The reported incidence of sexually transmitted infections STIs in Germany is rising. For example, the number of new reported cases of syphilis rose from in to in This review is based on pertinent articles retrieved by a selective search in MEDLINE, and on guidelines and systematic reviews from Germany and abroad.
We discuss sexually transmitted infections presenting with genital, anal, perianal, or oral ulcers, urethritis, cervicitis, urethral or vaginal discharge, or genital warts.
Acquired sexually transmitted infections elevate the risk of transmission of other sexually transmitted infections; thus, patients presenting for the diagnosis or treatment of any kind of sexually transmitted infection should be evaluated for others as well. Factors impeding effective treatment include antibiotic resistance an increasing problem and the late diagnosis of HIV and HCV infections.
Molecular genetic diagnostic techniques should be made widely available. Sexually transmitted infections are caused by a wide variety of bacteria, viruses, and parasites that are communicated from one human being to another primarily by vaginal, anal, or oral sexual contact.
Different sexually transmitted
Sexually transmitted infections ppt slides STIs can be present or be transmitted simultaneously, and the presence of any such infection increases the risk of contracting other types of STI.
Sexually transmitted infections are often oligo- or asymptomatic. According to the World Health Organization WHOsexually transmitted infections are one of the five types of disease for which adults around the world most commonly seek medical help 1. The current state of the data on the prevalence of sexually transmitted infections in Germany does not permit any reliable conclusions about infection rates, except for those of two diseases: Sexually transmitted infections can cause severe fetal and neonatal damage, genital neoplasia, and infertility.
A number of diagnostic strategies and tests, of variable quality, are available for the individual pathogens.
According to the WHO, sexually transmitted infections are one of the five types of disease for which adults around the world most commonly seek medical help. The diagnostic and therapeutic algorithms can generally be tailored to the leading clinical manifestations if the patient is symptomatic. Thus, sexually transmitted infections can usefully be classified by their presenting features, as follows:. If the availability of diagnostic tests is limited, effective treatment can also be initiated without any testing on the basis of the clinical findings alone, if these are clearly typical of a particular sexually transmitted disease.
Asymptomatic infections are common, however, and only detectable by testing. The likelihood that an infection will be asymptomatic depends both on the site of infection and on the responsible pathogen. For example, the probability of asymptomatic rectal infection with C. The treatment of sexual partners is important as well. Bacterial infections and trichomoniasis can now be cured with systemic treatment 156. Viral infections due to HIV, HSV, and human papillomaviruses cannot be cured, but they can be weakened or modulated with systemic treatment 156.
Hepatitis B infections, scabies, pubic lice, cytomegalovirus infections, lymphogranuloma venereum, ulcus molle, and inguinal granuloma will not be discussed here. Infectious ulcers in the genito-anal region are commonly due to HSV.
HSV infection is the Sexually transmitted infections ppt slides common sexually transmitted infection that causes ulcers. Herpes simplex virus "Sexually transmitted infections ppt slides" in the human host for his or her entire lifetime. Painful vesicles may develop into erosions or ulcers that secrete a hyaline infectious fluid Figure 1. The ulcers generally heal completely in two to three weeks.
HSV infection can manifest itself initially with regional lymphadenopathy and fever; on the other hand, it can also be asymptomatic. HSV infection can be transmitted by sexual contact including oral sex as well as perinatally from mother to child.
Persons with an acute HSV-1 infection should refrain from unprotected oral sex. Moreover, studies have shown that HSV-2 infection triples the risk of HIV infection through unprotected sexual intercourse e6.
The virus can also be revealed by antigen-detection techniques, but these are much less sensitive.
Genital herpes infections are treated systemically with aciclovir, valaciclovir, or famciclovir; the dose depends on whether the episode is an initial infection or a recurrence, and on whether the patient is immunocompromised Table. In patients who have HSV infections that recur four or more times a year, long-term viral suppression therapy with aciclovir, valaciclovir, or famciclovir should be considered The treatment of sexual partners may be indicated 5.
Syphilis is caused by Treponema pallidum.
Sentinel analysis in Germany revealed a fluctuating reported incidence of the disease in the range of 1. There were reported cases inand in 7. Half of all infected persons develop a painless ulcer with an indurated edge ulcus durum after an average interval of three weeks; this heals in 4—6 weeks with or without treatment Figure 2 7.
Painless lymphadenopathy develops regionally. Hematogenous spread stage II; secondary syphilis leads to systemic symptoms arising six weeks to six months later, including fever, myalgia, bone and joint pain, Sexually transmitted infections ppt slides elevation, and, typically, a maculopapular rash roseola syphilitica. Treponemes are present in these skin lesions, which can therefore transmit infection by contact 7. Stage III syphilis causes a wide variety of general medical, neurological, and psychiatric morbidity and may be life-threatening if untreated.
Various appearances and localizations of condylomatous warts: The pathogen is generally revealed serologically by antibody detection in the framework of the diagnostic algorithm. First, a pathogen-specific screening test is performed, e. If this test is positive, Sexually transmitted infections ppt slides is followed by a specific confirmation test employing a different antigen strategy, e.
If this test is positive as well, the activity level of syphilis is assessed in a third stage of evaluation e. With appropriate equipment, an experienced examiner can see Treponema pallidum directly on dark-field microscopy of vesicular fluid or genital secretions in primary syphilis caution: In Germany, all positive laboratory tests for syphilis must be reported anonymously to the "Sexually transmitted infections ppt slides" Koch Institute the governmental infection control agency.
The disease is transmitted exclusively by direct contact with the genito-anal or oral mucosa less commonly, the skin of infected persons, i. Intrauterine transmission is also possible. Syphilis cannot be transmitted by objects such as towels, toilet seats, etc. The spread of syphilis can be halted by timely diagnosis and rigorous treatment, with regular clinical and serologic monitoring of its effect; patients should be thoroughly informed of the diagnosis and its implications, and all of their sexual partners from the three months prior to the onset of the disease should be tested.
Penicillin is the drug of first choice for syphilis. Early syphilis is treated with a single injection of benzathine penicillin, 2. Patients who are allergic to penicillin can be alternatively given doxycycline mg p. The treatment of congenital syphilis will not be discussed here e8. Treatment failure rates are high—6. Thus, all patients need rigorous clinical and serologic follow-up every 3 months for a year 2 years in HIV-positive or immunocompromised patients 7.
All patients with syphilis should be tested for other sexually transmitted diseases, including gonorrhea and HIV
Sexually transmitted infections ppt slides. Half of all infected persons develop a painless ulcer with an indurated edge ulcus durum after an average interval of three weeks; this heals in 4—6 weeks with or without treatment.
Urethritis can be of either infectious or non-infectious origin.
It is often asymptomatic. If symptomatic, it generally presents with a mucopurulent or purulent discharge, dysuria, or itching.
The main pathogens are Neisseria gonorrhoeaeChlamydia trachomatisand Mycoplasma genitalium 6e4 ; rarer ones include Trichomonas vaginalis, Gardnerella vaginalis, Ureaplasma urealyticumherpes simplex virus HSVand adenoviruses 6e Mere visual inspection of the discharge is inadequate for a reliable etiologic diagnosis.
Patients are treated empirically with antibiotics covering N. Orally administered cefixime has been repeatedly reported to have a high rate of treatment failure and is therefore not recommended for first-line empiric treatment 69.
If antibiotic treatment brings no improvement, additional evaluation for T. Doxycycline treatment is generally ineffective against urethritis due to M. Treatment with a single dose of azithromycin 1 g p. If this is ineffective, moxifloxacin mg p. Insufficient data are available the efficacy of other fluoroquinolones, such as ciprofloxacin or levofloxacin.
The clinical significance of other Mycoplasma species and of Ureaplasma species is currently debated Patients with diagnosed urethritis should be tested for other sexually transmitted infections, including HIV and syphilis 6. The patient should remain sexually abstinent until at least 7 days after the end of treatment.