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PREPARED BY:
Kabita Shrestha
Roll No. 22
B. Sc. Nursing Student
3rdYear, 10th batch
KMCTH
STIS
 Reasons for increasing
incidence of STIS
Syphilis
Introduction
Mode of transmission
Activities that do not
tra...
 Sexually transmitted infections are
infections that are predominantly
transmitted through sexual contact from
an infecte...
Rising prevalence of
viral infections like HIV,
Hepatitis B and C.
Increased use of Pill and
IUCD which cannot
treat STI.
...
Lack of sex education
and inadequate
practice of safer sex.
Increased detection
due to heightened
awareness.
Types of
Infections
Infections Causative
Organism
Bacterial Syphilis
Lymphogranuloma venereum
Chancroid
Granuloma inguinal...
Types of
Infections
Infections Causative
organisms
Viral AIDS
Genital herpes
Condyloma acuminate
Molluscum contagiosum
Vir...
 Syphilis is a sexually transmitted infection
caused by motile anaerobic Spirocheta
Treponema palllidum.
 Host: Humans
 Syphilitic Lesion of genital tract is acquired
by direct contact with another person who
has open primary or secondary l...
o Contact with toilet seats, door knobs,
swimming pools, bath tubs etc.
o Sharing clothings, eating utensils etc.
 Incubation period: 9-90 days
A. Primary Syphilis:
 The classic lesion designated as chancre
may be single or multiple and is usually
located in labia,...
 The ulcer is painless without any
surrounding inflammatory reaction.
 The inguinal glands are enlarged, discrete
and pa...
B. Secondary syphilis:
 Within 6 weeks to 6 months from the onset
of primary chancre, secondary syphilis may
be evidenced...
 The characteristic rash of secondary syphilis
may appear as rough, red, or reddish brown
spots both on the palms and fee...
C. Latent Syphilis:
 It is the quiescence phase after the stage of
secondary syphilis has resolved.
 Infection remains i...
D.Tertiary Syphilis:
 About one-third of untreated patients
progress from late latent stage to tertiary
syphilis.
 Terti...
 It damages the central nervous,
cardiovascular and musculoskeletal
systems. (cranial nerve palsies, hemiplegia,
tabes do...
 Congenital Syphilis:
 Untreated babies
born of syphilitic
mother may become
developmentally
delayed, have
seizures or d...
1. History of exposure
2. Identification of the organism:
Motile, bluish white cork-screw shaped
organisms appear on exuda...
3. Serological tests:
Non-Treponemal
Tests
• VDRL
• RPR
Treponemal tests
• MHA-TP
• FTA-ABS
Non-TreponemalTests:
• These tests detect the body’s response to
the infection, but not to the actual
Treponema organism ...
TreponemalTests: (Confirmatory)
• These tests directly detect the body’s
response toTreponema pallidum.
 Early Syphilis:
o Benzathine Penicillin
G 2.4 million units IM
single dose, half to
each buttock
o In penicillin allergi...
Late Syphilis:
o Benzathine Penicillin G 2.4 million units IM
weekly*3 weeks (Total 7.2 million units)
o Alternative Regi...
Syphilitic pregnant woman:
o Penicillin is the drug of choice as other
antibiotics do not effectively cross the
placenta ...
 LGV is sexually transmitted chronic
infection of the lymphatic system caused
by one of the aggressive L serotypes of
Chl...
 Incubation period: 3-30 days
Initial lesion:
 Painless papules, papules or ulcers in the
vulvas, urethra, rectum or ce...
 The glands become necrosis and abscess
(bubo) forms.
 Within 7-15 days, the bubo ruptures and
results in multiple drain...
Secondary Phase:
 Painful adenopathy
 Groove sign- depression between groups of
inflamed nodes. (classical clinical sig...
 Lymphatic obstruction leads to vulval
swelling.
 Lymphatic extension to vulva, vagina, or
rectum leads to ulceration, f...
 History taking
 Physical examination- ulcer, fistula,
lymphadenopathy
 Culture and isolation: lymph node
aspiration
 ...
Definite treatment
 Doxycycline 100mg BD *21 days
 Azithromycin 1 g PO weekly * 3 weeks
 Erythromycin 500mg PO QID * 2...
Surgical treatment
 Abscess should be aspirated but not
excised
 Manual dilatation of stricture weekly
1. Which of the following is the most specific
test for syphilis?
a. FluorescentTreponemalAntibody
AbsorptionTest (FTA-ABS...
2. Which of the following is the best treatment
for syphilis in more than 1 year duration?
a. PenicillinV 250 mg QICD810 d...
3. Lymphogranuloma venereum is most
difficult to differentiate from which of the
following?
a. Granuloma inguinale
b. Chan...
4. What is the classical clinical sign of
Lymphogranuloma?
a. Hodgkin’s sign
b. Shrink sign
c. Deep sign
d. Groove sign
 Dutta DC, “Textbook of Gynaecology”. 6th
Edition 2013. Jaypee Brothers and Medical
Publishers. Page no. 148-150, 151
 H...
 http://en.wiki.org/syphilis (pictures)
 http://en.wiki.org/lymphogranuloma_vener
eum (pictures)
Q: Prepare note on Chancroid.
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum
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This presentation consists of detail information on sexually transmitted diseases Syphilis and Lymphogranulom venereum.
* It also consists of Multiple Choice Questions (MCQs).

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Sexually transmitted diseases- Syphilis and Lymphogranuloma venereum

  1. 1. PREPARED BY: Kabita Shrestha Roll No. 22 B. Sc. Nursing Student 3rdYear, 10th batch KMCTH
  2. 2. STIS  Reasons for increasing incidence of STIS Syphilis Introduction Mode of transmission Activities that do not transmit syphilis Stages and Clinical Features Diagnosis Treatment Lymphogranuloma venereum Introduction Stages and symptoms Diagnosis Treatment
  3. 3.  Sexually transmitted infections are infections that are predominantly transmitted through sexual contact from an infected partner.  Other modes of transmission include: • Placental • Blood transfusion • Needle prick • Organ or tissue transplant
  4. 4. Rising prevalence of viral infections like HIV, Hepatitis B and C. Increased use of Pill and IUCD which cannot treat STI. Increased rate of overseas travel.
  5. 5. Lack of sex education and inadequate practice of safer sex. Increased detection due to heightened awareness.
  6. 6. Types of Infections Infections Causative Organism Bacterial Syphilis Lymphogranuloma venereum Chancroid Granuloma inguinale Gonorrhoea Non gonococcal urethritis Non specific vaginitis Mycoplasma Infecton Treponema pallidum Chlamydia trachomatis Haemophilus ducreyi Donovania granulomatis Neisseriae gonorrheae Chlamydia trachomatis Haemophilus vaginalis Mycoplasma hominis Fungal Monoliassis vaginitis Candida albicans
  7. 7. Types of Infections Infections Causative organisms Viral AIDS Genital herpes Condyloma acuminate Molluscum contagiosum Viral hepatitis CIN HIV 1 or HIV2 HSV 2 HPV Pox virus HBV and HCV HPV 16, 18 or 31 Protozoal BacterialVaginosis Trichomonas vaginitis Gardnerella vaginalis Trichomonas vaginalis Ectoparasites Scabies Pediculosis Sarcoptes scabiei Crab louse
  8. 8.  Syphilis is a sexually transmitted infection caused by motile anaerobic Spirocheta Treponema palllidum.  Host: Humans
  9. 9.  Syphilitic Lesion of genital tract is acquired by direct contact with another person who has open primary or secondary lesion.  Transmission occurs through the abraded skin or mucosal surface during vaginal, anal or oral sex. (sexual contact)  Transplacental route
  10. 10. o Contact with toilet seats, door knobs, swimming pools, bath tubs etc. o Sharing clothings, eating utensils etc.
  11. 11.  Incubation period: 9-90 days
  12. 12. A. Primary Syphilis:  The classic lesion designated as chancre may be single or multiple and is usually located in labia, fourchette, anus, cervix and nipples.  The macular lesion becomes papular and then ulcerates.
  13. 13.  The ulcer is painless without any surrounding inflammatory reaction.  The inguinal glands are enlarged, discrete and painless.  The tubes are not affected and infertility does not occur.  The primary chancre heals spontaneously in 1-8 weeks leaving behind a scar.
  14. 14. B. Secondary syphilis:  Within 6 weeks to 6 months from the onset of primary chancre, secondary syphilis may be evidenced in the vulva in the form of condylomata lata (coarse, flat-topped, moist, necrotic lesions and teeming with treponemas.
  15. 15.  The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms and feet.  Patient may present with systemic symptoms like fever, head ache, sore throat etc.  Other symptoms include muscle ulcers, weight loss, alopecia, generalized lymphadenopathy.
  16. 16. C. Latent Syphilis:  It is the quiescence phase after the stage of secondary syphilis has resolved.  Infection remains in the body of sufferer though there are no sign and symptoms.  It varies in duration from 2 to 20 years.
  17. 17. D.Tertiary Syphilis:  About one-third of untreated patients progress from late latent stage to tertiary syphilis.  Tertiary syphilis is characterized by gumma. * A gummatous ulcer is a deep punched painless ulcer with rolled out margins and moist leather base.
  18. 18.  It damages the central nervous, cardiovascular and musculoskeletal systems. (cranial nerve palsies, hemiplegia, tabes dorsalis, aortic aneurysm etc)
  19. 19.  Congenital Syphilis:  Untreated babies born of syphilitic mother may become developmentally delayed, have seizures or die.
  20. 20. 1. History of exposure 2. Identification of the organism: Motile, bluish white cork-screw shaped organisms appear on exudates smear of primary chancre when examined under dark ground illumination through a microscope.
  21. 21. 3. Serological tests: Non-Treponemal Tests • VDRL • RPR Treponemal tests • MHA-TP • FTA-ABS
  22. 22. Non-TreponemalTests: • These tests detect the body’s response to the infection, but not to the actual Treponema organism that causes infection. • They can also produce a positive result when no infection is actually present so called false-positive results for syphilis.
  23. 23. TreponemalTests: (Confirmatory) • These tests directly detect the body’s response toTreponema pallidum.
  24. 24.  Early Syphilis: o Benzathine Penicillin G 2.4 million units IM single dose, half to each buttock o In penicillin allergic cases • Tetracycline 500 mg PO* 14 days • Doxycycline 100 mg BD PO*14 days
  25. 25. Late Syphilis: o Benzathine Penicillin G 2.4 million units IM weekly*3 weeks (Total 7.2 million units) o Alternative Regimen • Doxycycline 100mg PO BD * 4 weeks • Tetracycline 500mg PO QID * 4 weeks
  26. 26. Syphilitic pregnant woman: o Penicillin is the drug of choice as other antibiotics do not effectively cross the placenta to treat the infected fetus.
  27. 27.  LGV is sexually transmitted chronic infection of the lymphatic system caused by one of the aggressive L serotypes of Chlamydia trachomatis, which is an obligatory intracellular and Gram- intermediate organism.
  28. 28.  Incubation period: 3-30 days Initial lesion:  Painless papules, papules or ulcers in the vulvas, urethra, rectum or cervix.  Inguinal nodes are involved and feel rubbery.  Acute lymphangitis and lymphadenitis
  29. 29.  The glands become necrosis and abscess (bubo) forms.  Within 7-15 days, the bubo ruptures and results in multiple draining sinuses and fistulas.  The healing occurs with intense fibrosis with lymphatic obstruction.
  30. 30. Secondary Phase:  Painful adenopathy  Groove sign- depression between groups of inflamed nodes. (classical clinical sign of LGV)
  31. 31.  Lymphatic obstruction leads to vulval swelling.  Lymphatic extension to vulva, vagina, or rectum leads to ulceration, fibrosis and stricture of vagina or rectum.
  32. 32.  History taking  Physical examination- ulcer, fistula, lymphadenopathy  Culture and isolation: lymph node aspiration  Detection of LGV antigen: • Immunofluorescence method • ELISA method  LGV compliment fixation test: positive when rising titer >1:64
  33. 33. Definite treatment  Doxycycline 100mg BD *21 days  Azithromycin 1 g PO weekly * 3 weeks  Erythromycin 500mg PO QID * 21 days ~Sexual partner should also be treated.
  34. 34. Surgical treatment  Abscess should be aspirated but not excised  Manual dilatation of stricture weekly
  35. 35. 1. Which of the following is the most specific test for syphilis? a. FluorescentTreponemalAntibody AbsorptionTest (FTA-ABS) b. Gram stain of Lesion exudates c. Rapid Plasma ReaginTest (RPR) d. Veneral Disease Research LaboratoryTest (VDRL)
  36. 36. 2. Which of the following is the best treatment for syphilis in more than 1 year duration? a. PenicillinV 250 mg QICD810 days b. Benzathine Penicillin G 2.4 million units IM single dose c. Benzathine Penicillin G 2.4 million units IM weekly*3 doses d. Aqueous Penicillin G 4 million units every 4 hours*10 days
  37. 37. 3. Lymphogranuloma venereum is most difficult to differentiate from which of the following? a. Granuloma inguinale b. Chancroid c. Herpes simplex vulvitis d. syphilis
  38. 38. 4. What is the classical clinical sign of Lymphogranuloma? a. Hodgkin’s sign b. Shrink sign c. Deep sign d. Groove sign
  39. 39.  Dutta DC, “Textbook of Gynaecology”. 6th Edition 2013. Jaypee Brothers and Medical Publishers. Page no. 148-150, 151  Howkins and Bourne “Shaw’s Textbook of Gynaecology”. 14th Edition. Page no. 127- 130  Tamrakar Anupama, “ A Textbook of Gynaecological Nursing”. 2069. Vidhyarthi Pustak Bhandar Publishers. Page no. 260- 266
  40. 40.  http://en.wiki.org/syphilis (pictures)  http://en.wiki.org/lymphogranuloma_vener eum (pictures)
  41. 41. Q: Prepare note on Chancroid.
  • CharuWalia2

    Sep. 18, 2020
  • mackay14

    Mar. 13, 2018

This presentation consists of detail information on sexually transmitted diseases Syphilis and Lymphogranulom venereum. * It also consists of Multiple Choice Questions (MCQs).

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