SEXUALLY

TRANSMITTED
INFECTIONS
PA R A 2 4 0
MIKE THOMAS

TOPICAL OUTLINE
I. Classification of STIs by Pathogenesis
II. Infections of the External Genitalia
III. Urogenital Systemic Infections

Advisory: This presentation contains graphic images of male and

female genitalia.

I. CLASSIFICATION BY PATHOGENESIS
A. Bacterial

C. Viral

Chlamydia

Herpes

Gonorrhea

HPV

Syphilis

HIV/AIDS

B. Fungal
Candida

Hepatitis
Mono

D. Protozoan
Trichomona

II. INFECTIONS OF THE EXTERNAL

GENITALIA
Genital Warts
Genital Herpes

Candidiasis
Trichomoniasis

GENITAL WARTS
Condylomata acuminate
Caused by HPV (human papillomavirus)

Fastest growing STI of recent years

GENITAL HERPES
Herpes simplex virus
Most common cause of genital ulcers

Women at increased risk d/t mucosal surface area

Most new cases teens & young adults
Risk of HIV transmission (true with ANY ulcerative disease)

GENITAL HERPES
Can be transmitted via oral and anal sex (oral genital and vice versa, etc.)
Oral Herpes (HSV1) presents with cold sores around mouth
Genital Herpes (HSV2) S/S:

Tingling, itching
Pain in genital area
Followed by eruption of small pustules/vesicles (day 5)
Excruciatingly painful sores

No known cure
Antivirals help reduce flare-ups

CANDIDIASIS
Fungal: Candida albicans
Aka yeast infection, thrush
Very common
Not always sexually transmitted
with: antibiotics, pregnancy, BCP, DM, HIV
Clinical Manifestations:
Pruritus
Swelling
Erythema
Dysuria

Dyspareunia
Vaginal discharge: odourless, thick, cheesy
Obese pts may see in skin folds (breasts, abdo, inguinal)

Tx: antifungal

TRICHOMONIASIS VAGINALIS
Most common curable STI in young adults (more prevalent than Gonorrhea or Chlamydia)
Large anaerobic protozoan
Found in both paraurethral glands of both sexes
Can cause vaginitis in women when allowed to proliferate
Risk for: HIV transmission, infertility, premature births in pregnant women, chronic prostatitis,
sperm motility
S/S:
Produces copious, frothy, malodourous, green/yellow discharge
Often a/w erythema, pruritus, irritation

Tx: metronidazole
When treated, 100% cure rate (with both partners); recurrence is rare

III. UROGENITAL-SYSTEMIC
INFECTIONS
Chlamydia
Gonorrhea

Syphilis
Mononucleosis
Hepatitis
HIV/AIDS

CHLAMYDIA
Caused by Chlamydia trachomatis bacteria
Most common reported STI
Under-reported d/t most being asymptomatic
Risk for teenage girls & young women d/t cervix not fully matured, susceptible to infection

Transmitted during vaginal, anal & oral sex, as well as mother fetus
Can be found in the throats of women and men having oral sex

Intracellular parasites that are smaller than most bacteria

Lack ability to make ATP

Can lead to:

Infertility
Ectopic pregnancy
Chronic pelvic pain
PID (common cause)

CHLAMYDIA
S/S: resemble those produced by Gonorrhea
Most significant difference: often Chlamydia is asymptomatic (85-95%)

Also, S/S depend on where the infection occurs along the tract
Men: urethritis (erythema, discharge, dysuria, itching, burning)
Women: mucopurulent drainage, urinary frequency/urgency, post-coital bleeding
Initially infects urethra & cervix

Tx: doxycycline / azithromycin easily treated & cured w/ antibiotics

GONORRHEA
Caused by Neisseria gonorrhoeae bacteria
Grows & multiplies easily in warm, moist areas of
reproductive tract

Spread through contact with penis / vagina / mouth / anus

Ejaculation does not have to occur
Also mother fetus
HIV-infected people with gonorrhea can transmit HIV more easily

Tx: ceftriaxone, cefixine will stop infection, but not repair any damage done
People with gonorrhea often also have chlamydia, and are treated for both
Drug-resistant strains

GONORRHEA
S/S: MEN

S / S : WO M E N

Purulent discharge

Usually mild or asymptomatic

2-5 days after infection, up to 30 days

Common cause of PID

More likely to be symptomatic than women

Unusual genital/urinary (purulent) discharge

Urethral pain

Dysuria

Creamy, yellow/green, sometimes bloody d/c

Dyspareunia

Some men get painful/swollen testicles

Pelvic pain

May lead to epididymitis or infertility

Unusual vaginal bleeding (post-coital)

S/S: ANAL INFECTIONS (MALE OR FEMALE)

Discharge

Bleeding

Itching, soreness

Painful BMs

SYPHILIS
Caused by spirochete Treponema pallidum
Affects minority populations disproportionately (AA, Hispanic, Asian)

Passed through direct contact with a syphilitic sore

External genitalia
Vagina
Anus

Rectum
Lips
Mouth
Mother fetus

Appear first as a chancre (painless sore)

Sores make getting infected with HIV easier

Tx: Penicillin

SYPHILIS
The great imitator as S/S are like so many others
Incubation Stage
10-90 days
Not contagious

Primary Stage
3-6 weeks
Marked by appearance of a single chancre sore
Appears in the body where syphilis entered the body
Firm
Round
Small
Painless

Without Tx progresses to Secondary Syphilis

SYPHILIS
Secondary Stage
4-12 weeks
Skin rash & lesions (usually not itchy)
Can be so faint as to go undetected
Rough, red or reddish-brown spots on palms of hands or feet

May be a/w:
Fever, sore throat, swollen lymph glands
Myalgias, arthralgias
Patchy hair loss
Headaches
Weight loss, fatigue

Late/Latent Stage (hidden!)

When Primary & Secondary are done and gone
Can last for years, with no S/S
Can lead to multi-organ disease/failure, dementia, death

MONONUCLEOSIS
Member of Herpesviridae family (others include herpes simplex, varicella-zoster, cytomegalovirus)
Usually caused by the Epstein-Barr virus (EBV)
Most often occurs in people between 5-25 years of age
By adulthood, most people have already been infected with EBV

Once infected, a person develops lifelong immunity to future infections from the disease
May get periodic relapses or flare-ups in times of stress

EBV is transmitted through exposure to body fluids containing the virus

Most often transmitted via saliva, can also be spread through blood and genital secretions

Highly contagious, aka kissing disease or mono

MONONUCLEOSIS
Clinical Manifestations:
Symptoms usually develop b/w 4-6 wks after exposure
Fever

Sore throat
Swollen glands (lymph nodes)
Fatigue
Headache
Rash
Malaise
Loss of appetite
Jaundice
Tonsillitis
Body aches
Splenomegaly and/or hepatomegaly
Abdo pain
Difficulty breathing

HEPATITIS
Inflammation of the liver
Viral infection

Hepatitis B and C (less likely) can be transmitted sexually

May result in jaundice, other signs of liver disease
Hep B, if caught early, can be cured (or prevented) by vaccine

HIV & AIDS

Human Immunodeficiency Virus (HIV)
Causes the disease Acquired Immunodeficiency Syndrome (AIDS)
w/o Tx, avg survival is 9-11 years
HIV infection occurs by transfer of blood, semen, vaginal fluid, pre-ejaculate or breast milk
HIV infects vital cells in the immune system such as helper T cells (CD4+ T cells), macrophages
& dendritic cells
When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and
the body becomes progressively more susceptible to opportunistic infections
Currently no cure, but treatments do exist
HIV may incubate for up to 10 years or more before symptoms of AIDS appear