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1、,【教学目标】了解淋病、梅毒及病毒和沙眼衣原体感染的生殖道炎症的发病原因、传播途径、临床表现及诊断治疗和预防措施。【教学重点】淋病、梅毒及病毒和沙眼衣原体感染的生殖道炎症的传播途径、临床表现及诊断治疗和预防措施。【教学难点】淋病、梅毒及病毒和沙眼衣原体感染的生殖道炎症的发病原因、传播途径。,Sexually Transmitted Diseases,Bacterial infections:Chlamydia trachomatis Neisseria gonorrhoeae(GO)Syphilis Viral infections:Herpes genitalis Human papillo
2、mavirus(HPV)Human immunodeficency virus(HIV),Chlamydia vaginitis,E Chlamydia trachomatis Salpingitis(Peritonitis,infertility,etopic pregnancy,premature labor,stillbirth possible)S Often symptom free,associated with other pathogens of vaginitis(GO,vaginosis),Dysuria,pollakisuria,white glassing discha
3、rge.Chlamydia should be suspected in any patient with acute PID,possible GO or trichomonas vaginitis D Intracelluar inclusion,immunology with monoclonal antibody.T Azithromycin 1g oral,single dose Doxycycline 100mg bid for 7 d,Minocine?,Ofloxacin 100 mg tid for 7 d Erythromycin 500 mg qid for 7 d.fo
4、r pregnant patients,Gonorrhea(GO),E Gramnegative gonococci(Diplococci),Optimal pH 7.2,incubation time:ca.1 w.S 50-80%women with GO are asyptomatic.Acute infection in urethra,cervix,Sknes glands,Bartholins glands,evtl rectum.Confined in the mucosa only Profuse purulent urethral and vaginal discharge,
5、urethral burning,dysuria,bladder irritability,inflammation of urethra,cervix,Skenes and Bartholins glands.,Co-infection with other STD is common.Causing recurrent PID,chronic pelvic pain or infertility due to tubal damage or hydrosalpinx formation.Women with a history of salpingitis 710 X ectopic pr
6、egnancy,If treatment of the acute phase delayed or inadequate,GO via ascending surface spreading usually toward the end or after the next menstrual period Acute salpingitis and pelvic peritonitis.Accompany symptom:Condylomata acuminata.D History of exposure,microscopy,culture,PCR ELISA.,T Ceftriaxon
7、e 1g iv+Doxycycline 100 mg bid for 7 d.Failure is rare and a follow up culture is not necessary.For pregnant patients.Ceftriaxone 250 mg i.m.as single dose+Erythromycine 500 mg qid oral.for 7 d.,Syphilis,E Treponema pallidum by direct genital or oral-genital contact with an actively infected sexual
8、partner.Following transfusion with blood from an infected donor Transplacental spread:Mother fetus.Primary stage of the disease in the reproductive tract.S Prim.Stage:Incubation time 23 w.Ulcus durum with indolent swelling of regional LN in genital area.68 w.healing up.,S Sec.stage:Otherwise 612 w.a
9、fter formation of prim.affection Lymphogen or hematogen spreading Generalization of LN swelling,macular,later mixed with popular exanthema,together with condylomata lata in genital area,alopecia and tonsillitis.Tert.Stage:Latent time 10-20 years,Serotest:positive,without syndrome and sign.Mostly aff
10、ected in CNS,cardiovascular system,gumma in face,body and extremities.Lesions of the reproductive tract are uncommon.,D Darkfield examination,Serologic test(Cardiolipin,TPHA,FTA),RPR(rapid plasma reagin).T Benzathine（苄星）penicillin G 24 million u.i.m.or aqueous procaine penicillin G 600 000 u./di.m.f
11、or 8 d.,Erythromycin 500 mg oral qid for 15 d in pregnant patients.Patients should be followed by quatitative VDRL titers and examination at 3,4,12 months after treatment.A 4x decline at 6.month or 8 x decrease by 12 months should be anticipated,if the disease has been cured.,Herpes genitalisNeonata
12、l HSV infection in the US incidence of app.1133 cases/100 000 live birthHSV 30%spontaneous abortions.Babies born to mothers with active herpes virus infected.50%with disseminated disease die,even with antiviral therapy.Among neonates with encephalitis 50%of survivors are left with severe neurologic
13、impairment.,App.85%of early neonatal herpes infections are aquired during delivery from virion contaminated maternal vaginal secretions,therefore C-section for women with active genital lesions at time of labor.40 70%of all neonates with herpes are born to asymptomatic mothers.Incubation period abou
14、t 6 d with first episodes lasting for 10 12 d.,Location:Vulva,vagina,cervix,perineal and perianal skin,often extending to the buttocks.Prim.infection with symptoms such as malaise,low grade fever and inguinal adenopathy.Aseptic meningitis with fever,headache and menigismus can be found in some patie
15、nts 5 7 d after genital lesions.60 90%of patients with recurrence of herpetic lesions in the first 6 m.after initial infection.,Recurrences are similar in character,but milder in severity and shorter in duration.D 1.Suspicion and clinical findings.2.Viral culture.3.Immunofluorescence techniques to d
16、etect viral particles.T 1.Sitz baths,followed by drying with a heat lamp or warm hair dryer.2.Topical anesthetic(2%lidocaine jelly)3.Local antibacterial cream.,4.Acyclovir ointment or oral acyclovir(200 mg tid)for patients having frequent recurrence.Acyclovir prophylaxis for herpes infction during p
17、regnancy:At 36 w of gestation to(1)women who have experienced symptomatic HSV during their pregnancy Effective of reducing both symptomatic recurrence and asyptomatic shedding or to(2)women with history of HSV but no recurrence during pregnancy.,Human Papillomavirus(HPV)The most common viral STD in
18、the USA.found in 2.5 4%of women,presenting as condylomata acuminata.Subtypes 16,18,31,33,35 Cervical neoplasia.90%of pateints with cervical squamous cell carcinomas are HPV(+).Incubation period 1 6 m.Often accompanied by trichomonasis or bacterial vaginosis.,T 1.Podophyllin(not be used during pregna
19、ncy).2.Laser ablation,cryotharapy or electrodessication.3.5 FU cream as an adjunct for cervical vaginal lesions.,HIV and AIDS HIV(gp 120)APC(i.e DC)via gp120+DC SIGN(dendritic cell specific ICAM-grabbing non-integrin)+CD4R CD4+T cells via CCR5.HIV(gp 120)Endothelial cells via DC-SIGNR CD4+T cells vi
20、a CCR5.,Infected via blood transfusion,pregnancy or drug associated use of contaminated needles,but sexual transmission is a major mode of spread.In 90%of patients,infection by HIV produces only nonspecific symptoms,often mimicking mononucleosis,febrile pharyngitis,with fever,sweat,lethary嗜睡,arthral
21、gia,myalgia,headache,photophobia and lymphadenopathy seen soon after infection.Following the initial infection carrier state without symptoms but viral shedding occurs.Immune dysfunction becomes apparent roughly 10 years after the initial infection.D:Immunoassay,Western blot or immunofluorescence as
22、says.T:Azidovudine or combination multidrug therapy to delay the progress of HIV.,E Pathogen organisms:2/3 gram negative bacteria(E.Coli,Pseudomonas假单胞菌,Proteus变形杆菌,Klebsiella,Occasionally Clostridium)Endotoxin Septic shock,if untreated 50%,Puerperal and postabortal pelvic inflammatory diseases,Path
23、ogenesis of septic shock:Endotoxin(Lipopolysaccharide or lipoprotein=carbon-hydrate-complex)1.Releasing of catecholamines Vasoconstriction,initially microcirculation Peripheral vascular resistanceTissue perfusiona.Skin pale,cold and clammy,fever.b.Stagnant anoxia Tissue damage,metabolic acidosisEdem
24、a Pulmonary edema.Hypovolemic stage Renal function,Liver jaundice In irreversible phase(Vasomotor collapse)Generalized vasodilatation Final state.,2.Neurotoxic effectMental confusion or semicoma!Risk factors:a.Anemia,malnutrition,chronic disease.b.Coitus immediately before delivery.c.PROM(Premature
25、rapture of membranes)d.Chorioamnionitis.e.Intern CTG.f.Sectio.g.Forceps and trauma of birth canal.h.Postpartal bleeding.,S Fever,Pulse,Shaking chills,Pelvic pain+,Tenderness+,Purulent discharge+,Leukocytosis+,Later onOligouria,Hypotension,Pulseless,Subnormal temperature with pale,cold,clammy skin,Dy
26、spneic and cyanotic,Metal confusionnear moribund,Anuric,semicomatose,T For simple,uncomplicated case,initially bacteriogram or blood culture,broad spectrum antibiotics,i.e.Penicillin 10-20 million units i.v.After 6-12 hrs,afebrile,fluid and electrolyte balance,Emptying all retained infected and necr
27、osis tissue.For early endotoxic shock,massive antibiotic therapy i.v.Penicillin 40 60 million units/d,or Cephalosporin+Gentamycin 6080 mg tid i.m.,if urine output o.k.(Nephrotoxic and ototxic!),i.v.fluid therapy(CVP!urin output!)Corticosteroid for all patients i.v.vasospasm,cardiac output.e.g hydrocortisone 2.05.0 g/dRemoval the source of infection.Tetracycline 2g/dMetronidazole,THE END,
