「Sexually-transmitted infections」の版間の差分
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| 5行目: | 5行目: | ||
**oral sex | **oral sex | ||
| − | ==Pathogen== | + | ==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 | ||
| + | |||
| + | {|class="wikitable" | ||
| + | ! | ||
| + | !non-treponemal positive | ||
| + | !non-treponemal negative | ||
| + | |- | ||
| + | !treponemal positive | ||
| + | |active syphilis | ||
| + | |past syphilis | ||
| + | |- | ||
| + | !treponemal negative | ||
| + | |other active disease | ||
| + | |nothing | ||
| + | |} | ||
==Epidemiology== | ==Epidemiology== | ||
2021年4月16日 (金) 11:33時点における版
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 |
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
