Sexually Transmitted Disease

Gonorrhea
TULO, Nak-Nak, Taktak , The CLAP Caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract. The bacterium can also grow in the mouth, throat, eyes, and anus. Spread through contact with the penis, vagina, mouth, or anus People who have had gonorrhea and received treatment may get infected again if they have sexual contact with a person infected with gonorrhea In Male: Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis; symptoms can take as long as 30 days to appear. In Women: The symptoms of gonorrhea are often mild, but most women who are infected have no symptoms

Syphilis
Cause: Treponema pallidum Enters the body through minute abrasions in the skin or mucosal surfaces and replicates locally. Initial lesions occur in the vulva, vagina, cervix, anus, nipples, and lips. Primary stage: painless, red, round, firm ulcer approximately 1cm in size with raised edges: CHANCRE Develops approximately 3 weeks after inoculation. Secondary stage: T. pallidum starts to disseminates. Between 1 and 3 months after the primary resolves Appears as maculopapular rash and/or papules on the skin and mucous membrane. Classically, the rash appears on the palms of the hands and soles of the feet The Great Imitator meningitis, nephritis, or hepatitis. All lesions resolve spontaneously Tertiary syphilis: Uncommon, but is characterized by granulommas (Gummas) on the skin and bone. Cardiovascular syphilis with aortitis; neurosyphylis with meningovascular disease. Diagnosis: Commonly screen via a non-specific anti-body test. Rapid plasmin reagin (RPR) or Venereal Disease Research Laboratory (VDRL) test. Treatment: Drug of choice: Penicillin 2.4 million units IM Alternate Drugs: Tetracycline 500mg orally QID, Doxycycline 100mg BID

Chlamydia
Chlamydia trachomatis Can damage a woman's reproductive organs Symptoms are usually mild or absent Complications that cause irreversible damage, including infertility Chlamydia also can cause discharge from the penis of an infected man Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States Chlamydia can be transmitted during vaginal, anal, or oral sex. Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection Chlamydia is known as a "silent disease Treatment: A single dose of azithromycin or a week of doxycycline (twice daily)

Lymphogranuloma venereum
Caused by: Chlamidia trachomatis L serotypes Primary stage: Local lesion, papule or shallow ulcer, and is often painless, transient, and can go unnoticed Secondary stage: Inguinal syndrome, painful inflammation and enlargement of inguinal nodes Fever, headaches, body malaise, and anorhexia Tertiary stage: Anogenital syndrome, proctocolitis, rectal stricture, rectovaginal fistula, and elephantiasis Treatment: Doxycycline 100mg orally BID for 21 days.

Chancroid
Caused by Haemophilus ducreyi A commonly transmitted disease around the world Males vs Females; 3:1 ratio to 25:1 Appears as painful demarcated, non-indurated ulcer located anywhere in the anogenital region. There is usually painful inguinal lymphadenopathy Usually presents as single ulcer. Diagnosis: Difficult to diagnose because H. ducreyi is difficult to culture. Chocolate agar can aid in the culture. Treatment: Ceftriazone 250 mg intramuscular ONCE Azithromycin 1g orally ONCE Erythromycin 500mg QID for 7 days

HIV
Human Immunodeficiency Virus, a virus that attacks the body's immune system, leading to fullblown AIDS (Acquired Immunodeficiency Syndrome) Through oral, anal, or vaginal sex, and from an HIV-positive mother to her baby Some people develop symptoms shortly after being infected, but for many it takes more than ten years for symptoms to appear. Symptoms: Most symptoms of AIDS are not caused directly by HIV, but by an infection or other condition brought on by a weakened immune system. These include severe weight loss, fever, headache, night sweats, fatigue, severe diarrhea, shortness of breath, and difficulty swallowing. Testing: A blood test can tell you if you have HIV. Anyone who is sexually active and unsure of the sexual history or HIV status of their partner(s) should be tested every year. Treatment: So far, there is no cure for AIDS, but some drug regimens that combine medications such as AZT (Retrovir) with Ritonavir or Norvir are proving effective at strengthening immunity and keeping infections at bay, thereby prolonging the lives of many AIDS sufferers. Combination drug therapy has benefited many people for years, but it is still unclear how long the drugs will remain effective, especially since effectiveness varies significantly from person to person.

Herpes
Genital herpes simplex virus (HSV) Presents as classic painful genital ulcers Mild entirely asymptomatic Initially begins with flu-like symptoms: body malaise, myalgias, nausea, diarrhea, and fever Vulvar burning and pruritus precede. Ulcers require a 10-22 days healing time Possibility of frequent recurrence Diagnosis: Made clinically via examination and history Tzank smear Treatment: Primary infection: Acyclovir 200mg TID or q 4 Severe HSV: Intravenous should be done

HPV / Genital Warts Human Papilloma Virus (HPV) - a group of more than 70 viruses, some of which can lead to cervical cancer. Several strains of HPV cause external genital warts Through oral, anal, and vaginal sex and through skin-to-skin contact. It's not clear exactly how effective condoms are at protecting against HPV and genital warts, but they will protect you against other STDs, including HIV. Anywhere from one month to several years Many types of HPV have no symptoms, though some cause visible genital warts that may be found in the vagina or urethra or on the cervix, vulva, penis, or anus. They usually grow in more than one area and are often painless, although they may itch Treatment: There is no cure for HPV, so treatment aims at controlling outbreaks of warts -- if you have a strain that causes visible warts.

Sensory and motor functions of the cerebral cortex Sensory speech area ( Wernickes area )- in the parietal lobe Motor speech area ( Brocas area )- in the inferior portion of the frontal lobe

Sensory Function Sensory input in brains stem and diencephalou used to help maintain homeostasis. Input in cerebrum and cerebellum keep us informed of our environment and allow CNS to control motor function.

Ascending tract- pathway that transmit action potential from periphery to CNS. A. Lateral Spinothalamic- transmit action potential deal with pain, temperature, tickle and itch sensation. B. Dorsal Column- transmit action potential deal with body position touch and deep preasure. C. Spinocerebellar- transmit action potential to cerebellum or brain stem deal with body position to cerebellum.

Sensory Area of Cerebral Cortex -Ascending tract project to specific region of cerebral cortex (Primary Sensory Area) where sensation perceived. Primary Somatic Sensory Cortex- found in pariental lobe posterior to central sulcus which carry input such pain, pressure and temperature. -Synapse with thalamus and relay information to primary Somatic Sensory Area. Other Area Include: Occipital Lobe- visual cortex Temporal Lobe- auditory cortex Pariental Lobe- taste area

B. Primary Associated Area- adjacent to primary sensory area, involved in process of recognition, where present visual information is compared with past visual experience.

Motor Function: -responsible for maintaining body posture and balance, as well as movement of trunk, head, limb, tongue and eye. -communicate through facial expression and speech. Motor Area of Cerebral Cortex a.) Primary Motor Area- located posterior of frontal lobe anterior to central sulcus. Action potential initiated in these region is controlled by voluntary movement of skeletal muscle. b.) Pre motor Area- Area where motor function are organized before they initiate in primary motor cortex. Example: person decide to step, premotor area will determine which muscle to stimulate and to be contract while primary motor cortex will initiate planned movement. c.) Pre frontal Area- where motivation and foresight to plan and initiate movement occur in anterior of frontal lobe. -involve in regulation of emotional behavior and mood.

Descending Tract A. Direct- extend from cerebral cortex to spinal cord. 1. Lateral Corticospinal- muscle tone and skill movement especially hand (speed ans precision). 2. Anterior Corticospinal- mucle tone an movement of trunk muscle. Lateral Corticospinal- begin in cerebral cortex- descend to brainstem- end to medulla axon cross over the opposite side- go to spinal cord thus left side of brain control skeletal muscle on the right. B. Indirect- not directly connected between cortical and spinal cord. 1. Rubrospinal-movement coordination. 2. Reticulospinal- posture adjustment. 3. Vestibulospinal-posture and balance. 4. Teetospinal- movement in response to visual reflex. Basal Nuclei- group of functional related nuclei.

Cerebrum Nuclei - corpus striatum and midbrain dark pigment-substancia nigra important in planning, organization and coordinated movement and posture. a.) Stimulatory Circuit- facilitates muscle activity especially at beginning of voluntary movement like rising from sitting. b.) Inhibitory Circuit- decrease muscle tone at rest, disease uncontrolled movement at rest in parkinsons disease. Cerebellum- major function is that of comparator. Action Potential from cerebral cortex descend to Spinal Cord- collateral branch send also to Cerebellumto give information intended movement- spinal cord send action potential to skeletal muscle causing to contract-Proprioceptive Signal from skeletal muscle and joint-cerebellum coming information concern status and structure of muscle-cerebellum compare information from cerebral cortex and proprieoceptor, if different defect spinal correct the discrepancy. Right and Left Hemisphere- both connected by commisure where corpus callosum is the largest. Right Hemisphere- receives sensory input and control muscle activity in left side of body. -involve in three dimension or spatial perception and musical activity. Left Hemisphere- thought to be an analytical side such mathematic and speech. Speech- found on left cerebral cortex. 2 Area: a.) Werricke Area- Sensory Speech Area b.) Brocas Aaarea- motor Speech Area Aphasia- absent of language comprehension.

Memory
a.) Sensory Memory- brief retention received by brain while evaluate, scanned and action b.) Short Term Memory- information retain for second to minutes, memory is limited like number bits of information. c.) Long Term Memory- involve physical change in neuron shape, a series of neuron called memory trace involve in long term retention off information. -rehearsal information assist to long term memory.

Meninges- surround and protect the brain and spinal cord. 1.) Dura Mater- most superficial and thickest. a.) Dural Venous Sinus-fold in dura mater that contain space which collect blood in brain and exit in the skull. b.) Epidural Space- space between dura and spinal cord. 2.) Aranchnoid- second meningeal layer. Subdural Space- space between dura mater and aranchoid. 3.) Pia Mater- tightly bound to the surface of the brain and spinal cord. Subaranchnoid space- filled with CSF and blood vessel.

Limbic system
Includes olfactory, deep group cortical region, nuclei of the cerebrum and diencephalon Response to olfactory stimulation by initiating responses necessary for survival such as hunger and thirst Influences memory, visceral responses to emotion, motivation and mood Lesions can result to voracious appetite, increased sexual activity and docility

Limbic System- where, olfactory cortex, deep cortical and nuclei of ceebrum and diencephalou are group together. -response to olfactory stimulation by initiating response to survival (hunger and thirst). -influence memory, emotion, motivation and mood.

Ventricle- fluid filled cavity of CSF. a.) Lateral Vetricle- large cavity on both hemisphere. b.) Third Ventricle- small cavity in diencephalon with opening to connect with lateral ventricle. c.) Cerebral aqueduct- connect third and fourth ventricle. d.) Fourth Ventricle- located on the base of cerebellum, that continues to central canal and subaranchoid space.

Each cerebral hemisphere contains large cavities called lateral ventricle Third ventricle- small midline cavity located on the center of the diencephalon between the two halves of the thalamus and connected by foramina to the lateral ventricle Fourth ventricle- located at the base of the cerebellumand connected to the third ventricle by cerebral aqueduct, that continous to the central canal

Cerebrospinal fluid Produced by the choroid flexuses speciaized ependymal cells located on the ventricles CSF form the lateral ventricles flows through opening to the third ventricle CSF flows from the third ventricle through the cerebral aqueduct to the fourth ventricle CSF exits to the fourth ventricle through opening in the walls and roof and enters the subarachnoid space. Some CSF enters the central canal of the spinal chord CSF flows through the subarachnoid space to the arachnoid granulation in the superior sagittal sinus where it enters the circulation

Cranial nerves Sensory- special senses and more general senses e.g. touch and pain Motor Somatic- innervates skeletal muscle of the head and neck Parasympathetic- innervates glands, smooth muscle and cardiac muscle

Autonomic nervous system Axon from the autonomic motor neuron do not extends all the way from the CNS to the target tissues Two neurons in series extends from the CNS to the target tissues- preganglionic and postganglionic neuron It innervates smooth muscle, cardiac muscle and glands Controlled unconciously Sympathetic and parasympathetic division

Sympathetic division Prepares person for physical activity i.e. increasing heart rate ad blood pressure Stimulates the release of glucose in the liver Inhibits digestive activities Fight or flight system

Parasympathetic division stimulates vegetative stimulation e.g. digestion, defecation and urination Slows heart rate and respiration