「Sexually-transmitted infections」の版間の差分

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*difficulty of microscopy
+
*difficulty of microscopy - endemic treponematoses
 
**''T. pallidum'' - Syphilis
 
**''T. pallidum'' - Syphilis
 
**''T. ssp pertenue'' - Yaws
 
**''T. ssp pertenue'' - Yaws

2021年4月16日 (金) 11:39時点における版

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 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

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