SEXUALLY TRANSMITTED DISEASES CAUSATIVE ORGANISMS

Bacterial
Neisseria gonorrhoeae

Viral
Herpes simplex (type 2 mainly) Genital herpes Papilloma virus Genital warts Hepatitis B and may be C Hepatitis

Fungal
Candida albicans
Vaginal thrush, balanitis

Protozoa

Gonorrhea Haemophilus ducreyi Chancroid (soft chancre) Treponema pallidum Syphilis Chlamydiae: -Chlamydia trachomatis (D - K) Non-specific urethritis - Chlamydia trachomatis (L1,2,3) Lymphogranuloma venereum (LGV) Mycoplasma:
Non-specific urethritis

Trichomonas vaginalis
Trichomonas genital infections

HIV AIDS
CMV CMV infection Pox Virus Molluscum contagiosum

- Ureaplasma urealyticum

NEISSERIA GONORRHOEAE

 Morphology:

Identical to N. meningitidis.

Culture
Delicate organism, exacting nutritional and environmental requirements: - Aerobe , CO2.
- Optimum temperature: 37 C. - Enriched media: chocolate agar.

- Selective media: Thayer-Martin (chocolate + VCN =vancomycin, colistin and nystatin ) are {in isolating gonococci from heavily contaminated sites e.g.: Vagina, rectum, & pharynx}. - Colonies: small, smooth, glistening and semitransparent.

Biochemical Reactions:
1 - Oxidase positive.

2-

MAIN CHARACTER produce acid from glucose () maltose.

Antigenic Structure and virulence factors:

- Antigenically heterogeneous (>100 serotypes).

- Surface structures subjected to variation in vitro & in vivo to avoid host defences: Virulence factors : Pili: mediate resistance to phagocytosis and adherence to epithelial cells . Outermembrane proteins: - attachment of the organism to cells - the basis for serotyping the gonococci . Lipoligosaccharide ( LOS) = endotoxin IgA protease: split IgA present in mucosal surface

Pathogenesis and Clinical Findings:

Strict human parasite.

Acute or chronic infection.

No healthy carriers exist. Attacks mucous membranes (genitourinary tract, eye, rectum,throat), acute suppuration tissue invasion, followed by chronic inflammation and fibrosis (GONORRHOEA) M.O.T: sexual intercourse

GONORRHEA is a pyogenic infectious disease affecting the male and female genital system:
MALES

- Urethritis (yellow creamy pus +painful urination)

- Epididymitis and prostatitis (scanty discharge = morning drop)
- Untreated: suppuration fibrosis urethral strictures.

FEMALES

urethra and vagina mucopurulent discharge.

- Primary infection: endocervix ,extends to the

- May then progress to the fallopian tubes (PID). - Salpingitis Infertility (20%). - Chronic gonococcal cervicitis or proctitis (asymptomatic).

 Gonococcal bacteraemia (=disseminated infection): rare. skin lesions and suppurative arthritis.
Gonococcal endocarditis :uncommon severe infection. Gonococcal ophthalmia neonatorum: - Infection of the eye of the newborn - Acquired during passage through an infected birth canal. - Initial conjunctivitis, if untreated, results in blindness.

 Immunity:

-Repeated gonococcal infections are common.

-Protective immunity to reinfection does not develop, because of the antigenic variation of gonococci.

Laboratory Diagnosis
A. During the acute stage

Specimens

Urethral discharge

Urethral ischarge/ cervical secretion

a) Smears: (2)
- One stained by methylene blue
- The other by Gram stain: Gram-negative diplococci intracellularly in polymorphonuclear leukocytes with few extracellular organisms.

This is sufficient to diagnose GONORRHOEA

b) Culture:
- Chocolate blood agar (in CO2 at 37C for 48 hours).

- Colonies are identified by:

1) Oxidase test (positive).

2) Gram stained film (Gram negative diplococci).

3) Production of acid from glucose. 4) Coagglutination test using monoclonal antibodies

Culture is done during the acute stage for several reasons:

1. Confirmation. 2. Isolation of the organism (sensitivity to different antibiotics). 3. Medico-legal purposes.

c) Antigen detection and nucleic acid probe:

- Direct non culture tests.
- For screening specimens where culture facilities are not available.

ELISA Ag

Gene probe

B. During the chronic stage

Gram stained SMEAR: of no value because 1) The diplococci may be very few in number or totally absent 2) presence of secondary bacterial invadors.
CULTURE is necessary Thayer and Martin medium
Morning urethral drop or prostatic secretion Cervical swab

CO2 37C 48 hours

Colonies are identified as mentioned before

 Treatment:

-Penicillins are no longer recommended for the

primary treatment of uncomplicated infection bec. : Both chromosomally and plasmid-mediated resistance to penicillins is now widespread among strains of N. gonorrhoeae

- Broad-spectrum third generation cephalosporins (ceftriaxone) and fluoroquinolones (ciprofloxacin) may be used as primary therapy against uncomplicated gonococcal infections.