SEXUAL TRANSMITTED DISEASE

PRESENTER DR GEORGE KASONDA FACILITATOR ISAAC U. M DEPARTMENT OF MICROBIOLOGY AND PARASITOLOGY.

Topic overview
Based on three pathogens. -Chlamydia trachomatis -Group B strepococcal -Gardnerella Definition Route of transmision and treatment.

Introduction
Sexually transmitted disease (STD), also known as a sexually transmitted infection (STI) or venereal disease (VD), is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex. While in the past, these illnesses have mostly been referred to as STDs or VD, in recent years the term sexually transmitted infections (STIs) has been preferred

Chlamydia trachomatis
Domain: Bacteria Phylum: Chlamydiae Class: Chlamydiae Order: Chlamydiales Family: Chlamydiaceae Genus: Chlamydia Species: C. trachomatis

chl
Chlamydia trachomatis, an obligate intracellular human pathogen, is one of three bacterial species in the genus Chlamydia. C. trachomatis is a Gramnegative bacteria, therefore its cell wall components retain the counter-stain safranin and appear pink under a light microscope.The inclusion bodies of Chlamydia trachomatis were first described in 1907, the Chlamydia trachomatis agent was first cultured in the yolk sacs of eggs by Feifan Tang et al in 1957. Chlamydial infection. Advances in the diagnostic isolation of Chlamydia, including TRIC agent, from the eye, genital tract, and rectum.

chl
C. trachomatis includes three human biovars: trachoma (serovars A, B, Ba or C), urethritis (serovars D-K), and lymphogranuloma venereum (LGV, serovars L1, 2 and 3). Many, but not all, C. trachomatis strains have an extrachromosomal plasmid. - Most women are asymptomatic but if symptoms occur is 1-3 weeks. -other species,C.Psittacc,C.pneumoniae.

Identification
Identification Chlamydia species are readily identified and distinguished from other chlamydial species using DNA-based tests. Most strains of C. trachomatis are recognized by monoclonal antibodies (mAbs) to epitopes in the VS4 region of MOMP. However, these mAbs may also cross-react with two other Chlamydia species, C. suis and C. muridarum

Clinical significant

Chlamydia infection C. trachomatis is an obligate intracellular pathogen (i.e. the bacterium lives within human cells) and can cause numerous disease states in both men and women. Both sexes can display urethritis, proctitis(rectal disease and bleeding), trachoma, and infertility. The bacterium can cause prostatitis and epididymitis in men. In women, cervicitis, pelvic inflammatory disease(PID), ectopic pregnancy, and and acute or chronic pelvic pain are frequent complications. C. trachomatis is also an important neonatal pathogen, where it can lead to infections of the eye (trachoma) and pulmonary complications. Chlamydia trachomatis is the single most important infectious agent associated with blindness; approximately 600million worldwide suffer C. trachomatis eye infections and 20million are blinded as a result of the infection.

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Treatment C. trachomatis may be treated with any of several antibiotics: azithromycin, erythromycin or doxycycline/tetracycline.

. Gardnerella Vaginalis
Gardnerella Vaginalis is an infection of the female genital tract by bacteria of the Gardnerella vaginalis strain, often in combination with various anaerobic bacteria. Also called bacterial vaginosis. Incubation period is 5-10 days

cont
Gardnerella vaginalis was originally described by Gardner and Dukes in 1955. The infection often produces a gray or yellow discharge with a "fishy" odor that increases after washing the genitalia with alkaline soaps. Gardnerella vaginalis is the most common cause of bacterial vaginitis in the sexually active mature patient. The patient complains of a malodorous, nonirritating discharge, and examinations reveal homogenous, graywhite secretions. A transient "fishy odor" may be released on application of 10 percent potassium hydroxide to the vaginal secretion on a glass slide.

cont
Causes and Risk Factors of Gardnerella Vaginalis It is assumed that the infection is sexually transmitted. The bacteria are also found in women without a history compatible with a sexually transmitted disease, and often produces no symptoms. Symptoms of Gardnerella Vaginalis Symptoms of infection typically include a vaginal discharge associated with a "musty" or "fishy" odor. The amount of discharge is quite variable, and there is little vulvar or vaginal irritation associated with this infection, but the pungent odor is usually the chief complaint.

cont
Diagnosis of Gardnerella Vaginalis A wet mount preparation of physiologic saline mixed with vaginal secretions should be examined under low-power and high-power objectives. There are few white blood cells and lactobacilli. The characteristic "clue cells" are identified as numerous stippled or granulated epithelial cells. This appearance is caused by adherence of almost uniformly spaced G vaginalis organisms on their surfaces. Clumps of G vaginalis organisms may also be noted attached to the edges of epithelial cells or floating free in the preparation. Cultures are seldom necessary to establish a diagnosis.

cont
Treatment of Gardnerella Vaginalis The treatment of choice for G vaginalis is oral metronidazole, 500 mg twice daily for 6 days. A single dose of 2 g has proved effective in treatment of adolescent patients, but in general a 5- to 7-day course of treatment is more effective. Although it is recommended that sexual partners be treated simultaneously, it is unclear whether this significantly decreases the incidence of recurrent disease. Contraindications to metronidazole include certain blood dyscrasias and central nervous system diseases. An important side effect is intolerance to alcohol. The drug is contraindicated during early pregnancy and lactation.

cont
Cephradine, 500 mg by mouth 4 times daily for 6 days, will eliminate G vaginalis from the vagina and relieve symptoms but has little effect on the anaerobic flora of the vagina. Other oral and vaginal preparations have been prescribed but have not proved useful. Douching removes malodorous secretions temporarily but does not cure the infection.

BACTERIAL VAGINOSIS
When different types of bacteria outnumber the normal bacteria, Lactobacillus, an imbalance is caused in the bacterial organisms that exist in the vagina. Instead of Lactobacillus bacteria being the most numerous, increased numbers of other organisms are found in the vaginas of women with Bacterial vaginosis (BV) such as: Bacteroides Gardnerella vaginalis Mobiluncus Mycoplasma hominis

cont
Bacterial vaginosis (BV) is also called: Gardnerella-associated vaginitis nonspecific vaginitis It is one of the most common causes of vaginitis symptoms among women, particularly those who are sexually active, producing painful inflammation of the vagina.

symptoms
Although more than 50% of women with Bacterial Vaginosis (BV) have no symptoms, when symptoms do occur they include: excessive, thin gray or white vaginal discharge that sticks to the vaginal walls fishy or musty, unpleasant vaginal odor, most noticeable after sex vaginal itching and irritation

Group B Strep Infection

Group B strep (GBS) is a gram-positive streptococcal bacteria also known as Streptococcus agalactiae. This type of bacteria (not to be confused with group A strep which causes "strep throat") is commonly found in the human body, and it usually does not cause any symptoms. However, in certain cases, it can be a dangerous cause of various infections that can affect nonpregnant adults, pregnant women, and their newborn infants. Group B strep infection is the most common cause of sepsis and meningitis in the United States during a newborn's first week of life.

cont
Group B strep infection can also afflict adults with certain chronic medical conditions, such as diabetes, cardiovascular disease, and cancer. Although the incidence of neonatal group B strep infection has been decreasing, the incidence of group B strep infection in nonpregnant adults appears to be increasing

cont
Group B strep facts Group B strep are bacteria found normally in the intestine, vagina, and rectal area in 15%-45% of all healthy women. Group B strep infections can affect neonates and adults. Most pregnant women who are colonized by the bacteria have no symptoms.

cont
The infection is spread to infants before or during delivery. Signs and symptoms in babies may include fever, breathing problems, lethargy, and poor feeding. Diagnosis of GBS infection is made by isolating the organism from body fluid.

cont

- The treatment for GBS infection is antibiotics.

In pregnant women, routine screening for colonization with GBS is recommended.

Refferences
www.google.com Sexual transmitted infection manual by MOH

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