The words you are searching are inside this book. To get more targeted content, please make full-text search by clicking here.

23.SexualTransmittedDiseases(STD)-ศ.คลินิก พญ.ยุพิน ไทยพิสุทธิกุล(25-11-61)

Discover the best professional documents and content resources in AnyFlip Document Base.
Search
Published by Kunlayanee Reunroeng, 2019-11-18 04:02:07

23.SexualTransmittedDiseases(STD)-ศ.คลินิก พญ.ยุพิน ไทยพิสุทธิกุล(25-11-61)

23.SexualTransmittedDiseases(STD)-ศ.คลินิก พญ.ยุพิน ไทยพิสุทธิกุล(25-11-61)

Urethral discharges

Gonococcal urethritis
Non-gonococcal urethritis

Genital ulcers

Syphilis
Herpes simplex
Chancroid
Lymphogranuloma venereum
Granuloma inguinale
Warts

Gonococcal urethritis

Etiology

Neisseria gonorrhoeae
(gram negative diplococci)

Cilnical manifestations

dysurea
urethral discharge





Laboratory tests

gram negative
diplococci intracellular

Treatment
1. quinolones (oral)

-norfloxacin 800 mg single dose
-ofloxacin 400 mg single dose
-ciprofloxacin 250-500 mg single dose

2. spectinomycin 2 gm intramuscular
3. cephalosporins

-ceftriaxone 250 mg intramuscular
-cefotaxime 500 mg intramuscular

+ probenecid 1 gm. oral

Complications
-posterior urethritis
-epididymitis
-paraurethral duct abscess
-periurethral duct abscess
-disseminated gonococcal
infection(DGI)
-gonococcal conjunctivitis













Non-gonococcal urethritis

Etiology

•Chlamydia trachomatis
•Ureaplasma urealyticum
•Trichomonas vaginalis

Clinical manifestations

• dysurea
• urethral discharge
• leukorrhea in female

Laboratory tests

1. gram stain
2. culture in cyclohexamide

treated McCoy cell culture
3. direct fluorescent antibody

detection or enzyme
immunoassay

Treatment

1. tetracycline 500 mg. qid 1-3 wks
2. doxycycline or minocycline 100mg.

bid 1-3 wks
3. erythromycin 500 mg. qid. 1-3 wks or

roxithromycin 150 mg. bid. 1-2wks or
thiamphenical 500 mg. qid. 1wks or
ofloxacin 200 mg. bid. 1 wks or
ciprofloxacin 500 mg. bid. 1 wks

Syphilis

Etiology

Treponema pallidum
:active motile spiral spirochete
(4-14 spirals , 5-20 um)

Clinical manifestations

1. Primary syphilis
2. Secondary syphilis
3. Latent syphilis
4. Tertiary syphilis

1. Primary syphilis

• IP 18-21 day
• hard chancre (Hunterian chancre)
• non-tender not suppurate

lymphadenopathy
• chancre redux
• syphilitic balanitis of Follmann





Laboratory tests

1. direct fluorescent antibody tissue test for
T.pallidum (DFAT-TP)

2. dark field examination
3. nontreponemal tests

Rapid plasma reagin (RPR)
Venereal disease research laboratory(VDRL)
4. polymerase chain reaction (PCR)
5. microhemagglutination assay for
T.pallidum(MHA-TP)
6. fluorescent treponemal antibody absorption
(FTA-ABS) for treponemal test

2.Secondary syphilis (syphilids)

• maculopapular rash
• condyloma lata
• alopecia (moth-eaten)
• pharyngitis,tonsillitis
• relapsing secondary syphilis
• systemic involvement









Laboratory tests

1. VDRL strongly+ve
2. dark-field illumination

3.Latent syphilis

• early latent : no symtom (<2 yrs)
• late latent(>2 yrs)

4.Tertiary syphilis(3-5 yrs)

• nodular (reddish brown or copper-
color) with crust and scales(Kidney
shape),scars , ulceration , atrophy ,
macroglossia , perforation of hard
palate

• gumma (deep punched ulcer)



Laboratory tests

1. VDRL or RPR + ve 75%
2. FTA-ABS or MHA-TP + ve 100%
3. Dark field illumination
4. PCR

Late complication

• osseous syphilis
• neurosyphilis
• cardiovascular syphilis
• congenital syphilis



Treatment

Primary , Secondary , Early latent syphilis

1. benzathine penicillin 2.4 million IM
2. tetracycline (250mg) 2x4 pc x 2 wks
3. doxycycline (100mg) 1x2x2 wks
4. ceftriaxone 1 gm IM or IV x8-10 d.
5. azithromycin 2 gm single dose oral

Treatment

Late or Early latent syphilis > 1 yr

1. benzathine penicillin 2.4 milliom Imx
3 wks

2. tetracycline (250 mg) 2 x 4 x1 month
3. doxycycline (100 mg)1 x 2 x 1 month

Neurosyphilis

1. Pen G 3-4 mu IV every 4 hrs x2 wks.
2. Procaine Pen G 2.4 mu IM / day

+probenecid (500 mg) oral qid x 2wks
+Benzathine Pen G 2.4 mu IM/wk x 3wks

Congenital syphilis
Pen G 2-3 mu/kg/d IV
or 0.5mu every 4-6 hrs x2 wks

Pregnant
depends on stage

Jarisch – Herxheimer reaction

: 6-8 hrs after initial injection of Penicillin
: fever , sore throat , malaise , myalgia

headache , tachycardia
: erythematous swelling of initial syphilitic

lesions
: premature labor , fetal distress
: symtomatic treatment

Herpes simplex
fever blister , cold sore

Etiology

Herpes simplex virus (DNA virus)
type I , II

Clinical

1. Mild primary infections
2. Severe primary infection
3. Recurrent herpes simplex

I Mild primary infections

• gingivostomatitis
• genital herpes
• keratoconjunctivitis





2 Severe primary infection

• kaposi’s varicelliform eruption
(eczema herpeticum)

• meningoencephalitis
• disseminated herpes simplex



3.Recurrent herpes simplex

less severe , no symtom



Laboratory test

1. Tzanck test:multinucleated giant cell
2. Immunofluorescence:Ag detection
3. Elisa


Click to View FlipBook Version