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TRACT INFECTIONS
• RTI - Reproductive Tract Infection
• Any age
• Male or female
• Sexually active individuals
Modes of Transmission
• Sexual intercourse
• Blood and blood products
• Mother to infant
• Close contact
Factors that Influence
Transmission
• Multiple sex partners
• Frequent change of partners
• Casual sex
• Unsafe sex
• Treatment delay
• Untreated sexual partners
• Poor treatment compliance
CONSEQUENCES of RTI
• SOCIAL
Social stigma
Psychological
- guilt
- loss of self esteem
- depression
Marital instability
Violence, abusive behavior
CONSEQUENCES of RTI
ECONOMIC
Direct costs
- diagnostic and therapeutic
Indirect costs
- Lost days of productivity
- Infant morbidity : cost of care
CONSEQUENCES of RTI
• HEALTH
PID & infertility
Urethral strictures
Adverse pregnancy & neonatal outcomes
Cervical cancer
COMMON RTI
VAGINITIS
Trichomonas
Candidiasis
Bacterial vaginosis
URETHRITIS / CERVICITIS
√ Chlamydia trachomatis
√ Neisseria gonorrhea
COMMON RTI
GENITAL ULCERS
Syphilis
Primary Syphilis
Secondary Syphilis
Tertiary Syphilis
Congenital Syphilis
Herpes Simplex Virus Infection (HSV)
PARASITIC INFECTIONS
Pediculosis pubis
Scabies
PELVIC INFLAMMATORY DISEASE
HIV / AIDS
Trichomoniasis
Frothy foul -
smelling
discharge
adherent to
vaginal wall
“strawberry” cervix
with punctate
bleeding erosions
Vaginal pH>4.5
Microscopy:
Wet smear:
pyriform shaped
motile organisms
TRICHOMONIASIS
Recommended regimen
Metronidazole 2 g orally as single dose
Tinidazole 2 g orally as single dose
Alternative regimen
Metronidazole 500 mg BID x 7 days
Bacterial vaginosios
Copious thin, white to
grayish yellow homogenous
discharge with fishy odor
Vaginal pH >4.5
Fishy odor with 10% KOH
(Whiff’s test)
Microscopy:
Alternative regimen
Metronidazole 2 g orally as single dose
Clindamycin 300 mg BID x 7 days
Moniliasis
Intense vaginal pruritus exacerbated by menstruation
Potassium
hydroxide smear -
hyphal elements
Male Partner:
CANDIDIASIS
Intravaginal Agents:
Oral Agent:
PLUS
Doxycycline 100 mg po BID x 7 days
Azithromycin 1 g po single dose
* if chlamydial infection is not ruled out
Chlamydia Trachomatis
Presence of purulent
urethral discharge and
edema of the meatus noted
Cervical edema and ectopy with
mucopurulent exudation
Microscopy
Direct immunoflourescence test
detected elementary bodies
Male Partner
Chlamydia trachomatis infection
Recommended Regimen
Doxycycline 100 mg po BID x 7 days
Alternative Regimen
Patient-Applied:
Podofilox 0.5% solution or gel
Imiquimod 5% cream
Provider-Administered:
Electrocautery
Podophyllin resin 10%--25%
Trichloroacetic acid (TCA) 80%-90%
Bichloroacetic acid (BCA) 80%-90%
Surgical removal
GENITAL WARTS (HPV)
Alternative Regimen for External Genital Warts
Intralesional interferon
Laser surgery
GENITAL WARTS (HPV)
Regimen for Cervical Warts
• Electrocautery
Cryotherapy with liquid nitrogen
Excoriations and
erythema of the vulvar
skin
Few bluish spots
Microscopy:
Adult louse and nit containing larva
PEDICULOSIS PUBIS
Recommended Regimen
Permethrin 1% creme rinse applied to affected areas and
washed off after 10 minutes
Alternative Regimen
Lindane (1%) 1 oz. of lotion or 30 g of cream applied in a thin
layer to all areas of the body from the neck down and
thoroughly washed off after 8 hours
Elaborated criteria
Endometritis on endometrial biopsy
TOA on sonography / imaging study
Laparoscopy
Laparoscopy:
Evidence of perihepatitis
(Fitz-Hugh-Curtis
Syndrome)
Laparoscopy:
Out-Patient Regimen A
Ofloxacin 400 mg po BID
Levofloxacin 500 mg po OD, for 14 days
PLUS
Metronidazole 500 mg po BID, for 14 days
PELVIC INFLAMMATORY
DISEASE
Out-Patient Regimen B
Cefoxitin 2 g IM plus probenecid 1g po single dose
Ceftriaxone 250 mg IM
Other IV third generation cephalosporins (Ceftizoxime or
cefotaxime)
PLUS
Doxycycline 100 mg po 2 times daily for 14 days
with or without Metronidazole 500mg BID
PELVIC INFLAMMATORY
DISEASE
In-Patient Regimen A
Cefoxitin 2 g IV every 6 hours
Cefotetan 2 g IV every 12 hours,
PLUS
Doxycycline 100 mg IV or po every 12 hours
with or without Metronidazole 500 mg BID
PELVIC INFLAMMATORY
DISEASE
In-Patient Regimen B
Clindamycin 900 mg IV every 8 hours,
PLUS
Gentamicin loading dose IV, or IM (2 mg/kg of bw) followed by
a maintenance dose (1.5 mg/kg) every 8 hours
( IV meds x 48 hrs), then shift to
Speculum: white
cheesy discharge
Laboratory:
Positive ELISA
Positive Western Blot
CD4 count
<200/mm3
Cell culture
HIV/AIDS
Antiretroviral Drugs Approved by FDA for HIV
Nucleoside Analogs
Zidovudine (AZT, ZDV)
Didanosine (ddl)
Zalcitabine (ddC)
Stavudine (d4T)
Zidovudine/Lamivudine (3TC)
Abacavir (ABC)
HIV/AIDS
Antiretroviral Drugs Approved by FDA for HIV
Protease Inhibitors
Non-nucleoside
Reverse Indanavir (IDV)
Transcriptase Inhibitors Ritonavir (RTV)
(NNRTI) Saquinavir (SQC)
- Nevirapine (NVP) Nelfinavir (NFV)
- Delavirdine (DLV) Amprenavir (APV)
- Eavirenz (EFV) Lopinavir/Ritonavir
(LPV/RTV)
HIV/AIDS and STIs
Punch lesions of
secondary syphilis
Gingival lesion
Non-Hodgkin’s Lymphoma
Toxoplasmosis Cytomegalovirus
Pneumocystis carinii
HIV / AIDS
Cryptococcosis
Tuberculosis
Aspergillosis Blastomycosis
Main Objectives of RTI
Control
• HPV
Counseling
Inform the couple about the diagnosis and
complications