Professional Documents
Culture Documents
Infections
An Overview
Raja Iskandar Shah
Infectious Disease Unit
Department of Medicine
UMMC
Guidelines
Malaysian Guidelines in the treatment of
Sexually Transmitted Infections
Ministry of Health 3rd edition 2008
www.moh.gov.my/images/galleryGarispanduan/malaysi
an_guidelines_in_treatment_of_STI_pdf
Common STIs
Chlamydia
Gonorrhoea
Genital Herpes (Herpes Simplex Virus)
Human Papilloma Virus (HPV)
Trichomoniasis
Syphilis
Hepatitis B
HIV
2007-2008
1999-2008
Chlamydia
123,018
1%
116%
Genital warts
92,525
3%
29%
Genital herpes
28,957
10%
65%
Gonorrhoea
16,629
- 11%
1%
Syphilis
2,524
- 4%
1,032%
Unintended pregnancies
Sexually transmitted infections
Congenital/Neonatal infection
Adverse pregnancy outcomes miscarriages, low birth weight,
preterm labour
Pelvic Inflammatory Disease
Ectopic pregnancies
Infertility
Chronic Pelvic Pain
Neurological/Cardiovascular problems
Chronic liver disease
Anogenital cancers
Increased HIV transmission
Young people
Female Sex Workers (FSW)
Clients of Female Sex Workers
Transgenders
Men who have sex with men (MSM)
Those involved in jobs which separate them from their
regular sexual partner for long periods e.g lorry drivers,
soldiers
Refugees
HIV positive patients
Patient 1
26 year-old woman in a steady
relationship with her boyfriend of 1 year.
She presents complaining of a vaginal
discharge for the past week.
She describes increased discharge,
change in color, and a foul odor.
Vaginal Discharge
Common causes:
Neisseria gonorrhoeae
Chlamydia trachomatis
Trichomonas vaginalis
Bacterial vaginosis
Candida albicans
Patient complains
of vaginal discharge or
vulval itching/ burning
Vaginal Discharge
No
Yes
Lower abdominal tenderness
or cervical motion tenderness
Yes
Educate
Counsel
Promote and provide condoms
Offer VCT
Use flow chart for lower abdominal pain
No
Was risk assessment positive?
Is discharge from the cervix?
Yes
No
Treat for bacterial vaginosis
and trichomoniasis
Yes
Treat for
candida albicans
Sexual History
Must be non-judgemental
Establish rapport and trust with patient
Reassure regarding confidentiality
Explain why a sexual history is needed ask
patient if he/she minds about being asked very
personal questions
Acknowledge that many people find it difficult to
discuss their sexual lives openly
Ideally interview patient alone
General rules
Confidentiality
Chaperone.
Contact tracing
Health education and counselling
Abstain from sex until completed treatment
and partner notification
Follow up of infections
Disadvantages
Over-treatment
Asymptomatic infections
are missed
Gonococcal Urethritis:
Purulent Discharge
Neisseria gonorrhoea
Gram negative
intracellular
diplococcus
Infects mucous
membranes
Pharyngeal infection
90%
Incubation 3-5 days
Gonorrhoea (women)
Asymptomatic (50%)
16-19 yr women most
common
Vaginal discharge
Lower abdo pain
Dysuria
IMB/PCB
Pharyngitis
Opthalmia neonatorum
Females
Chlamydial Cervicitis
Source: CDC
Chlamydia
(women)
Asymptomatic (80%)
Abnormal bleedingPCB/IMB
Lower abdominal pain
Vaginal discharge
Dysuria
Chlamydia trachomatis
Most common STI in the under 25s
Most prevalent - Women 16-19yr, Men 2024yr
Women 80% asymptomatic
Men 50% asymptomatic
Incubation 7 to 21 days
COMPLICATIONS- PID, Reiters syn,
conjunctivitis, chronic pelvic pain, infertility,
ectopic pregnancy
Trichomonas vaginalis
Flagellated protozoan
10-50% asymptomatic
Vaginal discharge (70%)
offensive, frothy, yellow.
Vulvovaginitis
Itching, dysuria
Strawberry cervix 2 %
Urethritis
Strawberry cervix/TV
Clinial Manifestations
Source: CDC
Secondary syphilis
Secondary Syphilis:
Palmar/Plantar Rash
Pathogenesis
Treponema pallidum on
darkfield microscopy
Congenital syphilis
Congenital syphilis
Congenital syphilis
Congenital syphilis
Syphilis
Primary syphilis 9-90 days incubation
Caused by treponema pallidum
Solitary well-circumscribed ano-genital
ulceration (chancre) with regional
lymphadenopathy
Typically painless, may be multiple and
extragenital (oral)
Secondary syphilis 6 weeks to 6 months
Multisystem involvement
Generalized rash (palms and soles), fever,
lymphadenopathy, condylomata lata (moist wart
like lesions)
Arthralgia, alopecia, hepatitis, glomerulonephritis
Syphilis in pregnancy
33 year old Malay,18/40 pregnant,
Asymptomatic
RPR 1: 128
TPPA : Reactive
HSV
Source: CDC
Source: CDC
Herpes Simplex
Symptoms
Asymptomatic
Constitutional symptoms/prodrome
(tingling)
Painful Vesicles/ulcers (multiple)
Dysuria
vaginal discharge
Clinical syndromes
HSV in pregnancy-Case
A 32 year old woman 36 weeks pregnant
in her 2nd pregnancy presents at your
clinic.
She feels unwell, has inguinal
lymphadenopathy and has painful genital
ulcers which look typical of genital herpes
How would you manage this case?
LGV
Chancroid*
Granuloma
inguinale
Genital Warts
Keratinized Warts
Genital Warts
HPV Vaccination
Name 2 types of HPV vaccines available in the
market
What do HPV vaccines protect the individual
against?
Is there a national HPV programme?
If you were a parent, would you vaccinate your
child against HPV?
Give another example of a vaccine which is
used to prevent an STI
Cervical (43.5%)
Vaginal (2.4%)
Vulval (9.1%)
Anorectal (12.1%)
Oropharyngeal (29.5%)
Penile
ASK
Questions
Thank You