-based treatment.

Penicillin-G,administered parenterally, is the preferred drug for treating all stages of syphilis

• The preparation used, dosage, and the length of treatment depend on the stage and clinical manifestations

Tetracycline 500 mg, orally, 4 times a day for 2 weeks

Doxycycline 100 mg, orally, twice daily

• If intolerable to above Ceftriaxone 1 gm IM or IV for 8-10 days

Non-pregnant, penicillin allergic, HIV negative

LATE LATENT SYPHILIS:

• Benzathine Penicillin G - 2.4 MU

• Intramuscular- Once a week for 3 weeks

NEUROSYPHILIS

Penicillin G Crystalline (3-4 MU)-Intravenous - Every 4 hour for 10-14 days

Procaine Penicillin 2.4 MU/day, Intramuscular + Probenecid 500 mg orally, 4 times a day

If allergy conformed with penicillin, allergy should be desensitized, and treatment should be continued

CONGENITAL SYPHILIS:

It is complex to treat in neonate

• For older children with congenital syphilis

• Aqueous crystalline penicillin G- 200000 to 300000 IU/Kg/Day

• Intravenous or Intramuscular(50,000 IV every 4-6 hours) for 10-14 days.

PREGNANT WOMEN:

Treated with penicillin in dose appropriate for the stage of syphilis

2nd dose of Benzathine Penicillin, 2.4 MU, IM, administered 1 week after initial dose.

Penicillin Allergy should be desensitized.

Benzathine penicillin G • 2.4 MU •IM • For 3 weeks

If allergic to penicillin Desensitize to allergy

Follow up non treponemal test at 3, 6, 9 and 12 months

PREVENTION: 

1. Practice safe sex; advised to always use latex condom as precautionary measure for intercourse.

2. Limit the number of partners

3. Substance abuse such as drugs or alcohol may also help in transmission of syphilis so pt to be advised regarding its usage

4. Advice to Talk openly with their sex partners about their HIV status and history of other STDs so that preventive action can be taken.

5. Homosexuals or bisexuals must get a regular test for sexually transmitted infection (STI), including a blood test for syphilis.

6. Hand washing is the simplest and most cost effective way of preventing the transmission of infection. The hands must be washed for a minimum of 10-15 seconds with soap or other disinfectant

7. Common towels must not be used as they facilitate transmission of infection

REFERENCES:

1.Centres for disease control and prevention gonorrhea-CDC fact sheet.

2.http://www.ncbi.nim.nih/books/NBK534780

3.http://journals.asm.org/doi/10.1128/cmr.12.2.187.

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