Health Information

Chlamydia trachomatis
Associate with Gonorrhoea - 20% male & 40% female with Gonorrhoea has.
Most symptomatic.
Neonatal infection might occur.

Candida albicans

Extremely common organism – Present almost all women.
Most women asymptomatic –predisposing factors – pregnancy, pills, diabetes.
Clinical features -Vaginal discharge, puritus vulvae.
Balanitis in male – might associate with Diabetes.

Viral disease.
Genital and oral lesions.
Spread - contact of lips and/or genitals with sores/ulcer.
Can recur.

Treponema pallidum – spiochaete
Spread
Acquired – sexual contact
Congenital - transplacentally (mother to fetus)

Syphilis -acquired
Primary
After 10-90 days of exposure.
Papule in the inoculation site, later ulcerate.
Can be unnoticed.

Secondary
4-10 weeks after primary lesion.
Fever, sore throat, malaise.
Can found – Generalized lymphadenopathy, Skin rash,
Symptoms disappear without treatment.

Tertiary
Skin – characteristic lesion – Gumma (granulomatous lesions).

Congenital syphilis
Early stage
Nasal discharge, skin and mucous membrane lesions.
2-6 weeks after birth.
Late / ‘stigmata’ – teeth, bone defect.

Syphilis -Treatment
Can see organism by dark-ground microscopy.

Serology –
VDRL – screening test.
TPHA
Treatment – antibiotics

Neisseria gonorrhoeae (gonococus)
Infect epithelium – urogenital tract, rectum, pharynx, conjuctivae.

Gonorrhoea –clinical features
40% of woman and some men are asymptomatic.
Incubation – 2-14 days.

Men
Anterior urethritis - dysuria, urethral discharge are common.
Can cause – infection in epididymis, testes, prostate.
Homosexual – rectal infection with proctitis.
Gonorrhoea –clinical features

Women
Endocervical canal – vaginal discharge, dysuris, intermenstrual bleeding.
Can cause – salpingitis,
Commonest causes of female infertility.
Rectal infection due to local spread.
Pharyngeal infection – asymptomatic.
Conjunctivitis - Neonates born to infective mother.

Gonorrhoea – Treatment
Identify the organism – direct or culture.
Antibiotic –
Need to treat all sexual contact.
Prevention – avoid multiple partners, condoms etc.

World wide spread – more in Africa, south-east Asia,

Spread

Heterosexual contact main now, early it was homosexual.
Mother to child
Contaminated blood product
Contaminated needles.
Immune system
Cell receptor for HIV is CD4 molecule.
Lot of cells in immune system contain CD4 molecule – mainly T-lymphocytes.
Loss of CD4 helper lymphocytes.

Clinical features

Several stages
Acute infection
Asymptomatic infection
Persistent generalized lymphadenopathy
Symptomatic infection

Acute primary infection

Self limiting non-specific infection occur.
After 4-8 weeks of exposure.
Fever, arthralgia, myalgia, lethargy, lymphadenopathy.
Last 3 weeks.
CD4 may be depleted.

Asymptomatic infection

Majority asymptomatic.
Patient is infectious.
Can be 10 year from infection to develop AIDS.

Persistent generalized lymphadenopathy

Asymptomatic but lymphadenopathy.
Symmetrical, firm, non-tender.

Symptomatic infection

Reduction of CD4 cell.
Weight loss, night sweats, diarrhoea.
Skin & mucous membranes – different manifestation.
Neurological msnifestations.
Gastrointestinal manifestation – diarrhoea.

Symptomatic infection

Opportunistic infection and tumours.

Protozoa – Pneumocystis carinii, Toxoplasmosis, cryptosporidiosis.
Fungi – cryptococcus, candida,
Viruses – cytomegalovirus, Herpes.
Bacterial – TB,
Tumours – Kaposi’s sarcoma, Lymphoma.

Diagnosis
Antibody - IgG to envelop componenets.
Antigen - p24Ag

World wide spread and carriers.
Spread
intravenous route
Sexual contact particularly male homosexuals.
From mother to child during birth.

Virus replicate in the liver.
It can be
Acute infection
Acute infection lead to chronic hepatitis-B.

Clinical features of Hep B

Similar to Hep A.
Nausea, vomiting, headache.
Jaundice, enlarge liver.
Serum sickness like immunological syndrome – rash, polyarthritis.
Majority recover completely.
1% can develop fulminant hepatitis.
Some develop chronic hepatitis and hepatocellular carcinoma.
Some develop to asymptomatic carrier.

Chronic carriers
5-10% patient will become carriers (some of them had subclinical infection).
Children are more likely than adults.
Some of them might develop to chronic hepatitis and cirrhosis and risk of hepatocellular carcinoma.

Prevention of Hep B

Avoiding risk factors.
Shared needles, multiple male homosexual partners, prostitutes.

Immunization

Active – several doses
Passive – Hep B immunoglobulin.