17- STDs Year 4 Internal Medicine Notes OmpathStudy

17- STDs Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / INFECTIOUS -- PHC 432 Team 17 Sexual transmitted diseases\n\n Done By:\nYazeed Alhusainy\n\nCOLOR GUID: Doctor’s Notes Team Notes slides Not important Important 431 team work \n\n Objectives 1- List common sexual transmitted infections. 2- Discus how to obtain sexual history and risk factors. 3- Discus the differential diagnosis of:\n Vaginal and urethral discharge.\n Ulcerative and non-ulcerative genitalia.\n Pelvic pain and dysuria. 4- List the possible sexual transmitted infections among heterosexual and homosexual person. 5- Discus the investigation, diagnosis and management of sexual transmitted infections. 6- Discus the methods of prevention. 7- Discus the complications of sexual transmitted disease.\n8- Dermatological pictures of different sexual transmitted infection.\n\n • Syphilis\n• Chlamydia\n• Gonorrhea\nBacterial • chancroid\n\n • Herpes\n• Human Papilloma Virus\n• HIV\nViral • Hepatitis B Virus\n\n • Trichomonas vaginalis\nParasitic\n\n 1 \n\nSexually transmitted infections Definition: “Sexually transmitted infections (STIs) are infections that are spread primarily through person-to-person sexual contact. There are more than 30 different sexually transmissible bacteria, viruses and parasites.” World Health Organization.\n\nHow to approach a patient with STI: 1. Patients presenting with possible STIs are frequently anxious, embarrassed and concerned about confidentiality. The clinical setting must ensure privacy and reinforce confidentiality. 2. History: A. The three most common symptoms are: Vaginal discharge, urethral discharge and genital ulceration\n\n 2 \n\nB. Also any associated fever, pain, itch, malodour, genital swelling, skin rash, joint pains and eye symptoms. C. All patients should be asked about dysuria, haematuria and loin pain D. In women, menstrual, contraception and obstetric history should be obtained. E. What essential questions must be asked? \na) You must take a sexual history, perhaps prefacing this by saying, ‘I\nunderstand you are married. When did you last have sex with your wife?’. \nb) The next question should be, ‘When did you last have sex with anyone\nelse?’. Let’s say he answers somewhat gloomily, ‘Last week’. \nc) The questioning should continue along the following lines: ‘Is this a\nregular partner or was it more of a “one-off”?’; ‘Did you use a condom?’ and\n‘Was this partner female or male?’.\n\n 3 \n\n3. Examination: A. General examination must include the mouth, throat, skin and lymph nodes in all patients. B. The inguinal, genital and perianal areas should be examined with a good light source. C. The groins should be palpated for lymphadenopathy and hernias. D. The pubic hair must be examined for nits and lice. E. The external genitalia must be examined for signs of erythema, fissures, ulcers, chancres, pigmented or hypopigmented areas and warts. F. The urethral meatus is located and the presence of discharge noted G. The cervix should be inspected for ulceration, discharge, bleeding and ectopy and the walls of the vagina for warts.\n\nBacterial infections 1. Syphilis: Syphilis is infection with the bacteria Treponema pallidum which spread through broken skin or mucous membranes. It has several stages: 1) Primary syphilis: The first stage present with chancre (a firm, painless, nonitchy skin ulceration) that form at the site of infection about 2-3 weeks after pateints are first infected. He may not notice the sores or any symptoms. The sores disappear in about 4-6 weeks, even without treatment. The bacteria become dormant (inactive) in the system at this stage. 2) Secondary syphilis: Occurs about 5 weeks after the first sores heal. About 33% of those who do not have their primary syphilis treated will develop this second stage. These symptoms are; diffuse rash which frequently involves the palms of the hands and soles of the feet +snail track ulcer. They will often also go away without treatment again, the bacteria become dormant (inactive) in the system.\n\n 4 \n\n3) Latent syphilis: No symptoms just sero-postivevity in the blood. 4) Tertiary syphilis: Final stage of syphilis 3-10 years after initial infection. The infection spreads to the brain, nervous system (causing meningitis siezures, dementia), heart, skin, and bones. The dormant bacteria may be detectable either by seeing the damage they cause to a part of the body, or through a blood test for syphilis.\n\nInvestigations a. Dark field microscopy of smear: from primary or secondary lesions. May be negative. b. Serologic tests: (commonly used) \ni. Nontreponemal tests: The tests are called rapid plasma reagin (RPR)\nand venereal disease research laboratory (VDRL). Become positive during\nthe primary stage. Used for screening and titer used to follow up therapy. \nii. Treponemal tests: Detects specific antibody to T.pallidum \n1. Fluorescent treponemal antibody (FTA-ABS). \n2. Microhemagglutination