「Sexually-transmitted infections」の版間の差分
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==Definition== | ==Definition== | ||
*infections that are commonly transmitted by sexual activity | *infections that are commonly transmitted by sexual activity | ||
40行目: | 42行目: | ||
**''T. carateum'' - Pinta | **''T. carateum'' - Pinta | ||
*morphologically identical and serologically indistinguishable | *morphologically identical and serologically indistinguishable | ||
+ | |||
+ | |||
+ | *maternal syphilis | ||
+ | **congenital syphilis | ||
+ | ***neonatal presentation - poor prognosis | ||
+ | ***postnatal presentation - fair prognosis | ||
+ | *importance of syphilis screening during pregnancy | ||
+ | |||
+ | ===genital herpes=== | ||
+ | *Herpes simplex | ||
+ | |||
+ | ===chancroid=== | ||
+ | *''Haemophilus ducreyi'' | ||
+ | *Azithromycin | ||
+ | |||
+ | ===lymphogranuloma venerum (LGV)=== | ||
+ | *''Chlamydia trachomatis'' L1,2,3 | ||
+ | **different serovars from genital chlamydiasis | ||
+ | *rare; increasing among MSM in Europe and US | ||
+ | |||
+ | ===donovanosis (granuloma inguinale)=== | ||
+ | *''Krebsiella granulomatis'' | ||
+ | *India, Papua New Guinea, Brazil, Caribbean | ||
+ | *microscopy shows Donovan bodies similar to lieschmania | ||
+ | |||
+ | ===''Chlamydia trachomatis'' serovars A, B, Ba, C=== | ||
+ | *cervicitis and urethritis in females | ||
+ | *urethritis in males | ||
+ | *neonatal conjunctivitis | ||
+ | *classical ocular trachoma | ||
+ | *worldwide resistance against azithromycin | ||
+ | |||
+ | ===gonorrhea=== | ||
+ | *''Neisseria gonorrhoea'' | ||
+ | *microscopic investigation tends to be false-negative in female gonorrhea | ||
+ | |||
+ | ===ophthalmia neonatorum=== | ||
+ | *etiology | ||
+ | **gonorrhea | ||
+ | **chlamydia | ||
+ | **herpes simplex | ||
+ | **and more | ||
+ | |||
+ | ===human papilloma virus=== | ||
==Epidemiology== | ==Epidemiology== | ||
92行目: | 138行目: | ||
***problems with partner notification; stigmatization | ***problems with partner notification; stigmatization | ||
***only symptomatic STIs treated | ***only symptomatic STIs treated | ||
+ | |||
+ | ==Control== | ||
+ | *Primary prevention | ||
+ | **risk reduction | ||
+ | **condom distribution | ||
+ | **health education | ||
+ | **vaccine | ||
+ | *Secondary prevention | ||
+ | **promote early healthcare seeking behavior | ||
+ | ***facility based | ||
+ | ***online self test; send self-sampling test kit | ||
+ | **health education | ||
+ | **contact tracing | ||
+ | |||
+ | |||
+ | <math>R_0 = B \times C \times D</math> | ||
+ | *<math>B</math>: transmission coefficient ←condoms, education | ||
+ | *<math>C</math>: mean rate of partner change ← | ||
+ | *<math>D</math>: mean duration of infectiousness ← |
2023年9月10日 (日) 13:59時点における最新版
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目次
Definition
- infections that are commonly transmitted by sexual activity
- vaginal sex
- anal sex
- oral sex
Pathogen and disease
syphilis
- Treponema pallidum
- one of 3 major spirochaetes - leptospirosis and borrelia
- 6 mil. new cases/2018
- higher in female sex worker and MSM
- diagnosis
- non-treponemal - positive during active stage; sensitive, not specific
- VDRL
- RPR
- treponemal - positive for lifelong; specific, not sensitive
- TPHA
- TPPA
- FTA
- non-treponemal - positive during active stage; sensitive, not specific
non-treponemal positive | non-treponemal negative | |
---|---|---|
treponemal positive | active syphilis | past syphilis |
treponemal negative | other active disease | nothing |
- difficulty of microscopy - endemic treponematoses
- T. pallidum - Syphilis
- T. ssp pertenue - Yaws
- T. pallidum spp. endemicum - Bejel
- T. carateum - Pinta
- morphologically identical and serologically indistinguishable
- maternal syphilis
- congenital syphilis
- neonatal presentation - poor prognosis
- postnatal presentation - fair prognosis
- congenital syphilis
- importance of syphilis screening during pregnancy
genital herpes
- Herpes simplex
chancroid
- Haemophilus ducreyi
- Azithromycin
lymphogranuloma venerum (LGV)
- Chlamydia trachomatis L1,2,3
- different serovars from genital chlamydiasis
- rare; increasing among MSM in Europe and US
donovanosis (granuloma inguinale)
- Krebsiella granulomatis
- India, Papua New Guinea, Brazil, Caribbean
- microscopy shows Donovan bodies similar to lieschmania
Chlamydia trachomatis serovars A, B, Ba, C
- cervicitis and urethritis in females
- urethritis in males
- neonatal conjunctivitis
- classical ocular trachoma
- worldwide resistance against azithromycin
gonorrhea
- Neisseria gonorrhoea
- microscopic investigation tends to be false-negative in female gonorrhea
ophthalmia neonatorum
- etiology
- gonorrhea
- chlamydia
- herpes simplex
- and more
human papilloma virus
Epidemiology
- Syphilis in pregnancy > 350,000/year adverse birth outcome
- Cervical cancer due to HPV
- Infertility due to gonorrhea and chlamydia
- HIV, needless to say
- considerations
- no significant non-human reservoirs
- role of sexually active groups
- highlye dependent upon human behavior
[math]\displaystyle{ R_0 = B \times C \times D }[/math]
- [math]\displaystyle{ B }[/math]: transmission coefficient
- [math]\displaystyle{ C }[/math]: mean rate of partner change
- [math]\displaystyle{ D }[/math]: mean duration of infectiousness
- mode of propagation
- core groups ⇄ bridging population ⇄ general population
- size of each group differs among different countries
Presentations
genital ulcer
- herpes simplex
- syphilis
- chancroid
- donovanosis
- LGV
- undetermined
urethral discharge
- vaginal discharge
- inguinal swelling
- scrotal swelling
- lower abdominal pain
- neonatal conjunctivitis
- warts/carcinoma
- hepatitis
- fever
Diagnosis
Treatment
- WHO has published Tx guidelines for each of STIs
- syndromic management algorithms, e.g. by MSF, are more effective in high STI burden situation without advanced diagnostics
- disadvantages of over treatment
- e.g. using penicillin, azithromycin and aciclovir for genital ulcer (against each of syiphilis, chancroid and HSV)
- disadvantages for women
- problems with partner notification; stigmatization
- only symptomatic STIs treated
- disadvantages of over treatment
Control
- Primary prevention
- risk reduction
- condom distribution
- health education
- vaccine
- Secondary prevention
- promote early healthcare seeking behavior
- facility based
- online self test; send self-sampling test kit
- health education
- contact tracing
- promote early healthcare seeking behavior
[math]\displaystyle{ R_0 = B \times C \times D }[/math]
- [math]\displaystyle{ B }[/math]: transmission coefficient ←condoms, education
- [math]\displaystyle{ C }[/math]: mean rate of partner change ←
- [math]\displaystyle{ D }[/math]: mean duration of infectiousness ←