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infections whose primary route of transmission is through sexual contact. The infection can be caused by a broad range of pathogens that affect both the sexually active couple & neonates born to an infected mother.
*CVV & scabies are often diagnosed in STI clinics although not usually acquired sexually
A. Characterized by ulcer :
1. 2. 3. 4. 1. 2. 3. 4. 5. Syphilis Ulcus Mole Herpes Simplex LGV
C. Other STI :
1. 2. 3. 4.
Human Papiloma Virus (condyloma accuminata) Syphilis (condylomata lata) Molluscum Contagiosum Virus Scabies
Def :
chronic systemic inf, characterized by the appearance of a painless ulcer/chancer at the site of inoculation, associated with regional lymphadenopathy. *Shortly after inoculation syphilis becomes a systemic infection with characteristic secondary and tertiary stages *Syphilis is the great imitator~ other skin diseases
Transmission :
- sexual contact : inf lesion (contact with chancre, primary sy), mucous patch, condyloma latum, cutaneous lesions (secondary sy) - Congenital nf : in utero/perinatal transmission - Blood products : transfusion
Lab :
- Dark-field microscopespirochaete bacterium from ulcer, cutaneous lesions, condylomata lata - spirochaete 6-10 - STS : - VDRL(non specific) : - TPHA (specific): 1/80 1/1024
Late (non-infectious)
Latent (late) Neurosyphilis Cardiovascular Gummatous syphylis >2 years 3-20 years >10-40 years 3-12 years after primary inf
3 stages of sy :
* Primary sy (L1) - symptom : painless ulcer (genital/extra genital) - incubation : 21 drange 10-90 d - skin lesions :(heal within 3-10 weeks) Clinical feature: button like papule few mm-1-2 cm, painless clean ulcer (firm indurated border, scanty, serous exudate) *extragenital fingers may be painfull
Predilection :
: corona sulcus, shaft, base, inner prepuce : servix, vagina, vulva - extragenital : anus/retum, mouth, lips, tongue, tonsil, fingers (painful), toes, breast, nipple. General exam : 7d regional lymphadenopathy discrete nodes, firm, rubbery, nontender,painless,unilateral persist for months
DD :
Genital herpes Fixed drug eruption Ulcus Mole LGV Dx : Clinicaly & Lab
Secondary Sy
2-6 m primary inf (contact) 2-10 w appearance of primary chancre 6-8 w healing of chancre *Symptom : - fever, sore throat, loss of weight, malaise, anorexia, headache - asymptomatic mucocutaneous lesions duration of lesions : weeks
*Skin lesions : - Trunk : generalized eruptionmacules, papules 0,5-1cm, round oval, pink/brownish/red - Head (hair line, nasolabial, scalp), neck, palms & soles hyperkeratotic-psoriasisform, anular/polycyclic (face in dark-skinned) - Neonatal congenital Sy : vesico-bullous palms & soles - Genital (anogenital, mouth) : condylomata-lata soft, flat-topped, moist, red-pale papules, nodules or plaques
-Hair : diffuse hair loss, patchy moutheaten alopecia (scalp & beard), loss of eyelashes 1/3 lat *Generalized lymphadenopathy & splenomegaly *Lab : - spirochaete from the lesions - STS *Dx : - clinical suspicion dark-field - STS
Latent Sypphilis
- no sign & symptom - STS (+) - history of primary or secondary lesion, history of exposure to sy, delivery of infant with congenital sy early latent <1 year late latent 1 year
Tertiary / Late Sy
- 15% untreated late benign, mostly skin lesions - duration 3-7 year history - Gumma 15year
*Physical exam : - Gumma ; nodular/pappulosquamous ulcer heal expand rapidly destruction location : skin (scalp, face, chest), internal (skeletal system) - Neurosyphilis : 25% untreated 25% asymptomatic 20% clinical neurosyphilis tabes dorsalis, general paresis - Cardiovascular sy : 10% untreated 10-40 y after inf aortitis,regurgitation
DD : cutaneous tuberculosis
invasive fungal inf Dx : clinical findings STS
Congenital Syphilis
- transmission : during gestation/inpartum - adequad tx <19 w pregnancy prevent fetal demage - clinical manifestation : early : <2 yoften 2-10 w, very inf, rhinitis/snuffles (23%), bullae/vesicles, superficial desquamation/ papulosquamous, ptechiae, condylomata latum, hepatosplenomegaly, lymphadenopathy late : >2 y, noninfectious, ~ late acquired sy - residual stigmata : - Hutchinson teeth - abnormal facies : frontal bossing, saddle nose, poorly developed maxillae TX: baca buku UI hal 409 dan ABC of sexually transmitted infection
Skin lesions :
tender papule with erythematous halo pustule erosion/ulcertender,painful,nonindurated multiple ulcer (autoinoculation) Distribution : : prepuce, frenulum, coronal sulcus, glans penis, shaft : labia, vestibule, clitoris, perianal, vaginal wall, introitus, cervix
bacillus / chain-like DD : Genital Herpes Primary Syphilis LGV Traumatic Lesions Dx : Clinicalpainful ulcer + tender lymphadenopathy Tx : azitromycin 1 gr PO single dose or ceftriaxone 250mg IM single dose or ciprofloxacin 500mg PO bid 3d or erythromycin 500mg PO qid 7d * Sex partners : evaluation & treatment
DD : ulcus Molle, primary sy, impetigo Dx : clinical, giemsa-stain : Tzank cell Tx : not specific
Limphogranuloma Venereum
Def : venereal disease is characterized by a
transient primary genital lesion followed by multilocular suppurative regional lymphadenopathy. Etiol : chlamidya trachomatis Incubation : 2-12d Lesion : - acute : small painless vesicle or nonindurated ulcer/papule on penis - ingunal synd : unilat painful inguinal adenopathy 2-6w after presumed exposure.
urethrafish mouth urethra Dx : culture, serologic tests Tx : Azythromycin 1 g PO single dose or Doxycycline 100mg PO bid 7 d
Physical exam :
: urethritis seropurulent discharge : dysuria, vaginal discharge, bartolinitis DD : genital inf that characterized by urethritis & vaginal discharge Dx : clinically & lab Tx : Doxycycline 100mg PO bid 7d or Azithromycin 1 g PO single dose or Erythromycine 500mg PO qid 7d
Trichomoniasis
Def : acute or chronic urogenital inf Etiol : T Vaginalis Physical Exam:
- : mild urethritis - : seropurulent discharge, yellowish / yellow-green, malodorous, foamy Lab : T. Vaginalis from fresh discharge Dx : lab finding Tx : Metronidazole 2g PO single dose or Metronidazole 500mg PO tid or Nimurazole 2 g PO single dose or Omidazole 1,5 g PO single dose
RESUME
The three most common presenting symtoms of an STI
are :
Urethra discharge Genital ulceration Vaginal discharge
Cervical cancer Anal cancer Infertility Ectopic pregnancy Spontaneus abortion Neuro sifilis