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Dr Tony Worthington School of Life and Health Sciences Room 455a T.Worthington@aston.ac.uk
The morbidity and associated mortality is high and disproportionately affects: (a) Men who have sex with men (MSM) (b) Disadvantaged socio-economic communities (c) Young people with high risk sexual lifestyles
Organism
Disease
Chlamydia trachomatis Neisseria gonorrhoae Treponema pallidum* Papillomavirus Herpes simplex Hepatitis B/C* HIV* Candida albicans Trichomonas vaginalis Sarcoptes scabei Phthirus pubis (crab louse)
Non-specific urethritis Gonorrhoea Syphilis Genital warts Genital herpes Hepatitis AIDS Thrush Vaginitis Genital scabies Pediculosis pubis
Viruses
Drugs / alcohol
(a) Alcohol consumption; binge drinking (b) Ecstasy / amphetamines / heroin
MSM
Increased numbers; multiple partners; risky sexual practices
CLINICAL MANIFESTATIONS
Cervicitis
Vaginitis
Frequently asymptomatic (the silent epidemic): 75% women / 50% men; reservoirs of infection
Male: urethritis (watery, mucoid discharge) Female: urethritis / cervicitis / vaginitis
COMPLICATIONS
(a) Pelvic Inflammatory Disease (PID): 40% (b) Infertility in male and female (c) Ocular infection: neonates / adults
Male urethral discharge
Treatment:
Azithromycin (Clamelle): single dose; 2 x 500mg
CLINICAL MANIFESTATIONS Warts: Penis, vulva / vagina, perianal /anal, throat, mouth Genital warts (90%=types HPV 6 / HPV 11); multiple, dry, keratinised, cauliflower in appearance; painless
Anal warts Penile warts: typical cauliflower appearance
NEOPLASIA (CANCER) Neoplastic conversion (eg. cervical cancer): HPV 33, 35, 39, 40, 43, 45, 51-56, 58) moderate risk; HPV 16 / 18- high risk
(100%) 90%
40%
40%
3%
20%
Prevention:
Vaccination -Gardasil (HPV 6, 11, 16, 18) -Cervarix (HPV 16, 18) Safe sex
TRANSMISSION Via vaginal, anal and oral sex Incubation: 3-7 days
Oral herpes (predominantly HSV1)
CLINICAL MANIFESTATIONS Primary infection Asymptomatic in 70% cases Symptoms: constitutional and localised Untreated attack lasts approx 28 days; latency
Reactivation Tenderness, pain, and burning at the site of eruption lasting 2 hours to 2 days Women: Lesions on the labia and perineum Men: Lesions on the shaft, prepuce, glans.
Genital herpes (predominantly HSV 2)
Safe sex
EPIDEMIOLOGY Rates higher in urban regions esp. London Men form 70% of the diagnoses; MSM and black ethnic groups account for 1/3 of these Female16-19 years; male 20-24 years
Gram- negative intracellular diplococci in urethral discharge
Complications of gonorrhoea
(a) Males: epididymitis, prostatitis (b) Females (20%): spread to fallopian tubes (salpingitis); pelvic inflammatory disease (PID); infertility Opthalmia neonatorum 1% DGI: bloodstream infection fever, sepsis, arthritis, skin lesions
Skin lesions and arthritis
Opthalmia neonatorum
PID
(a) (b)
Stage 3: Formation of transferrin and lactoferrin binding receptors Tbp1 , Tbp2 Lbp 1
Oxidase +
Catalase + CHO fermentation (glucose+, maltose-, sucrose-); API Prolylaminopeptidase + (Gonochek II, commercially available)
Oxidase +
Gonochek +
Catalase +
CHO fermentation
(a) ceftriaxone (250mg; IM; single injection) (b) cefixime (400mg; oral; single dose) (c) spectinomycin (2g; IM; single injection) (a) (b) Safe sex Minimise number of sexual partners Use condoms during mouth-to-penis sex, vaginal and anal intercourse
Laboratory diagnosis is essential to confirm the identity of the causative agent and determine antimicrobial sensitivity
Ceftriaxone, cefixime, spectinomycin: first line treatment for GC Prevention is better than cure!
A complex picture: HIV and other sexually transmitted infections in the UK. Health Protection Agency (2006)
STIs in the 21st century. Royal Institute of Public Health supplement