Genital infections

Genital Infections Genital infections by source Sexually transmitted diseases (STD’s) (STI’s) • “venereal disease” • Gonorrhoea, herpes, chlamydia, syphilis Non sexually transmitted • Endogenous - thrush • Exogenous - post surgery (wound) Grey areas Genital Infection by site Females Vulva, urethra, vagina, cervix, fallopian tubes pelvic cavity Males Foreskin, penis head, urethra Non traditional “genital sites” e.g., throat and rectum Symptoms of genital infections Highly variable • Organism / disease • Site of infection • Sex and age of the host Asymptomatic infection • Relatively common, especially in females. • Problematic for treatment and transmission. Host defenses Males • “better” design, less vulnerable. • Flushing of urine and prostatic fluid. Females • Relatively accessible (Ruby) / hospitable. • Normal flora • Cervical secretions, phagocytic cells. Chlamydia trachomatis • Sexually transmitted • Most common STD (? HPV), prevalence of about 5%. (2000 – 17 000, 80 in < 10 y/o) Male - urethritis (NGU) - mild non purulent discharge Female - cervicitis, pelvic pain. - some discharge - up to 50% asymptomatic Chlamydia trachomatis 2 Complications • Salpingitis, pelvic inflammatory disease. • Infertility • Transmission to neonate (eye, respiratory) Diagnosis • Choice of test and specimen (NOT pus) • Screening Treatment • Azithromycin or doxycycline Chlamydia Testing 2002 - Age and Gender 500 450 400 402 481 Male Female Undisclosed Number of Tests Performed 350 300 250 200 150 124 Tas data. 2000-2002, 49.5% of all pos were from asympt screens 180 238 100 70 55 58 48 27 4 10 3 0 0 0 1 33 24 11 13 0 6 7 0 9 6 73 50 25 6 44 0 <1 5 0 0 1 to 20 6 21to 25 26 to 30 31to 35 36 to 40 41to 45 46 to 50 51to 55 56 to 60 61 + Age Neisseria gonorrhoeae • Sexually transmitted (males > females) • Less common than chlamydia (y2000 - 6000 cases) Males • Copious urethral discharge Females • Cervicitis + discharge, up to 50% asympt Complications • Ascending infection • Transmission to neonate (eye) Neisseria gonorrhoeae Diagnosis • Less technical problems compared to Chlamydia, but viability is an issue. • Rapid diagnosis in males. Treatment • Penicillin no longer appropriate. • IM ceftriaxone or ciprofloxacin • PLUS a drug for chlamydia Syphilis • Organism is Treponema pallidum • Transmission - sexual, vertical or transfusion. • Incidence - global decline following penicillin. - about 2000 cases annually in Aus - 1/100 000 Vic, 400 / 100 000 NTind • Symptoms - primary - chancre - secondary - 2 - 6 months, rash. - tertiary -15 - 20 yrs, systemic • Congenital syphilis - post 4th month, screening • Diagnosis - blood test. Herpes ( Love is temporary, herpes is forever) A tale of 2 viruses: HSV-1 and HSV-2 Oral herpes (cold sores) • Childhood infection with HSV-1/ saliva • 80% seropositivity, most asymptomatic Genital herpes • Usually HSV-2, about 30% are HSV-1 • 15% serpositivity, most asymptomatic • Primary (1o) attacks versus recurrent (2o) • Issues of transmission (1o, 2o, hidden, secretions) Treatment with acyclovir is NOT curative Vaginal thrush Candida (nice name for a girl) albicans An endogenous infection • 5 - 30% in vagina in absence of symptoms. • Bowel reservoir. • Role for sexual transmission / males and balanitis Pathogenesis • Risk factors: antibiotics, pregnancy, diabetes, immune disorders • Recurrences can be problematic Treatment: topical azoles or nystatin, 6/12 oral for recurrent Human Papilloma virus (HPV) Is cervical cancer a sexually transmitted disease? • Many serotypes of HPV, some of which infect the genitals, many without obvious lesions. • HPV highly prevalent in sexually active groups. • 1992, WHO accepts that infection with some types of HPV probably causes cancer of cervix. • 1996, accepts HPV as a major cause of cervical intra-epithelial neoplasia (CIN) and cancer of cervix. • ? A factor, NOT a cause, only 5% with HPV 16/18 get cancer. • A role for HPV testing in prediction of cancer of cervix ? Bacterial vaginosis (Gardnerella) • NOT vaginitis. • Not a distinct “infection”, but overgrowth of a range of normal vaginal organisms. • Unknown risk factors • Malodorous and copious discharge. • ? No role for male partners. • Easily treated (flagyl) but may recur.