STI and PID

Definitions
• STI – Infections acquired through sexual intercourse (may be
symptomatic or asymptomatic),also includes, close body
contact, kissing, cunnilingus, anilingus, fellatio, mouth–breast
contact, and anal intercourse
• STD – Symptomatic illness acquired through sexual
intercourse
• STI has been adopted
• Most STIs are treatable

• Other have no cure, such as herpes, HIV…

• STD in developing countries

• Education, prevention, and effective managment

 Interaction B/n HIV and STIs

• HIV alters the clinical features of STIs

• Response to treatment may be reduced
• Complications may increase and occur more quickly
• Increased transmission of HIV
• Implications of the interaction:
– Reduction in conventional STI could result in reduction of
HIV incidence
– Effective STI prevention and control should be components
of HIV prevention programs
 Diagnoses of STI/STD
• Three approaches

A. Clinical (presumptive)without laboratory

support

B. Aetiologic (laboratory based)

C. Syndromic Approach
 …diagnoses
A. Clinical dx - often inaccurate & incomplete
- similarities of Sn and Sx
- misses Co-infection
- atypical presentation – HIV
B. Aetiologic (laboratory based)
Expensive
Exposed for delay in Dx and Rx
Depends on technician and lab accuracy
Often not available in resource poor settings
Requires quality control procedures
 …diag

• Syndrome
– a group of symptoms and easily
recognized signs associated with a
number of well defined etiologies.
• Syndromic Management(aprouch )
- management based on identification
of a syndrome
 Genital ulcer

Genital Ulcer Disease

• Cause
-HSV
-Syphilis
-Chancroid
-lymphogranuloma venereum (LGV) and granuloma inguinale
(donovanosis).

• These diseases are associated with an increased risk for HIV infection.

– Other infrequent and noninfectious causes of genital ulcers include

• abrasions,
• fixed drug eruptions,
• carcinoma, and
• Behçet's disease.
Diagnosis

• Consequences of inappropriate therapy--- tertiary disease and

congenital syphilis in pregnant women
• diagnostic efforts are directed at excluding syphilis.

• Optimal the evaluation of a patient with a genital ulcer should include

– darkfield examination or direct immunofluorescence testing for
Treponema pallidum,
– culture or antigen testing for HSV, and
– culture for Haemophilus ducreyi.
– are not available in most offices and clinics. treatment recommendations on
their clinical impression of the appearance of the genital ulcer
 Chancroid has irregular margins and is deep with undermined edges.
The genital herpes ulcer is superficial and inflamed.
The syphilis ulcer has a smooth, indurated border and a smooth base.
Syphilis
– A painless and minimally tender ulcer, not accompanied by inguinal
lymphadenopathy, is likely to be syphilis, especially if the ulcer is indurated.
• Chancre , it is an isolated nontender ulcer with raised rounded borders and an
uninfected but integrated base, commonly found on the cervix, vagina, or vulva,
but may also form in the mouth or around the anus
– A nontreponemal
• rapid plasma reagin (RPR) test, or
• venereal disease research laboratory (VDRL) test, and a

– Confirmatory treponemal test—

• fluorescent treponemal antibody absorption (FTA ABS) or
• microhemagglutinin—T. pallidum (MHA TP), should be used to diagnose
syphilis presumptively.

– The results of nontreponemal tests usually correlate with disease activity and
should be reported quantitatively.
Syphilis
.
• Parenteral administration of penicillin G is the preferred treatment of all stages
of syphilis.
• Benzathine penicillin G, 2.4 million units intramuscularly in a single dose, is the
recommended treatment for adults with primary, secondary, or early latent
syphilis. The
• Jarisch-Herxheimer---patients should be advised of this possible adverse reaction.
• Latent syphilis is defined as those periods after infection with T. pallidum when
patients are seroreactive but show no other evidence of disease.
• Patients with latent syphilis of longer than 1 year's duration or of unknown
duration should be treated with benzathine penicillin G, 7.2 million units total,
administered as three doses of 2.4 million units intramuscularly each, at 1-week
intervals.
• All patients with latent syphilis should be evaluated clinically for evidence of
tertiary disease (e.g., aortitis, neurosyphilis, gumma, and iritis).
• Quantitative nontreponemal serologic tests should be repeated at 6 months and
again at 12 months. An initially high titer (1:32) should decline at least fourfold
(two dilutions) within 12 to 24 months.
Chancroid

• One to three extremely painful ulcers, accompanied by tender inguinal

lymphadenopathy (adenopathy is fluctuant).
• An inguinal bubo accompanied by one or several ulcers is most likely
chancroid.
– If no ulcer is present, the most likely diagnosis is LGV.

• Treatment

– Recommended regimens for the treatment of chancroid include: azithromycin,1 g

orally in a single dose; ceftriaxone, 250 mg intramuscularly in a single dose;
ciprofloxacin, 500 mg orally twice a day for 3 days; or erythromycin base, 500 mg
orally 4 times daily for 7 days.
– Patients should be reexamined 3 to 7 days after initiation of therapy (can be
expected to heal within 2 weeks unless it is unusually large)