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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 p
2、apillomavirus (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,
3、 white glassing discharge. 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 Erythr
4、omycin 500 mg qid for 7 d. for 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 Prof
5、use purulent urethral and vaginal discharge,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.
6、Women with a history of salpingitis 710 X ectopic pregnancy,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 Histor
7、y of exposure, microscopy, culture, PCR ELISA. .,T Ceftriaxone 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 di
8、rect genital or oral- genital contact with an actively infected sexual 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 swell
9、ing of regional LN in genital area. 68 w. healing up.,S Sec.stage: Otherwise 612 w. after 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.
10、Tert. Stage: Latent time 10-20 years, Serotest: positive,without syndrome and sign. Mostly affected 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 rea
11、gin). T Benzathine（苄星） penicillin G 24 million u. i.m. or aqueous procaine penicillin G 600 000 u./di.m. for 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.
12、month or 8 x decrease by 12 months should be anticipated, if the disease has been cured.,Herpes genitalis Neonatal HSV infection in the US incidence of app. 1133 cases / 100 000 live birth HSV 30 % spontaneous abortions. Babies born to mothers with active herpes virus infected. 50 % with disseminate
13、d disease die, even with antiviral therapy. Among neonates with encephalitis 50% of survivors are left with severe neurologic impairment.,App. 85 % of early neonatal herpes infections are aquired during delivery from virion contaminated maternal vaginal secretions, therefore C-section for women with
14、 active genital lesions at time of labor. 40 70% of all neonates with herpes are born to asymptomatic mothers. Incubation period about 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 sympt
15、oms such as malaise, low grade fever and inguinal adenopathy. Aseptic meningitis with fever, headache and menigismus can be found in some patients 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 i
16、n character, but milder in severity and shorter in duration. D 1. Suspicion and clinical findings. 2. Viral culture. 3. Immunofluorescence techniques to detect viral particles. T 1. Sitz baths, followed by drying with a heat lamp or warm hair dryer. 2. Topical anesthetic ( 2% lidocaine jelly) 3. Loc
17、al antibacterial cream.,4. Acyclovir ointment or oral acyclovir (200 mg tid) for patients having frequent recurrence. Acyclovir prophylaxis for herpes infction during pregnancy: At 36 w of gestation to(1) women who have experienced symptomatic HSV during their pregnancy Effective of reducing both sy
18、mptomatic 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 the USA. found in 2.5 4 % of women, presenting as condylomata acuminata. Subtypes 16, 18, 31, 33, 35 Cervical neoplasia. 90 %
19、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 pregnancy). 2. Laser ablation, cryotharapy or electrodessication. 3. 5 FU cream as an adjunct for cervical vaginal l
20、esions.,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 via CCR5.,Infected via blood transfusion, pregnancy or drug associated use of contaminated n
21、eedles, 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, arthralgia, myalgia, headache, photophobia and lymphadenopathy seen soon after infecti
22、on. 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 assays. T : Azidovudine or combination multidrug therapy to delay the pr
23、ogress 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,Pathogenesis of septic shock: Endotoxin ( Lipopolysaccharide
24、 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 acidosisEdema Pulmonary edema. Hypovolemic stage Renal fu
25、nction, 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 rapture of membranes) d. Chori
26、oamnionitis. 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, Dyspneic
27、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 an
28、d necrosis 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/d Removal the source of infection. Tetracycline 2g/d Metronidazole,THE END,