MARGIE REYES-POSADAS, MD

MARGIE REYES-POSADAS,
MD
 STD
 • RTI - Reproductive Tract Infection

- General term used to refer to infections

of the reproductive tract which will
include both the sexually transmitted and
non-sexually transmitted infections.

 STI - Sexually Transmitted Infection

 What is a Sexually Transmitted
Infection or STI?
 STI’s are infections that are spread from
person to person through intimate sexual
contact.
 STI’s are dangerous because they are easily
spread and it is hard to tell just by looking
who has an STI.
 1 in 4 sexually active teens has an
STI ?.
 STDs
 STDs are diseases and infections
which are capable of being spread
from person to person through:
› sexual intercourse
› oral-genital contact or in non-sexual
ways.
› IV drugs
Dr.T.V.Rao MD 09/25/2020 4
 RISK FACTORS
 Multiple sexual partners
 New sexual partner
 Partner with multiple sexual partner
 Unprotected sexual intercourse
 Douching (non sexually active)
 Single
 Prostitue
 RTI
Major public health problem
Cause serious complications Facilitate transmission of HIV Social and economic burden
Four Classes of STD’s
 Bacterial
 Fungus
 Parasites

 Viruses- NOT curable ?

Common STI’s
 Chlamydia  HIV and AIDS
 Gonorrhea  Pubic Lice
 Genital Herpes  Syphilis
(HSV-2)
 Trichomoniasis
 Genital Warts
(HPV)
 Hepatitis B

Dr.T.V.Rao MD 09/25/2020 8
 SYPHILIS IN PREGNANCY
 Ethiologic agent: Treponema pallidum
 Treponema: greek term “turning head”
 It is a labile organism that can’t survive drying or
exposure to disinfectants.
 It is solely a human pathogen & does not
naturally occur in other species.
 SYPHILIS IN PREGNANCY

PREVALENCE:
 US: 17.4 cases per 100,000 population
 2-11% are diagnosed during pregnancy
 Highest infection rate= aged 20-29 y/o
 SYPHILIS IN PREGNANCY

MODE OF TRANSMISSION
 Penetration of the spirochete through mucosal membranes &
abrasions on epithelial surfaces.
 Sexual contact
 Exposure to blood products
 In utero by crossing the placenta & infecting the fetus
INCUBATION PERIOD
 3 weeks (10-90 days)
 SYPHILIS IN PREGNANCY
 SIGNS & SYMPTOMS
 PRIMARY SYPHILIS
› CHANCRE- primary lesion
› Solitary raised, firm papules
› Erodes to create ulcerative crater w/ elevated edges
› Manifest mainly in the glans penis, vulva or cervix
› 10%, found in anus, fingers, oropharynx, tongue,
nipples or extragenital sites
PRIMARY SYPHILIS
PRIMARY SYPHILIS
 SYPHILIS
 SECONDARY SYPHILIS
 localized or diffuse mucocutaneous rash &
generalized, non-tender lymphadenopathy
 Red papular lesions appear on palms, soles, face, &
scalp
 CONDYLOMA LATA: reddish brown papular
lesions on the penis or anogenital area
 Superficial painless mucous patches on the
tongue, oral mucosa, lips, penis & vulva
SECONDARY SYPHILIS
SECONDARY SYPHILIS
 SYPHILIS
 TERTIARY SYPHILIS
 GUMMATOUS SYPHILIS: manifest cutaneously or
may involve visceral organs
 Maybe single or multiple
 Generally asymmetric & grouped together
 Liver & skeleton commonly affected
 Cardiovascular syphilis
 Neurosyphilis
 Not infectious at this stage
 SYPHILIS
 TERTIARY SYPHILIS
 MANIFESTATIONS:
› Meningovascular syphilis: perivascular inflammation
in the brain
› Paretic syphilis: cell death & brain atrophy
› Tabes dorsales: damage of the sensory nerves
producing ataxia, loss os pain sensation,
proprioception, & deep tendon reflexes in joint
TERTIARY SYPHILIS
TERTIARY SYPHILIS
 SYPHILIS
 LATENT SYPHILIS
 Spreads during first year after infection
 Asymptomatic & dse. detected only by serologic tests
 May last few years to 25 years
 Divided into:
› EARLY LATENT PERIOD: first yr. after the resolution
of primary & secondary syphilis
› LATE LATENCY PERIOD: not infectious & can
spread in utero.
 Congenital Syphilis
 Uncommon before 18 weeks
 Once fetal syphilis develops, it manifests as a
continuum of involvement.
 Abortion
 Fetus: hepatic abnormalities, anemia,
thrombocytopenia, then ascites and hydrops
 Newborn: jaundice with petechiae or purpuric skin
lesions, lymphadenopathy, rhinitis, pneumonia,
myocarditis, or nephrosis.
 SYPHILIS
 DIAGNOSIS:
› 1. Darkfield microscopy
› 2. Direct flourescent antibody test
SCREENING TEST:
› RPR OR VDRL- 70-80% sensitivity for Primary
Syphilis
- 90-100% sensitivity for
Secondary Syphilis
 SYPHILIS
 DIAGNOSIS:
› CONFIRMATORY TESTS:
› 1. Flourescent treponemal antibody absorption test
› 2. T. Pallidum Heamagglutination test & T. Pallidum
Particle Agglutination test
› 3. Treponemal Enzyme Immunoassay
 Used by some labs & blood banks to screen blood
samples
 SYPHILIS
 DIAGNOSIS:
 Chest x-ray
 CT Scan
 MRI
 SLIT Lamp Examination
 Lumbar puncture
 SYPHILIS
 TREATMENT:
 PENICILLIN= 2.4 M units = drug of choice
 OTHERS:
 Cephalosporins= ceftriaxone
 Macrolide= azithromycin
 Tetracyclines, including doxycycline, for
nonpregnant woman.
 SYPHILIS
 Special concerns:
 1. Routinely screen all pregnant women.
 2. Pregnant patients w/ + VDRL test = perform
monthly VDRL for the duration of pregnancy.
 3. Penicillin is safe while breastfeeding
 4. Partner/s should be evaluated clinically &
serologically & treated
 5. All women with syphilis should be offered
counseling and testing for HIV
 GONORRHEA IN PREGNANCY

 Etiologic agent: Neisseria Gonorrhea

 Gram-negative intracellular diplococci, non-
motile, non-spore forming organism
 Shaped like a coffee-bean w/ adjacent concave
sides
 It is oxidase positive
 Has the ability to grow on selective media & to
utilize glucose
 GONORRHEA IN PREGNANCY

 EPIDEMIOLOGY:
 1997: 62 M new cases worldwide
 US: 650,000 cases/year, 40,000 pregnant women
 PHILS. (DOH): 600,000 cases annually
 Female sex workers in manila & cebu found
23.3% & 37% gonococcal & chlamydial cervical
infections.
 GONORRHEA IN PREGNANCY

 MODE OF TRANSMISSION:
 Sexual contact (vaginal, anal, oral sex) w/ an
infected person
 Vertical transmission
 80-90% = risk of transmission to an infected male
to unprotected female
 20-25% = infected female to male per episode of
sexual contact
 40-60% = after 4 or more exposures
GONORRHEA IN PREGNANCY

 SIGNS & SYMPTOMS:  Hypogastric pain

 Painful urination  fever
 Persistent profuse  Anal infection: discharge
vaginal or pain on bowel
discharge/mucopurulent movement
cervical discharge  Throat & mouth infection
 Vaginal spotting  Eye infection
 Purulent urethral
discharge
Purulent urethral discharge with edema of the meatus
Purulent urethral discharge with edema of the meatus
reddish and edematous cervix with exudation
 Frequency and progressive dysuria
 Increase amount of urethral discharge
 Frequency and progressive dysuria
 Increase amount of urethral discharge
 GONORRHEA
 DIAGNOSTIC TESTS:
 1. Microscopy = gram staining of vaginal smears
 Culture = Modified Thayer Martin (80-90%
sensitivity)
 Nucleic Acid Amplification Tests = sensitivity is
as good as culture
 DNA probe
 GONORRHEA
 TREATMENT:
 * uncomplicated gonococcal infections in
pregnancy:
 1. ceftriaxone = 250mg IM single dose
 2. cefixime = 400mg PO single dose
 3. spectinomycin = 2g IM single dose
* All gonorrhea cases be tested for Chlamydia infection using
NAAT, or be treated concurrently against chlamydia.
 GONORRHEA
 SPECIAL CONCERNS:
 1. Evaluation of sex partners of infected patients w/in 60 days
before onset of symptoms or diagnosis.
 2. adverse effects in pregnancy:
› PROM/PPROM
› PRETERM LABOR & DELIVERY (14%)
› CHORIOAMNIONITIS
› SALPINGITIS & PID
 GONORRHEA
 SPECIAL CONCERNS:
 3. adverse effects on fetus/neonate
› Funisitis
› Ophthalmia neonatorum
› Disseminated Gonococcal Infection
 CHLAMYDIA IN PREGNANCY
 Etiologic agent: Chlamydia trachomatis
 Obligate intracellular parasite that infects humans.
 Exists as 15 different serotypes causing four major
diseases in humans:
› 1. endemic trachoma
 (caused by serotypes A & C)
› 2. STD
› 3. Inclusion conjunctivitis
› 4. Lymphogranuloma venereum
 (caused by serotypes L1,L2 & L3)
 CHLAMYDIA IN PREGNANCY
 EPIDEMIOLOGY:
 US: 4M cases annually, 600,000 diagnosed cases
 Worldwide: 1997, 89M new cases
 PHILS: 1M cases
 CHLAMYDIA IN PREGNANCY
 MODE OF TRANSMISSION:
 Transmitted during vaginal, anal or oral sex.
 From an infected mother to her baby during
vaginal birth
 The greater the number of sexual partners, the
greater the risk of infection.
 Life cycle has 2 stages: a. Elementary body & b.
reticulate body
 INCUBATION PERIOD: 7-21 DAYS
 CHLAMYDIA IN PREGNANCY
 SIGNS & SYMPTOMS:
 Asymptomatic = 75% of infected women, 50% in
men
 Abnormal vaginal discharge or bleeding
 Burning sensation when urinating
 Lower abdominal pain or low back pain
 Nausea
 dyspareunia
Purulent urethral discharge and edema
cervical edema with mucopurulent exudation
Painful urination
 CHLAMYDIA
 DIAGNOSTIC TEST:
 Culture
 Nucleic Acid Amplification test( NAAT) using
PCR
 Ligase chain reaction assay = sensitive and
specific for genitourinary infection in pregnant
women.
 CHLAMYDIA
 TREATMENT:
 1. Azithromycin 1g single dose
 2. Amoxicillin 500mg TID for 7 days
 Alternative:
› 1. erythromycin base 500mg QID x 7 days
› 2. erythromycin base 250mg QID x 14 days
› 3. erythromycin ethylsuccinate 800mg QID x 7 days
› 4. erythromycin ethylsuccinate 400mg QID x 14 days
 CHLAMYDIA
 SPECIAL CONCERNS:
 1. All sex partners should be tested for genital tract
infections & treated.
 2. Persons w/ chlamydia should avoid sexual contact
until after 7-day treatment regimen has been
completed or one week after single dose of
Azitrhomycin.
 3. In pregnant, retest chlamydia 3 weeks after
completion of treatment to confirm eradication of
infection.
 CHLAMYDIA
 SPECIAL CONCERNS:
 4. Screen pregnant patients during 1st trimester &
again 3rd trimester for women younger than 25
years.
 5. Multiple sexual partners

PREVENTION:
1. Abstinence
2. Mutually monogamous relationship
 CHLAMYDIA
 SPECIAL CONCERNS:
 Route of delivery = vaginal preferred
 Adverse pregnancy outcome:
› Abortion
› PID
› Premature delivery
› PROM
› Postpartum endometritis
› Postpartum salpingitis
› Ectopic pregnancy
 HERPES GENITALIS IN
PREGNANCY
 Etiologic agent: HERPES SIMPLEX VIRUS =
Chronic illness that persists for life in the body.
 HERPES- greek word means “to creep or crawl”
 2 TYPES:
 1. HSV 1= oral herpes
 2. HSV 2 = genital, usually sexually transmitted
 HERPES GENITALIS IN
PREGNANCY
 Linear double-stranded DNA virus
 HSV invades the mucosal surface > replicates on
the epidermis & dermis > cetrifugal migration of
the virions via the peripheral sensory nerves .
 HERPES GENITALIS IN
PREGNANCY
 MODE OF TRANSMISSION:
› Transmitted sexually
› Fetal & neonatal dse acquired in 3 ways
 A. Intrauterine (5%) – virus shed thru the cervix
 B. Peripartum (85%) – following rupture of
membranes
 C. Posnatal (10%)
 *Neonatal herpes is caused by both HSV-1 and HSV-2,
although HSV-2 infection predominates
 HERPES GENITALIS IN
PREGNANCY
 SIGNS & SYMPTOMS:
 Majority are asymptomatic
 Classic signs: multiple, painful vesicular or
ulcerative lesions
 Herpes Simplex Oralis

patient age: 15 years, patient sex: male

Erythematous labia with vesicles and
ulcers
Erythematous labia with vesicles and ulcers
cervical erosions
Multiple ulcerations in the glans
penis
 HERPES GENITALIS IN
PREGNANCY
 THREE CATEGORIES:
 1. 1ST EPISODE PRIMARY INFECTION:
› HSV-1 or -2 is isolated from genital secretions in the
absence of HSV-1 or -2 antibodies
› Incubation period of 2 to 10 days
› Classic presentation = characterized by a papular
eruption with itching or tingling, which then becomes
painful and vesicular.
 HERPES GENITALIS IN
PREGNANCY
 THREE CATEGORIES:
 2. FIRST EPISODE NONPRIMARY
INFECTION = newly acquired HSV2 w/ pre-
existing HSV1 cross reacting antibodies.
 = fewer lesions, fewer systemic manifestations,
& less pain
 HERPES GENITALIS IN
PREGNANCY
 THREE CATEGORIES:
 3. REACTIVATION OR RECURRENT INFECTION
 Recurrences are most common in the first year after
initial infection.
 = paresthesia of the vulva
 = papules & vesicle formation
 = involvement of the vagina & cervix
 = multiple crops of ulcers for (2-6wks)
 = viral shedding (2-3wks)
 HERPES GENITALIS IN
PREGNANCY
 NEONATAL HERPES:
 = Localized to eye or mouth disease (35 %)
 = Central nervous system disease = encephalitis
(30%)
 = Disseminated disease with involvement of multiple
major organs (30%) mortality
 Txt: acyclovir
 HERPES GENITALIS IN
PREGNANCY
 DIAGNOSTIC TESTS:
 Tissue culture= confimatory but low sensitivity
in recurrent lesions
 Tzanck smear= low sensitivity
 PCR= test of choice
 HSV direct flourescent assay
 Type-specific HSV serologic assays
 HERPES GENITALIS IN
PREGNANCY
 TREATMENT:
 FIRST EPISODE GENITAL HERPES:
› ACYCLOVIR 400mg PO TID 7-10 days or
› ACYCLOVIR 200mg PO TID 7-10 days
RECURRENT HERPES:
 ACYCLOVIR 400mg TID x 5 days
 ACYCLOVIR 800mg BID x 5 days
 ACYCLOVIR 800mg TID x 2 days
SEVERE DSE: IV ACYCLOVIR 5-10 MG/K/BW EVERY 8
HRS FOR 2-7 DAYS FOLLOWED BY ORAL ACYCLOVIR
TO COMPLETE 10 DAYS
 HERPES GENITALIS IN
PREGNANCY
 SPECIAL CONCERNS:
 Not associated w/ increase rate of abortion or
stillbirth.
 Cesarean delivery = indicated for active herpetic
lesions during labor.
 Vaginal delivery = in active lesions cause vertical
transmission near the time of delivery.
 Breastfeeding is allowed as long as there are no
active lesions on the breast.
 CHANCROID

 Etiologic agent: Haemophilus ducreyi

 = cause painful, nonindurated genital ulcers
termed soft chancres that at times are
accompanied by painful suppurative inguinal
lymphadenopathy.
 = Drug use and sex-for-drugs: risk factors
 = Ulcerative lesion is a high-risk cofactor for
HIV transmission
 = Common in uncircumcised men
CHANCROID
 CHANCROID

 Treatment:
 = Azithromycin, 1 g orally as a single dose
 = Erythromycin base, 500 mg orally three times
daily for 7 days
 = Ceftriaxone, 250 mg in a single intramuscular
dose
 HUMAN PAPILLOMA VIRUS
IN PREGNANCY
 ETIOLOGIC AGENT: HUMAN PAPILLOMA
VIRUS
 double-stranded DNA viruses
 30 different types
 HPV 6 & 11= linked to Anogenital warts
› (Condyloma Acuminata)
 HPV 16 &18 = linked to squamous cell CA of the
cervix
 Others: HPV 31,33,45,51,52,56,58,59
Human Papillomavirus (HPV)
 EPIDEMIOLOGY:
 20 million people
are currently
infected with HPV
 Very common
amongst sexually
active college
students < 30 y/o

74
Human Papillomavirus (HPV)
 EPIDEMIOLOGY:
 Pregnancy:
increases
prevalence from
1st to 3rd tri &
decreases
postpartum

75
 HUMAN PAPILLOMA VIRUS

 MODE OF TRANSMISSION:
 Spread by sexual or skin to skin contact with
someone who has HPV
 Non-sexual: beddings, underwear, cervical
instruments, infected hands
 Vertical transmission = in utero exposure to
amniotic fluid or from maternal genital tract
 HUMAN PAPILLOMA VIRUS

 SIGNS & SYMPTOMS:

 Appear soft, moist, pink, or flesh-colored
swellings
 Raised or flat, single or multiple, small or large &
cauliflower-shaped
 Lesions are not painful but pruritic
 Sites: vulva, perineum, perianal skin, uterine
cervix, vagina, urethra, anus, & mouth
Warty lesions
Pedunculated lesions
whitish lesions on the cervix
Multiple warty lesions in the penis
Multiple warty lesions in the penis
 HUMAN PAPILLOMA VIRUS

 DIAGNOSTIC TESTS:
 1. Visual examination
 2. Papanicolau smear: Primary screening test
 3. Polymerase chain reaction: determine the HPV DNA type
 4. Colposcopy: done on patients w/ abnormal pap smear
 5. Biopsy: show evidence of hyperkeratosis, acanthosis,
parakeratosis, koilocytosis (perinuclear cytoplasmic halos)
 HUMAN PAPILLOMA VIRUS

 TREATMENT:
 1. Surgical removal (Cauterization) = done before
labor and not at the time of delivery because it will
lead to uncontrolled bleeding.
 2. Cryotherapy w/ liquid nitrogen or cryoprobe =
destroys warts by cytolysis
 3. Trichloroacetic acid(TCA)
 HUMAN PAPILLOMA VIRUS

 TREATMENT:
 4. Laser vaporization- used for large & multiple
lesions
 5. Refrain from sexual contact after treatment
 6. others: Podophyllin resin, podofilox 0.5 %
solution or gel, imiquimod 5 % cream, and interferon
therapy are not recommended in pregnancy
 HUMAN PAPILLOMA VIRUS

 PREVENTION:
 1. use Latex Condoms = may reduce but not prevent
transmission
 2. sexual abstinence
 3. monogamous sexual relationships
 4. regular screening
 5. regular Pap smear: (starting at age 18 or 3 years after
onset of sexual activity)
 6. HPV vaccination: 9-55 y/o
(CERVARIX/GRADASIL)
 HUMAN PAPILLOMA VIRUS

 MODE OF DELIVERY:
 Routine Cesarean delivery w/ genital warts is not
recommended since mother to infant transmission is rare.
 C-Section: done if w/ obstetric indication
 SPECIAL CONCERNS:
 Genital warts may proliferate during pregnancy due to
high levels of estrogen
 Perinatal exposure to HPV: JUVENILLE LARYNGEAL
PALILLOMATOSIS (benign neoplasm of the larynx in
children)= RARE
 VAGINITIS

 VAGINITIS:
 Pregnant women commonly develop increased
vaginal discharge, which may not be
pathological.
 Troublesome leukorrhea = is the result of
vulvovaginal infections that include bacterial
vaginosis, candidiasis, or trichomoniasis
 BACTERIAL VAGINOSIS

 Not an infection in the ordinary sense.

 Maldistribution of normal vaginal flora.
 Lactobacilli are decreased, and overrepresented
species are anaerobic bacteria, including
Gardnerella vaginalis, Mobiluncus, and some
Bacteroides species
 30 % of nonpregnant women have vaginosis
 Pregnancy = associated with preterm birth
 BACTERIAL VAGINOSIS

 Nonspecific vaginitis or Gardnerella vaginitis.

 Alteration of the vaginal ecosystem causing
overgrowth of sev. Anaerobic bacteria &
reduction or absence of Lactobacilli.
 Pregnancy = associated with preterm birth
 BACTERIAL VAGINOSIS

 INCIDENCE:
 Most common cause of vaginal discharge
 50% - occur in pregnant women
 30% - non-pregnant
 Most common Genital tract infection among
admitted pregnant women
 BACTERIAL VAGINOSIS

 ETIOLOGIC AGENT:
 Overgrowth of anaerobic & gram negative &
gram variable bacteria
 (Mycoplasma hominis, Bacteriodes, Mobiluncus,
& Garnerella vaginalis)
 MODE OF TRANSMISSION:
 Not sexually transmitted but appears to be related
to sexual activity.
 BACTERIAL VAGINOSIS

 SIGNS & SYMPTOMS:

 Majority are asymptomatic
 May present w/: thin, off-white, fishy odor
discharge adherent to vaginal walls
 Common after vaginal intercourse or after
menses
Copious thin, white-grayish yellow discharge with fishy odor
 BACTERIAL VAGINOSIS

 DIAGNOSTIC TEST:
› 2 CRITERIAS USED:
› 1. AMSEL’S CLINICAL CRITERIA
 3 out of 4 findings needed
 - Homogenous vaginal discharge
 - Positive amine (fishy odor)- whiff test
 - presence of Clue cells (> 20%)
 - vaginal Ph > 4.5
 BACTERIAL VAGINOSIS

 DIAGNOSTIC TEST:
› 2. NUGENT’S CRITERIA: GRAM STAIN OF
VAGINAL FLUID
› Preferred test
› Using a scoring system
 BACTERIAL VAGINOSIS

 TREATMENT:
 1. Clindamycin 300mg BID for 7 days OR
 2. Metronidazole 500mg BID for 7 days
 3. Metronidazole 250 mg TID for 7 days
 * All pregnant women w/ BV require TXT
 * Asymptomatic pregnant women but high risk for
preterm delivery or previously delivered a premature
infant requires TXT.
 TRICHOMONIASIS
 ETIOLOGIC AGENT: protozoan Trichomonas
vaginalis
 Parasitic Infection of the vagina in women and
urethra in men.
 Mostly passed through sexual contact.
 Also spread through damp towels, bathing suits
or wash clothes shared with an infected person.
 TRICHOMONIASIS
 SIGNS & SYMPTOMS:
 Foamy leukorrhea with pruritus and irritation.
› Men: discharge from penis, mild discomfort in penis
and swelling in genitalia.
› Women: green to yellow discharge with bad odor,
vaginal itching, painful urination, inflammation in
genitals. Sometimes in lower abdomen.
Frothy foul - smelling discharge adherent to vaginal wall
 “strawberry”
cervix with punctate
bleeding erosions
 TRICHOMONIASIS
 DIAGNOSTIC TESTS:
 Vaginal Ph > 4.5
 (+) Whiff test upon application of 10% KOH
 Saline microscopic exam =Trichomonads
demonstrate as flagellated, pear-shaped, motile
organisms that are somewhat larger than
leukocytes.
 Culture: most sensitive & specific test
 TRICHOMONIASIS
 TREATMENT:
 Metronidazole 2gm PO single dose, OR
 Metronidazole 500mg BID for 7 days
 Evaluate & treat sexual partner
 Avoid sexual contact until both partners
completed the treatment.
 TRICHOMONIASIS
 SPECIAL CONCERNS:
 Infection w/ trichomonas may facilitate
transmission of HIV
 Avoid breastfeeding while taking metronidazole
until 12 hrs after the last dose
 Adverse pregnancy outcome:
› Preterm delivery
› PROM
› Low birth weight
 CANDIDIASIS

 ETIOLOGIC AGENT: Candida albicans

 Common in immunocompromised patients &
prolonged antibiotic therapy
 MODE OF TRANSMISSION:
 Normal flora of the skin & vagina & are not
considered sexually transmitted
 CANDIDIASIS

 MODE OF TRANSMISSION:
 Risk factor for Candida overgrowth:
 1. pregnancy
 2. high dose OCP
 3. broad spectrum antibiotics
 4. Diabetes
 5. Iron deficiency anemia
 6. HIV infection
 CANDIDIASIS

 SIGNS & SYMPTOMS:

 Itching, soreness or burning discomfort in the
vagina & vulva
 Heavy white curd-like vaginal discharge
 Bright red rash affecting the inner & outer parts
of the vulva, groin, pubic areas, inguinal areas &
thighs
Vulvar edema and erythema
white cheesy discharge on the cervix, vagina and
vulva
Itchy, reddish, swollen penis
Dry, scaly lesions with mucopurulent exudates
 CANDIDIASIS

 LAB. DIAGNOSIS:
 Vaginal pH – NORMAL
 Direct microscopy using 10% KOH = mycelia &
pseudohyphae
 Vaginal yeast cultures = recommended in patients
w/ neg. KOH preparation
 CANDIDIASIS

 TREATMENT:
 Clotrimazole 1% cream for 7 days
 Clotrimazole 100mg vag tab for 7 days
 Miconazole 2% cream for 7 days
 Nystatin 100,000 units vag tab for 14 days
 SPECIAL CONCERNS:
 Candida infection in pregnancy has not been
linked to preterm birth & adverse fetal outcome.
 HEPATITIS
 Hepatitis A, B, and C all can be transmitted
sexually
 Hepatitis B is the most common & its sexual
transmission is the most efficient
 Hepatitis A & B  can be prevented by
vaccination
 Sexual transmission accounts for 45% of new
cases
 HEPATITIS
 Hepatitis B immunoglobulin's  post exposure
prophylaxis within 14 days
 Pregnant mothers with Hepatitis B  transmit the
infection to their infants during or after birth
 Newborn infant should receive Immunoglobulin's +
Vaccination within 12 hrs of birth
 HIV
 Acquired immunodeficiency syndrome (AIDS)
was first described in 1981 when a cluster of
patients was found to have defective cellular
immunity and Pneumocystis jiroveci (formerly P.
carinii) pneumonia
 ETIOLOGY:
 DNA retroviruses
 1. HIV- 1 = most cases, including PHILS
 2. HIV – 2 = seen in West Africa
 HIV
 EPIDEMIOLOGY:
 (United Nations Programme on HIV/AIDS and
World Health (2007)
 = 33M infected persons with HIV/AIDS
 = 2.7M new cases of HIV infection, and
 = 2M HIV-related deaths
 AFRICA- still has the highest rates
 PHILS – low prevalence rate w/ < 1% filipino
adults
 HIV
 PATHOGENESIS:
 The common denominator of clinical illness with
AIDS is profound IMMUNOSUPPRESSION.
 T Cells drops = give rise to opportunistic
infections & neoplasms
 HIV
 SIGNS & SYMPTOMS: for HIV
 Acute retroviral syn: (VIREMIA) fever,
headache, photophobia, body malaise,
lymphadenopathy, skin rash, weight loss,
urticaria, alopecia, oral candidiasis, cough,
abdominal pain, diarrhea,
 HIV
 SIGNS & SYMPTOMS:
 MEDIAN time: 10 years
 AIDS is diagnosed when HIV- positive assay
results are associated w/ a number of clinical
findings:
 1. generalized lymphadenopathy
 2. oral hairy leukoplakia
 3. aphthous ulcers
 4. thrombocytopenia
 HIV
 SIGNS & SYMPTOMS:
 5. opportunistic infections:
› Esophageal or pulmonary candidiasis
› Persistent herpes simples or zoster lesions
› Condyloma acuminata
› Cytomegaloviral pneumonia
Complaints:
 On and off fever
 Malaise
 Diffuse maculopapular rash
 Weight loss
Examination:
 Cervical
lymphadenopathy

 Whitish plaques
adherent to buccal
mucosa
Examination:
 Vesicular lesions
on the dermatome

 Speculum: white
cheesy discharge
HIV/AIDS and STIs
 Punch lesions of
secondary syphilis

 Severe vulvar and

perianal herpes
 HIV/AIDS and STIs
 Giant molluscum
contagiosum

 Florid genital wart

HIV/AIDS and STIs
 Crusted scabies lesions
Kaposi’s Sarcoma

 Generalized skin
lesions
 Gingival lesion
 Kaposi’s Sarcoma
 Hard palate  KS of the nose
 HIV
 MODE OF TRANSMISSION:
 1. inoculation of blood
› Transfusion, needle sharing, needlestick in health
care workers.
 2. sexual
› Homosexual, heterosexual
 3. perinatal
› Intrauterine, intrapartum, post-partum (breastfeeding)
 HIV
 MODE OF TRANSMISSION:
 1. inoculation of blood
› Transfusion, needle sharing, needlestick in health
care workers.
 2. sexual
› Homosexual, heterosexual
 3. perinatal
› Intrauterine, intrapartum, post-partum (breastfeeding)
 HIV
 HIV SCREENING:
 Universal, but voluntary, prenatal screening
 Repeat HIV testing in the 3rd tri. In areas w/
prevalence of 1 per 1000 persons
 HIV
 DIAGNOSTIC TESTS:
 1. Enzyme immunoassay (EIA) for HIV1&2
› Screening test for HIV antibodies
› 99.5% sensitivity
 2. Western Blot – confirmatory test
 3. Immunofluorescence Assay (IFA) – confirmatory test
 4. Nucleic Acid Amplification test
 5. Prognostis markers:
› CD4/CD8 counting
› Viral load
› * CD4 counts < 200/mm3 (definitive diagnosis of AIDS)
 HIV
 MATERNAL & FETAL-NEONATAL INFECTION:
 Mother to child transmission accounts for most
pediatric HIV infections.
 Vertical transmission is more common in preterm
births & prolong rupture of menbranes.
 HIV- 1transmission at birth = 15-25%
 Maternal morbidity & mortality is not increased in
seropositive asymptomatic women.
 HIV
 MANAGEMENT:
 1. pre-conceptional counselling
 2. anti-retroviral drugs = Zidovudine regimen
› Antepartum = 100 mg PO five times daily, initiated at
14 to 34 weeks and continued throughout pregnancy
› Intrapartum = During labor, intravenous zidovudine
until delivery
› Neonate = Begin at 8 to 12 hours after birth, and give
syrup at 2 mg/kg every 6 hours for 6 weeks.
 HIV
 Recommended immunization for seropositive
pregnant mother:
› HEP B
› INFLUENZA
› PNEUMOCOCCAL VACCINE

PREVENTION OF VERTICAL TRANSMISSION:

1. ANTIRETROVIRAL TXT
2. CESAREAN DELIVERY
 HIV
 MODE OF DELIVERY:
 Scheduled C- Section at 38 weeks to minimize
the chance of rupture of membranes
 BREASTFEEDING:
 Advise formula feeding
 If breastfeeding, there shld be early weaning at 6
months.
 HIV
 POSTPARTUM:
 1. Discontinue treatment if CD4 counts are
normal after delivery.
 2. Psychosocial support
 3. Contraceptive (IUD insertion)
 4. Gynecologic care
 5. Antiretroviral treatment initiated if CD4 Counts
falls to < 200mm3 or RNA levels > 55,000
copies/ml
 HIV
 MANAGEMENT OF THE NEONATE:
 1. Test the infant w/ Polymerase Chain Reaction
@ birth, 3 wks, 6 wks, & 6 mons
 2. HIV antibody test = definitive test
› A negative test @ 18 months of age confirms that the
child is uninfected.
HOW TO PREVENT IT?
(ABCD)
A - Abstinence
B – Be Faithful
C - Condom
D – Drug-Free