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BIOC33H3 (127)

Sexually Transmitted Diseases

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Biological Sciences
Stephen Reid

Chapter 53: Sexually Transmitted Diseases  Sexually transmitted diseases (STDs) are infectious diseases transmitted most commonly through sexual contact.  Types of STD infections include bacterial (gonorrhea, chlamydia, syphilis) and viral (genital herpes, genital warts).  Most infections start as lesions on the genitalia and other sexually exposed mucous membranes. Wide dissemination to other body areas can then occur.  A latent, or subclinical, phase is present with all STDs. This can lead to a long-term persistent infection and transmission of disease from asymptomatic (but infected) person to another contact.  Different STDs can coexist within one person. GONORRHEA  Gonorrhea is the second most frequently reported STD in United States.  It is caused by Neisseria gonorrhoeae, a gram-negative diplococcus.  Gonorrhea is spread by direct physical contact with an infected host, usually during sexual activity (vaginal, oral, or anal).  The initial site of gonorrhea infection in men is usually the urethra.  Symptoms of urethritis consist of dysuria and profuse, purulent urethral discharge developing 2 to 5 days after infection.  Women with gonorrhea are often asymptomatic or have minor symptoms that are often overlooked. A few women may complain of vaginal discharge, dysuria, or frequency of urination.  Complications of gonorrhea in men are prostatitis, urethral strictures, and sterility from orchitis or epididymitis.  Because women with gonorrhea who are asymptomatic seldom seek treatment, complications are more common and include pelvic inflammatory disease (PID), Bartholin’s abscess, ectopic pregnancy, and infertility.  Typical clinical manifestations of gonorrhea, combined with a positive finding in a Gram-stained smear of the purulent discharge from the penis, gives an almost certain diagnosis in men. A culture must be performed to confirm the diagnosis in women.  The most common treatment for gonorrhea is a single IM dose of ceftriaxone (Rocephin). Patients with coexisting syphilis are likely to be cured by same drugs used for gonorrhea.  All sexual contacts of patients with gonorrhea must be evaluated and treated to prevent reinfection after resumption of sexual relations. SYPHILIS  The cause of syphilis is Treponema pallidum, a spirochete which enters the body through very small breaks in skin or mucous membranes.  In addition to sexual contact, syphilis may be spread through contact with infectious lesions and sharing of needles among IV drug users.  If syphilis is not treated, specific stages are characteristic of disease progression.  In the primary stage, chancres appear. During this time, draining of microorganisms into lymph nodes causes regional lymphadenopathy. Genital ulcers may also be present.  Without treatment, syphilis progresses to a secondary (systemic) stage. Manifestations include flu-like symptoms of fever, sore throat, headaches, fatigue, and generalized adenopathy.  The third stage is most severe stage. Manifestations include gummas, aneurysms, heart valve insufficiency, and heart failure, and general paresis.  Syphilis is commonly diagnosed by a serologic test. Benzathine penicillin G (Bicillin) or aqueous procaine penicillin G remains the treatment for all stages of syphilis. CHLAMYDIAL INFECTIONS  Chlamydial infections are the most commonly reported STD in the United States.  They are caused by Chlamydia trachomatis, a gram-negative bacterium that is transmitted during vaginal, anal, or oral sex.  Chlamydial infections are associated with gonococcal infections, which makes clinical differentiation difficult. In men, urethritis, epididymitis, and proctitis may occur in both diseases. In women, bartholinitis, cervicitis, and salpingitis (inflammation of the fallopian tube) can occur in both diseases. Therefore, both Chlamydia and gonorrhea are usually treated concurrently even witho
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