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| Trematode (fluke, distoma)
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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
- treponemal - positive for lifelong; specific, not sensitive
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non-treponemal positive
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non-treponemal negative
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| treponemal positive
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active syphilis
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past syphilis
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| treponemal negative
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other active disease
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nothing
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- 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
- importance of syphilis screening during pregnancy
genital herpes
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
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]\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 ←
