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This document discusses sexually transmitted infections (STIs), including bacterial infections like chlamydia, gonorrhea, and syphilis, and viral infections like genital warts and herpes. It describes the symptoms, stages of infection, potential complications (especially for pregnancy), tests for diagnosis, and treatments for each of these STIs. Prevention methods like education, partner treatment, risk reduction counseling, and condom use are also outlined.
This document discusses sexually transmitted infections (STIs), including bacterial infections like chlamydia, gonorrhea, and syphilis, and viral infections like genital warts and herpes. It describes the symptoms, stages of infection, potential complications (especially for pregnancy), tests for diagnosis, and treatments for each of these STIs. Prevention methods like education, partner treatment, risk reduction counseling, and condom use are also outlined.
This document discusses sexually transmitted infections (STIs), including bacterial infections like chlamydia, gonorrhea, and syphilis, and viral infections like genital warts and herpes. It describes the symptoms, stages of infection, potential complications (especially for pregnancy), tests for diagnosis, and treatments for each of these STIs. Prevention methods like education, partner treatment, risk reduction counseling, and condom use are also outlined.
• Normal vaginal discharge in a non pregnant is small
in quantity and white to colourless • During pregnancy there is increased vaginal discharge which is known as Leucorrhea • RX is counseling and advice on personal hygiene Pathological vaginal discharges • In all cases there is abnormal increase of vaginal discharge • Trichomoniasis causes a classic frothy yellow- green discharge, with a fishy smell, itching of the vulva • Gonorrhea produces a thin mucoid slightly yellow pus discharge with no smell • Chlamydia may cause a non itchy, thin colourless discharge • Candidiasis-intense vulval pruritus,soreness with often a thick white curdy discharge Differential diagnosis Ca of the cx especially in older women who are multiparous- causes a blood stained smelly discharge Bacterial infections include: Chlamydia, Gonorrhea and syphilis Trichomoniasis • Is almost exclusively sexually transmissible • It is caused by infection with the parasite trichomonas vaginalis, around or oval flagellated protozoan • It has been linked with a small risk of preterm delivery and low birth weight and an increase in the risk of HIV via sexual intercourse • It may be acquired perinatally and occurs in about 5% of babies born to infected mothers Clinical signs and symptoms • Burning sensation of the vulva sometimes with itching, dysuria • A greenish vaginal discharge containing small bubbles or having a foamy appearance • An inflammatory reaction on the vaginal walls and cervix presenting with red patches or dots • A vague lower abdominal pain may be present RX; -Metronidazole 5-7 days -Clotrimazole pessaries daily for 7 days -Treat partners and advise against coitus until Rx is completed Chlamydia • the most prevalent bacterial STI ,most common cause of PID, is as a result of the Chlamydia trachomatis bacterium, which can infect the urethra and cervix. • The disease is easily treated, but like other STIs, chlamydia tends to be silent and therefore go undiagnosed until it becomes more serious than in its early stages. • 3in 4 women and one in two men have no symptoms. • In 40 % of cases, by the time a female seeks medical attention, the disease has progressed to a PID, a major cause of female infertility and pelvic pain Symptoms Always asymptomatic in≈ 80% of cases. Some women may have: • Purulent vaginal discharge • Post coital or intermenstrual bleeding • Lower abdominal pain • Mucopurulent cervitis and/ or contact bleeding • Mild dysuria • Progression to PID • Rx- Macrolides e.g. Erythromycin • Tetracyclines & floroquinolones are currently contraindicated in pregnancy • TEO for opthalmia neonatorum Gonorrhea • Chlamydia infection is sometimes confused with gonorrhea, another bacterial infection. Not only do they share many of the same symptoms, the two diseases can occur together. • Gonorrhea usually begins in the urethra or the cervix. However, the rapidly proliferating Neisseria gonorrhoea bacterium can migrate to the uterus and the fallopian tubes, giving rise to PID. • The infection, like chlamydia, may also involve the rectum symptoms • yellow or bloody vaginal discharge • Lower abdominal pain • Dysuria • Intermenstrual bleeding & menorrhagia • Fever • Progression to PID Incidence in pregnancy is low 1 to 5% Maternal gonococcal infection is associated with: spontaneous abortion, very low birth weight, PROM, chorioamnitis, preterm delivery, postpartum endometritis and pelvic sepsis Diagnosis and RX:
• A dx is made by endocervical and rectal swabs
for culture and sensitivity • RX: Azithromycin, ceftriaxone • TEO for opthalmia neonatorum prophylaxis Syphilis • caused by Treponema pallidum bacteria • It can also be congenitally transmitted • It is a complex systemic disease that can involve almost any organ in the body • Syphilis in pregnancy and congenital syphilis remain a major cause of fetal and neonatal loss in developing countries • Every pregnant woman should be screened for syphilis stages • Stage 1: Primary Syphilis • Initial symptoms typically occur 2 to 6 weeks after exposure and last 4 to 6 weeks. • Painless chancre on the vulva, vagina, cervix or around the mouth • Inflamed lymph nodes Stage 2: Secondary Syphilis • Symptoms typically occur one to six weeks after the chancre heals and last three to six months • Light rash with brown sores roughly the size of a penny, typically on the palms of the hands and soles of the feet; may also cover the rest of the body • Sores in or around the genitals or anus • Mild fever • Fatigue • Headaches • Sore throat • Patchy hair loss • Appetite loss • Weight loss Stage 3: Tertiary Stage • Symptoms typically occur anywhere from 3 years to more than 20years after the onset of infection . • Syphilis in multiple systems, including the heart and blood vessels, skin, bones and brain. • untreated syphilis may result in spontaneous abortion, preterm birth, still birth, neonatal deaths and significant infant morbidity • Congenital syphilis in majority of live born infected infants do not have any signs & symptoms at birth will present over weeks, months or years • Investigations- RPR,TPHA • Rx: erythromycin Viral infections • Genital Warts • Caused by HPV 6 &11 • Genital warts may cause physical discomfort, are disfiguring and are psychologically distressing • Most cases can be managed with topical treatment of the warts, i.e. podophylum paint though the lesions tend to return & is contraindicated in pregnancy • It is advised that no RX is given during pregnancy. Other alternatives are: -cryosurgery (freezing), -electrocautery (burning). A C/S can be done if warts are extensive Genital Herpes • HSV-2 is the most common cause of genital herpes and is sexually transmitted • HSV infection may be asymptomatic, but painful, vesicular or ulcerative lesions of the skin and mucous membranes occur frequently • Dysuria, vaginal or urethral discharge, fever, myalgia • Dx- viral cultures from open leisions can be done • Rx-Acyclovir 200mg every 5hrs for 5days Prevention of STIs • Give health education about STIs • Provide specific education on the need for early reporting and compliance with treatment. • Ensure notification and treatment of sexual partners. • Counsel patient on risk reduction, eg. Practice of safe sex by using condoms, remaining faithful to one sexual partner, personal hygiene. • Provide condoms