Korir jebett

Msc. Tropical and Infectious Diseases

U.N.I.T.I.D
 Sexually transmitted diseases (STDs) are
diseases that are mainly passed from one
person to another during sex. There are at
least 25 different sexually transmitted
diseases with a range of different symptoms.
These diseases may be spread through
vaginal, anal and oral sex.
Disease Cause

Gonorrhea Neisseria gonorrhoeae

Non gonococcal urethritis Chlamydia trachomitis

Syphilis Treponema pallidum

Chancroid Haemophilis ducreyi

Bacterial vaginosis Gardernella

Vulvo vaginitis Candida albicans

 Chlamydia is one of the most common sexually
transmitted diseases. The Centers for Diseases
Control and Prevention estimates that more
than 3 million cases of chlamydia occur every
year, In the USA.
 As many as 1 in 10 adolescent girls tested for
Chlamydia is infected.  
 Teenage girls have the highest rates of
Chlamydial infection regardless of
demographics or location:
 15-19 year old girls 46% of infections
 20-24 year old women 33% of infections
 People infected with Chlamydia often have
no symptoms therefore are often unaware
they are infected and may not seek
professional health care. 
 Approximately:
 50% of men
 75% of women
 Females
 Asymptomatic (80%)
 Cervicits, urethritis and salpingitis
 Postpartum fever
 Increased rate
▪ Premature delivery
▪ Ectopic pregnancy
 Males
 Symptomatic (75%)
 Urethritis, dysuria and pyuria
 Cause of nongonococcal urethritis (35 - 50%)
 Common cause of postgonococcal urethritis
 Conjunctivitis, polyarthritis and genital or
gastrointestinal inflammation
 Associated with HLA-B27
 50 - 65 % have C. trachomatis infection
 80% have antibodies to C. trachomatis
 First stage
 Small painless vesicular lesion at infection site
 Fever, headache and myalgia
 Second stage
 Inflammation of draining lymph nodes
 Fever, headache and myalgia
 Buboes (rupture and drain)
 Proctitis
 Ulcers or Elephantiasis
 If Chlamydia is untreated up to 40% of women
with the infection will develop Pelvic
Inflammatory Disease (PID), a serious infection of
the reproductive organs.  
 Each year up to 1 million women in the United
States develop Pelvic Inflammatory Disease (PID)
and of those: 
 18% will experience debilitating, chronic pelvic
pain and discomfort
 20% will become infertile
 an estimated 100,000 women will become
infertile
 Azithromycin (one-day course)
 Doxycycline (seven day course) *
 Erythromycin *
 Tetracycline (some people are allergic to the
drug) 
 Ofloxacin
 Sulfonamides
*  able to be used during pregnancy
 Vaccines are of little value
 Treatment of patients and their sexual partners
 Complications
 When treated early, there are no long term consequences of Chlamydia. Serious
complications can result however when left untreated.
 In men
 Long term complications may include:
 Epididymitis - an inflammation of the testicles that can cause sterility
 Prostatitis - an infection of the prostate gland
 Reiter's Syndrome - an autoimmune, arthritis-like condition
 Sterility
 In women Long term complication may include:
 Pelvic Inflammatory Disease
an infection that spreads from the vagina and cervix to the the lining of the uterus
and fallopian tubes and can lead to sterility
 Perihepatitis
 an infection around the liver
  
 Reiter's Syndrome
 an automimmune, arthritis-like condition

Sterility
 Long term complication in infants may include:
 Blindness
 Ear infections
 Eye infections
 Pneumonia
 Death
Pregnancy
 Of women with Pelvic inflammatory Disease caused by the Chlamydia
infection, 9% will have a life-threatening tubal (ectopic pregnancy). Tubal
pregnancy is the leading cause of first-trimester, pregnancy-related
deaths in American women
Newborns
 Chlamydia infection during pregnancy can result in Neonatal
Conjunctivitis (eye infection) usually within the first ten days
Symptoms include:
 eye discharge
 swollen eyelids
 Chlamydia infection during pregnancy can also result in Pneumonia,
usually with 3-6 weeks
Symptoms include:
 a progressively worsening cough
 congestion
 Both conditions can be treated successfully with antibiotics
 Routine testing of pregnant women for Chlamydial infection is
recommended because of the risks to newborn babies
 caused by , Neisseria gonorrhoeae
 second only to Chlamydial infections in the
number of reported cases. 
 Gram negative diplococcus that can be
cultivated in chocolate blood agar.
 the organisms are found on or with in the
leucocytes in the urethra pus.
 Most are susceptible to cold and drying and
hence do not survive well outside the host.
1. Through sexual contact including:
 penis to vagina (infection rate for males 30-50%, females 60-90%)
 penis to mouth,
 penis to rectum
 mouth to vagin
2. From mother to child
as the child passes through the birth canal during delivery causing: eye
infections
3. In children,
usually due to sexual abuse it is found in the:
 genital tract
 mouth
 rectum
4 Other Risk Factors
 An infected person can spread the infection to another area of their
body by touching the infected area and transferring the excretions
 Clothing or wash cloths of infected people can spread the infection
 Any person who is sexually active can be
infected with Gonorrhea
 Common among younger people, ages 15-30,
who have multiple sex partners
 Increases in Gonorrhea have been found among
men who have sex with men
 Occurs more frequently in urban areas than in
rural areas
 It is the most common reportable sexually
transmitted infection in the United States, with
an estimated 800,000 cases of Gonorrhea
reported annually 
In Women:
 Bleeding between periods
 Creamy or green, pus-like or bloody vaginal discharge
 Excessive bleeding during menstrual period
 Irritation of the vulva
 Lower abdominal pain 
 Painful intercourse
 Painful urination (burning sensation)
 Rectal infection
 Throat infection 
 The disease can spread into the womb and fallopian tubes,
resulting in Pelvic Inflammatory Disease (PID) which can
cause infertility in up to 10% of infected women and
ectopic pregnancy
 In Men:
 Creamy or green, pus-like discharge from the
penis
 Painful urination (burning sensation)
 Testicular pain
 Rectal infection:
 Constipation
 Creamy, pus-like discharge
 Itching
 Painful bowel movement with blood in feces
 Rectal bleeding
 Symptoms usually appear 2-7 days after infection in males, but it
can sometimes take up to 30 days for symptoms to appear.
 Often there are no symptoms at all in:
 10-15 % of men
 80% of women
 People with no symptoms are at risk of developing complications
from Gonorrhea and can unknowingly spread the infection.  
 From the time of infection gonorrhea can be spread and will
continue to be spread until properly treated.
 Past infection does not make a person immune to gonorrhea and
previous infections with Gonorrhea may allow complications to
occur more rapidly and increase your risk of getting HIV.    
 In Men
 Epididymitis an inflammation of the testicles that can cause sterility
 Skin problems
 Swelling of the testicles and penis
 Approximately 2% of persons with untreated gonorrhea may
develop Disseminated Gonococcal Infection (DGI).
In Women
 Abscesses
 Ectopic pregnancy
 a pregnancy outside of the uterus
 Pelvic Inflammatory Disease (PID)
 an ascending infection that spreads from the vagina and cervix to
the uterus and fallopian tubes, which can lead to sterility
 Perihepatitis an infection around the liver
 Sterility
In newborns
 Gonorrhea can be transmitted to newborns
If untreated the Gonorrhea infection can
spread
 and through the bloodstream infecting: 
 brain (rarely)
 heart valves
 Joints
 Staining Biological Samples
 Staining biological samples directly for the bacterium is carried out
by placing on a slide a sample of the discharge from the penis or
cervix and staining.
Detection of Bacterial Genes or Nucleic Acid (DNA) Test
 Detection of bacterial genes or nucleic acid (DNA) test is carried
out using urine or cervical swabs to detect the genes of the bacteria
 This test is often more accurate than culturing the bacteria
Cultures
 Growing the bacteria in laboratory cultures involves placing a
sample of the discharge onto a culture plate and incubating it for
up to 2 days to allow the bacteria to multiply
 Cultures of cervical samples detect infection approximately 90% of
the time
 A culture can also be taken to detect Gonorrhea in the throat
 Antibiotics that are currently used are: 
 Cefixime
 Ceftriaxone
 Ciprofloxacin*
 Ofloxacin*
 Tetracycline
 * The antibiotics should not be taken in pregnancy
 Gonorrhea and Chlamydial infection, another common STD, often
infect people at the same time. A combination of antibiotics is
taken which will treat both diseases, such as:
  Azithromycin
 Ceftriaxone
 Doxycycline
 All sexual partners should be tested and treated if infected,
whether or not they have symptoms of the infection.
 Abstinence
 Monogamous relationships
 Condom use
 Pelvic inflammatory disease, is an infection of a
woman's pelvic organs (uterus, fallopian tubes,
and ovaries).
 PID can affect the fallopian tubes.
 It can also involve the tissues in and near the
uterus and ovaries.
 PID can be treated and cured with antibiotics. If
left untreated, PID can lead to serious problems
like infertility, ectopic pregnancy , constant pelvic
pain, and other problems.
 PID is caused by bacteria. Bacteria can move upward,
from a woman's vagina or cervix into her fallopian
tubes, ovaries and uterus, causing infection.
 Many types of bacteria can cause PID. But, two
common sexually transmitted diseases (STDs) -
gonorrhea and chlamydia - are the most frequent
causes of PID.
 After being infected, it can take from a few days to a
few months to develop PID.
 Although rare, a woman can develop PID without
having an STD. No one is sure why this happens, but
normal bacteria found in the vagina and on the cervix
can cause PID.
 As many as half of all cases of Pelvic Inflammatory
Disease (PID) may be due to Chlamydial infection,
often without symptoms, producing scarring of the
fallopian tubes which can: 
 block the tubes and prevent fertilization occurring 
 interfere with the passage of the fertilized egg down
into the uterus causing the egg to implant in the
fallopian tube.
 threaten the life of the mother and fetus 
 Pelvic Inflammatory Disease (PID) is the most
common cause of pregnancy-related death among
poor teenagers in the inner cites and rural areas of the
United States
 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
 Bacterial Vaginosis (BV)
 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.
 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
The risk of acquiring Bacterial Vaginosis (BV) is
increased by:
 changing  sexual partners
 douching
 using intrauterine devices (IUDs)
The infection can not be spread from person to
person by casual contact, such as:
 clothing
 door knobs
 eating utensils
 swimming pools
 toilet seats
 Patients complaining of bacterial vaginal discharge
and odor and having a grayish white, thin, adherent,
homogenous discharge on speculum examination
can be diagnosed with bacterial vaginosis with
reasonable certainty meet three of the four criteria.
Diagnostic of criteria for bacterial vaginosis
1. Homogeneous discharge
2. Distinct fishy odor released immediately after mixing vaginal secretions with
10% KOH. ( amine whiff test)
3. Vaginal p.H> 4.5
4. Clue cells and characteristic alterations of vaginal microflora on microscopy.
Laboratory Tests
A sample of the vaginal discharge is obtained and viewed under the
microscope,either stained or in special lighting, to determine:
 Absence of lactobacilli
 Change in pH of vaginal fluid
 Decreased acidity
 If the vaginal cells have the classic appearance of 'clue cells', cells
from the vaginal lining that are coated with Bacterial Vaginosis
(BV) organisms, which appear in Bacterial Vaginosis (BV)
 The presence of Gardnerella bacteria to confirm  by microscopic
examination
 As an added confirmation
 The sample is mixed with potassium hydroxide and produces a
strong fishy odor when the bacteria is present
 Treatment
 Bacterial Vaginosis (BV) can be difficult to cure using
either conventional or alternative treatments. 
 Conventional Treatment
 Although it is uncertain if Bacterial Vaginosis (BV) is
sexually transmitted treatment of all sexual partners is
essential to prevent re-infection
 The usual treatment is antibiotics, taken orally or
vaginally, including:
 Ampicillin
 Ceftriaxone
 Clindamycin, 
 Metronidazole
 Tetracycline  
 Although it is uncertain if the infection is sexually
transmitted, sexually active women appear to suffer
from the infection more than other women
 Help Factors
 Abstain from sex until the infection is cured and all
symptoms have ceased
 Inform any sex partners so treatment may be
undertaken  
 Limit sexual relationships to a single, uninfected
partner
 Regular use of condoms may offer protection  against
the infection 
 Bacterial Vaginosis (BV) is thought to be associated
with: 
 ectopic pregnancy
 infertility
 low birth weight in infants born to infected mothers
 pelvic infections
 premature birth in infants born to infected mothers
 Bacterial Vaginosis (BV) increases the risk of
acquiring:
 gonorrhea
 HIV infection
 other STDS 
 Syphilis is a chronic, systemic, sexually
transmitted disease caused by the spirochete
Treponema pallidum subspecies pallidum.
 Most cases are caused by sexual contact with
mucocutaneous lesions that occur in the
primary or secondary stages. Late syphilis is
considered noninfectious.
 Primary syphilis: Although classic syphilis is divided into stages,
there is considerable temporal, clinical, and histopathologic
overlap among them. The chancre, the primary lesion of syphilis,
appears at the incubation site after an incubation period of 10 to
90 days (average, 3 weeks). It begins as an erythematous papule
that ulcerates before healing spontaneously within 2 to 4 weeks.
The typical chancre is painless, solitary, rounded, and has a raised,
discrete border with a rubbery consistency. Approximately 50% of
patients with primary syphilis have painless, nonsuppurative,
bilateral regional lymphadenopathy. Primary syphilis must be
differentiated from other causes of genital ulceration, including
venereal infection (e.g., chancroid, herpes genitalis,
lymphogranuloma venereum, and granuloma inguinale),
nonvenereal infection (e.g., cat-scratch fever and sporotrichosis),
and noninfectious disorders (e.g., trauma and malignant disease).
 : About 6 to 24 weeks after infection, usually when the chancre is either healing
or has disappeared entirely, the secondary, or disseminated, stage of syphilis
begins. The cutaneous lesions (syphilids) usually are described as macular or
maculopapular and are generally symmetric and widespread, varying from
several millimeters to several centimeters in diameter. Some patients have
lesions characteristically confined to the distal extremities, especially the palms
and the soles. Syphilids may resemble lesions of psoriasis, lichen planus, or
pityriasis rosea. Other common mucocutaneous manifestations include patchy
alopecia and thinning of the eyebrows and beard; diffuse redness of the tonsils
and pharynx; and moist, papular excrescences in the intertriginous areas
(condyloma lata) that are highly infectious. Generalized lymphadenopathy often
is present, and splenomegaly may occur. Other organ systems that may be
involved include the gastrointestinal tract (granulomatous hepatitis associated
with a markedly elevated alkaline phosphatase level), the central nervous system
(headache and meningism, less commonly basilar meningitis, acute
hydrocephalus, optic neuritis, or cerebrovascular syndromes), the eyes (anterior
uveitis), the kidneys (rare instances of immune complex glomerulonephritis), and
the bones (mild osteitis with bone pain).
 After the manifestations of secondary syphilis
subside, untreated patients enter an
asymptomatic stage, called latency.
 About 25% of patients experience one or more
infectious relapses during the first 4 years of
latency; after that, infectious relapses are rare.
These relapses may be indistinguishable from
the patient’s previous secondary episode, but
cutaneous lesions tend to be less prominent, and
mucosal lesions may predominate. Isolated
visceral relapses can occur.
 Approximately 30% of untreated patients with late latent disease have one or more forms of
tertiary syphilis years, even decades, after infection. Tertiary syphilis is traditionally divided into
three categories
 benign tertiary (gummatous),
 cardiovascular, and
 neurosyphilis
 Gummatous disease is characterized by the development of one or more granulomatous lesions
(gummas) 7 to 10 years after initial infection. They can occur anywhere but are most common on
mucocutaneous surfaces and in bone.
 Cardiovascular syphilis is caused by obliterative endarteritis of the vasa vasorum of the large
arteries, particularly the proximal ascending aorta, that leads to aneurysmal dilatation. Aortic
regurgitation and congestive heart failure can occur.
 There are four categories of neurosyphilis—asymptomatic (cerebrospinal fluid [CSF]
abnormalities only), meningovascular (manifesting as stroke), gummatous (central nervous
system mass lesions), and parenchymatous (tabes dorsalis and generalized paresis). Tabes
dorsalis is caused by demyelinization of the posterior columns of the spinal cord, dorsal roots, and
dorsal root ganglia. Patients experience lancinating pain, pupillary abnormalities, impotence,
bladder incontinence, truncal ataxia, lower extremity areflexia, and a profound loss of position
and vibratory sensation in the lower extremities that gives rise to chronic traumatic arthritis
(Charcot joints). Generalized paresis is an insidious dementia that can include seizures, dramatic
and bizarre changes in personality, and intellectual deterioration.
 Unborn baby can be infected depending on how
long a pregnant woman has been infected, she
may have a high risk of having a stillbirth or of
giving birth to a baby who dies shortly after
birth.
 An infected baby may be born without signs or
symptoms of disease. However, if not treated
immediately, the baby may develop serious
problems within a few weeks. Untreated babies
may become developmentally delayed, have
seizures, or die
 Penicillin is the drug of choice for therapy for all stages of
syphilis. Several hours after receiving therapy, some
patients experience a sudden onset of chills, fever,
tachycardia, headache, flushing, and headache (Jarisch–
Herxheimer reaction). Symptoms usually abate within 24
hours and can be managed with aspirin. When initially
reactive, nontreponemal serologic results should be
followed at regular intervals, ideally beginning 3 months
after therapy, to confirm cure. On average, among
successfully treated patients with primary or secondary
syphilis, titers decrease fourfold at 6 months and eightfold
at 12 months. Patients with early syphilis and
nontreponemal test results that remain active at a low,
stable titer also may be considered cured
 Caused by Haemophilus ducreyi
 It is a fastidious gram-negative coccobacillus.
 A major cause of genital ulceration in tropica
countries.
 Another early symptom is dark or light green
shears in excrement.
 Chancroid starts as an erythematous papular
lesion which breaks down into a painful bleeding
ulcer with a necrotic base and ragged edge.
 It increases the risk of HIV
 Specimen should be collected from base and
margin s of ulcers following cleaning with a
saline swab.
 Morphology – they are gram negative
coccobacilli.
 In culture it requires the X factor and not the
V factor. The recommended media is
chocolate blood agar.
Specimen Possible pathogens

Urethral swabs Neisseria gonorrhoeae

Chlamydia trachomatis ( serovars D-K)

Urea plasma

mycoplasma

Trichomonas vaginalis

Cervical swabs Non puerperal women Neisseria gonorrhoeae

Chlamydia trachomatis

Streptococcus pyogenes

HSV

Puerperal sepsis or septic abortions Streptococcus pyogenes

Other beta haemolytic streptococci

Staphylococcus aureas

Enterococcus species
Vaginal swabs Trichomonous vaginalis

Candida species

Gardnerella vaginallis with anaerobes

Genital ulcer specimen Treponema pallidum

Haemophilus ducreyi

Klebsiella granulomatous

Chlamydia trachomatis

HSV
 Amies media is the effient transport media
for urogenital specimen.
 In collection of specimen from men- the area
around the urethra is cleaned.
 The urethra is massaged from above
downwards , then swab and collect the
discharge.
 A slide is made by rolling the swab on the
slide to avoid damaging the pus cells.
 A speculum is inserted into the vagina
 Cleanse the cervix using a sterile moistened
swab.
 Pass a sterile cotton-wool swab 20-30 mm into
the endocervical canal and gently rotate the
swab against the endocervical wall to obtain the
specimen.
 In cases where Gonorrhea is suspected, before
inserting the swab in Amies medium, if possible
inoculate into a culture medium.
 Label and transport the laboratory as soon as
possible.
 Gram stain and observe for
▪ Clue cells
▪ Intracellular gram negative diplococci.

 In wet preparations look for pus cells and

yeasts cells and trophozoites
1. Modified New York City or thayer Martin
Medium
 The specimen is innoculated and incubated
overnight at 370 c.
 Used for Isolation of N. gonorrhoeae
 They will produce small raised, grey shiny
colonies.
 Oxidase positive
 Gram stain- gram positive cocci
 Dark field preparation for detection of motile
spirochaetes – the specimen should be
examined as soon as possible after the
specimen is collected.
 Serum for RPR , TPHI
 The term prostatitis has been used for various inflammatory
conditions affecting the prostate, including acute and chronic
infections with specific bacteria and, more commonly, instances in
which signs and symptoms of prostatic inflammation are present
but no specific organisms can be detected.
 Patients with acute bacterial prostatitis can usually be identified
readily on the basis of typical symptoms and signs, pyuria, and
bacteriuria.
 To classify a patient with suspected chronic prostatitis correctly, a
midstream urine specimen, a prostatic expressate, and a
postmassage urine specimen should be quantitatively cultured
and evaluated for numbers of leukocytes.
 On the basis of these studies and other considerations, patients
with suspected chronic prostatitis can be categorized as having
chronic bacterial prostatitis or chronic pelvic pain syndrome, with
or without inflammation
Classification Clinical Prostate EPS Etiologic Antibiotics
Presentation Agent
Acute Acute onset Tender, PMNs, Escherichia Fluoroquinol
bacterial of fever, tense, boggy bacteria coli, other one, other
prostatitis chills, uropathogen (see text)
dysuria, s 
urgency
Chronic Recurrent Normal PMNs, E. coli, other Fluoroquinol
bacterial UTIs, bacteria uropathogen one, other
prostatitis obstructive s  (see text)
symptoms,
perineal pain
Chronic          
pelvic pain
syndrome
  Inflammator Perineal and Normal PMNs Ureaplasma? 4–6 weeks of
y low-back Mycoplasma? oral