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Sexually Transmitted Infections. Ataei .B , MD. MPH. مرد جوانی 4 روز بعد از تماس جنسی مشکوک دچار ضایعه دردناک الت تناسلی می شود د. در معاینه زخم نمای کثیف دارد وبه اسانی خونریزی می نماید. ودر لمس سفتی ندارد. غده لنفاوی بزرگ و دردناک نیز در ناحیه اینگوینال لمس میگردد. تشخیص بالینی شما چیست؟. - PowerPoint PPT Presentation
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ATAEI .B , MD. MPH.
Sexually Transmitted Infections
CASE 1
جوانی مشکوک 4مرد جنسی تماس از بعد روز . در د شود می تناسلی الت دردناک ضایعه دچار
خونریزی اسانی وبه دارد کثیف نمای زخم معاینه . . لنفاوی غده ندارد سفتی لمس ودر نماید می
لمس اینگوینال ناحیه در نیز دردناک و بزرگمیگردد.
چیست؟ شما بالینی تشخیص
ETIOLOGY
Usual causes Herpes simplex virus (HSV) Haemophilus ducreyi (chancroid)
USUAL INITIAL LABORATORY EVALUATION
culture, direct FA, ELISA, or PCR for HSV; consider HSV-2-specific serology.
In chancroid-endemic area: PCR or culture for H. ducreyi
INITIAL TREATMENT
Herpes confirmed or suspected (history or sign of vesicles):
Treat for genital herpes with : acyclovir, valacyclovir, or famciclovir
INITIAL TREATMENT
First episodes: acyclovir (200 mg 5 times per day or 400 mg
tid), valacyclovir (1 g bid), famciclovir (250 mg bid) for 7–14 days is
effective.
INITIAL TREATMENT
Symptomatic recurrent genital herpes: Short-course (1- to 3-day) regimens are
preferred because of low cost and convenience.
Oral acyclovir (800 mg tid for 2 days), valacyclovir (500 mg bid for 3 days), or famciclovir (750 or 1000 mg bid for 1 day,
INITIAL TREATMENT
Chancroid confirmed or suspected (diagnostic test positive, or HSV and syphilis excluded, and lesion persists):
Ciprofloxacin 500 mg PO as single dose or Ceftriaxone 250 mg IM as single dose or Azithromycin 1 g PO as single dose
CASE 2
ای 30بیمار جنسی 3ساله تماس یک از بعد هفتهشده تناسلی دستگاه روی پاپول یک دچار مشکوک
ضایعه این جدار 3است با اولسر به تبدیل بعد روزسفت معاینه ودر درد بدون که شود می منظمیکطرفه درد بدون لنفادنوپاتی با وهمراه است
میباشد. چیست؟ شما بالینی تشخیص
ETIOLOGY
Usual causes Treponema pallidum (primary syphilis) lymphogranuloma venereum
USUAL INITIAL LABORATORY EVALUATION
Dark-field exam, direct FA, PCR for T. pallidum; RPR or VDRL test for syphilis (if negative but
primary syphilis suspected, repeat in 1 week);
INITIAL TREATMENT
Syphilis confirmed (dark-field, FA, or PCR showing T. pallidum, or RPR reactive):
Benzathine penicillin 2.4 million units IM once to patient,
Preventive treatment Recent (e.g., within 3 months) Seronegative partner(s), All seropositive partners
MANAGEMENT OF SYPHILIS IN PREGNANCY
Every pregnant woman should undergo a nontreponemal test at her first prenatal visit
If at high risk of exposure, again in the third trimester and at delivery.
In the untreated pregnant patient with
presumed syphilis, expeditious treatment appropriate to the stage of the disease is essential.
RECOMMENDED FOLLOW-UP EVALUATION AFTER THERAPY FOR SYPHILIS
Stage of Syphilis Tests to Perform When to Perform Re-Treatmenta Considered If:
Primary or secondary
Quantitative RPR or VDRL
HIV-uninfected: 6 and 12 monthsHIV-infected: 3, 6, 9, 12, and 24 months
1 .Titer increases by fourfold or
2 .Titer fails to decline by fourfold or test fails to become nonreactive by 6 months or
3 .Clinical signs persist or recur
CASE 3 ای 23جوان جنسی 4ساله تماس از بعد روز
سوزش و مجرا از ترشح علت به مشکوک. نماید می مراجعه شما مطب به ادرار
چیست؟ شما بالینی تشخیص
URETHRITIS
(1) mucopurulent or purulent urethral discharge,
(2) Gram stain of urethral secretions demonstrating 5 or more leukocytes per oil immersion microscopic field, or
URETHRITIS
(3) a positive leukocyte esterase test on first-void urine or microscopic examination of first-void urine demonstrating 10 or more leukocytes per high-power field.
ETIOLOGY
Neisseria gonorrhoeae*
CAUSES OF NONGONOCOCCAL URETHRITIS
Chlamydia trachomatis (15–50%)* Ureaplasma urealyticum (10–40%)* Mycoplasma genitalium (30%??) Trichomonas vaginalis (1–17%)* Herpes simplex virus (primary) (?%)
TREATMENT
Treat chlamydial infection: plus Treat gonorrhea (unless excluded):
Azithromycin, 1 g PO; or Ceftriaxone, 125 mg IM; or
Doxycycline, 100 mg bid for 7 days
Cefpodoxime, 400 mg PO; or
Cefixime, 400 mg PO
Initial Treatment for Patient and Partners
*Epidemiologic treatment of sexual partners is recommended
ALTERNATIVE REGIMENS
Ceftizoxime (500 mg IM, single dose)or Cefotaxime (500 mg IM, single dose)or Spectinomycin (2 g IM, single dose)or Cefotetan (1 g IM, single dose) plus
probenecid (1 g PO, single dose)or Cefoxitin (2 g IM, single dose) plus probenecid
(1 g PO, single dose)
Recommended