Infection diseases: Syphilis,
Gonorrhea, Tuberculosis,
Leprosy.
Clinic, diagnostic, treatment.
Gonorrhea
Gonorrhea is a sexually
transmitted disease (STD).
Gonorrhea is caused by
Neisseria gonorrhoeae, a
bacterium that can grow and
multiply easily in the warm,
moist areas of the
reproductive tract, including
the cervix (opening to the
womb), uterus (womb), and
fallopian tubes (egg canals)
in women, and in the urethra
(urine canal) in women and
men. The bacterium can also
grow in the mouth, throat,
eyes, and anus.
Gonorrhea
Caused by:
Neisseria gonorrhoeae
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It is typically genital
lesions with rare oral
manifestations; painful
erythema or ulcers or
both
How do people get gonorrhea?
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The infection is transmitted from one person to
another through vaginal, oral, or anal sex
Men have a 20% risk of getting the infection from a
single act of vaginal intercourse with an infected
woman. The risk for men who have sex with men is
higher.
Women have a 60–80% risk of getting the infection
from a single act of vaginal intercourse with an
infected man.
A mother may transmit gonorrhea to her newborn
during childbirth; when affecting the infant's eyes, it
is referred to as ophthalmia neonatorum. It cannot
be spread by toilets or bathrooms
Symptoms
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Some men with gonorrhea may have no symptoms at all. However,
some men have signs or symptoms that appear one to fourteen days
after infection. Symptoms and signs include a burning sensation when
urinating, or a white, yellow, or green discharge from the penis.
Sometimes men with gonorrhea get painful or swollen testicles.
In women, the symptoms of gonorrhea are often mild, but most women
who are infected have no symptoms. Even when a woman has
symptoms, they can be so non-specific as to be mistaken for a bladder
or vaginal infection. The initial symptoms and signs in women include a
painful or burning sensation when urinating, increased vaginal
discharge, or vaginal bleeding between periods. Women with gonorrhea
are at risk of developing serious complications from the infection,
regardless of the presence or severity of symptoms.
Symptoms of rectal infection in both men and women may include
discharge, anal itching, soreness, bleeding, or painful bowel
movements. Rectal infection also may cause no symptoms..
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Infections in the throat
may cause a sore
throat, but usually
causes no symptoms
Symptoms in men:
Symptoms in men include:
 Burning and pain while
urinating
 Increased urinary frequency
or urgency
 Discharge from the penis
(white, yellow, or green in
color)
 Red or swollen opening of
penis (urethra)
 Tender or swollen testicles
 Sore throat (gonococcal
pharyngitis)
Symptoms in women:
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can be very mild or nonspecific, and
may be mistaken for another type of
infection. They include:
Vaginal discharge
Burning and pain while urinating
Increased urination
Sore throat
Painful sexual intercourse
Severe pain in lower abdomen (if
the infection spreads to the fallopian
tubes and stomach area)
Fever (if the infection spreads to the
fallopian tubes and stomach area)
If the infection spreads to the
bloodstream, fever, rash, and
arthritis-like symptoms may occur
Signs and tests:
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Gonorrhea can be quickly identified by staining a sample of tissue or discharge and then looking at it
under a microscope. This is called a gram stain. Although this method is fast, it is not the most certain.
Gram stain tests used to diagnose gonorrhea include:
Cervical gram stain in women
Gram stain of urethral discharge in men
Joint fluid gram stain
Cultures (cells that grow in a lab dish) provide absolute proof of infection. Generally, samples for a
culture are taken from the cervix, vagina, urethra, anus, or throat. Cultures can provide a preliminary
diagnosis often within 24 hours and a confirmed diagnosis within 72 hours.
Cultures used to diagnose gonorrhea include:
Endocervical culture in women
Urethral discharge culture in men
Throat swab culture in both men and women
Rectal culture in both men and women
Culture of joint fluid
Blood cultures
DNA tests are especially useful as a screening test. They included the ligase chain reaction (LCR) test.
DNA tests are quicker than cultures. Such tests can be performed on urine samples, which are a lot
easier to collect than samples from the genital area.
Treatment:
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1.
2.
There are two goals in
treating a sexually
transmitted disease,
especially one as easily
spread as gonorrhea.
The first is to cure the
infection in the patient.
The second is to locate
and test all of the other
people the person had
sexual contact with and
treat them to prevent
further spread of the
disease.
Tuberculosis
Caused by:
Mycobacterium
tuberculosis
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Tuberculosis (TB) is an
infectious disease caused
by bacteria whose scientific
name is Mycobacterium
tuberculosis. It was first
isolated in 1882 by a
German physician named
Robert Koch who received
the Nobel Prize for this
discovery. TB most
commonly affects the lungs
but also can involve almost
any organ of the body.
Tuberculosis
Tuberculosis
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Injects about the one third of the world’s
population and kills approximately 3 million
people per year, making it the most important
cause of death in the world.
Oral manifestation of tuberculosis can be
primary and secondary. Oral mucous
memranes may become infected through
implantation of organisms found in sputum or,
less commonly, through hematogenous
deposition.
Clinical features:
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Unless the primary infection
becomes progressive, an
infected patient will probably
exhibit no symptoms.
In reactivated disease, lowgrade signs and symptoms of
fever, night sweats, malaise
and weight loss may appear.
Than, cough, hemoptysis and
chest pain develop.
Oral manifestation - typical
lesion is an indurated, chronic,
nonhealing ulcer that is usually
painful.
The tongue and palate are
favored locations.
Clinical features:
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Bony involvement of
the maxilla and
mandible may produce
tuberculous
osteomyelitis.
Pharyngeal
involvement results in
painful ulcers, and
laryngeal lesions may
cause dysphagia and
voice changes.
Treatment:
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5.
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Such drugs as:
Isoniazid
Rifampin
Pirazinamid
Ethambutol
Streptomycin (for multidrug-resistant cases)
Combination of that drug are often used in
6-, 9-, 12- month to 2 year.
Syphilis
Syphilis:
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Syphilis is a sexually
transmitted disease
(STD) caused by the
bacterium Treponema
pallidum. It has often
been called “the great
imitator” because so
many of the signs and
symptoms are
indistinguishable from
those of other
diseases.
How do people get syphilis?
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Syphilis is passed from person to person through
direct contact with a syphilis sore.
Sores occur mainly on the external genitals, vagina,
anus, or in the rectum. Sores also can occur on the
lips and in the mouth.
Transmission of the organism occurs during vaginal,
anal, or oral sex.
Pregnant women with the disease can pass it to the
babies they are carrying.
Syphilis cannot be spread through contact with toilet
seats, doorknobs, swimming pools, hot tubs,
bathtubs, shared clothing, or eating utensils.
Primary stage:
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The primary stage of syphilis is usually marked by
the appearance of a single sore (called a chancre),
but there may be multiple sores.
The time between infection with syphilis and the
start of the first symptom can range from 10 to 90
days (average 21 days).
The chancre is usually firm, round, small, and
painless. It appears at the spot where syphilis
entered the body. The chancre lasts 3 to 6 weeks,
and it heals without treatment. However, if adequate
treatment is not administered, the infection
progresses to the secondary stage.
Primary syphilis:
Secondary stage:
Skin rash and mucous membrane lesions characterize the secondary stage.
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This stage typically starts with the development of a rash on one or more areas
of the body.
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The rash usually does not cause itching. Rashes associated with secondary
syphilis can appear as the chancre is healing or several weeks after the chancre
has healed.
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The characteristic rash of secondary syphilis may appear as rough, red, or
reddish brown spots both on the palms of the hands and the bottoms of the feet.
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However, rashes with a different appearance may occur on other parts of the
body, sometimes resembling rashes caused by other diseases.
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Sometimes rashes associated with secondary syphilis are so faint that they are
not noticed. In addition to rashes, symptoms of secondary syphilis may include
fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight
loss, muscle aches, and fatigue.
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The signs and symptoms of secondary syphilis will resolve with or without
treatment, but without treatment, the infection will progress to the latent and
possibly late stages of disease.
Secondary syphilis
Secondary syphilis:
Late and Latent Stages:
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The latent (hidden) stage of syphilis begins when primary and
secondary symptoms disappear.
Without treatment, the infected person will continue to have
syphilis even though there are no signs or symptoms; infection
remains in the body. This latent stage can last for years.
The late stages of syphilis can develop in about 15% of people
who have not been treated for syphilis, and can appear 10–20
years after infection was first acquired.
In the late stages of syphilis, the disease may subsequently
damage the internal organs, including the brain, nerves, eyes,
heart, blood vessels, liver, bones, and joints.
Signs and symptoms of the late stage of syphilis include difficulty
coordinating muscle movements, paralysis, numbness, gradual
blindness, and dementia.
This damage may be serious enough to cause death.
Syphilis tetriary stage:
Early infections
treatment:
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The first-choice treatment for uncomplicated syphilis
remains a single dose of intramuscular penicillin
G or a single dose of oral azithromycin.
Doxycycline and tetracycline are alternative
choices; however, they cannot be used in pregnant
women.
Antibiotic resistance has developed to a number of
agents including macrolides, clindamycin,
and rifampin.
Ceftriaxone, a thirdgenerationcephalosporin antibiotic, may be as
effective as penicillin based treatment.
Late infections
treatment:
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For neurosyphilis due to the poor penetration of penicillin G into
the central nervous system it is recommended that those affected
be given large doses of intravenous penicillin for a minimum of
10 days.
If a person is allergic, ceftriaxone may be used or penicillin
desensitization attempted.
Other late presentations may be treated with once weekly
intramuscular penicillin G for three weeks.
If allergic as in the case of early disease doxycycline or
tetracycline may be used but for a longer duration. Treatment at
this point will limit further progression but has only slight effect on
damage which has already occurred
Leprosy:
Leprosy:
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Leprosy is a disease
caused by the bacteria
Mycobacterium leprae,
which causes damage
to the skin and the
peripheral nervous
system.
What is the history of leprosy
(Hansen’s disease)?
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Unfortunately, the history of leprosy and its interaction with man
is one of suffering and misunderstanding.
The newest research suggests that at least as early as 4000 B.C.
individuals had been infected with M. leprae, while the first
known written reference to the disease was found on Egyptian
papyrus in about 1550 B.C.
The disease was well recognized in ancient China, Egypt, and
India, and there are several references to the disease in the
Bible.
Because the disease was poorly understood, very disfiguring,
slow to show symptoms, and had no known treatment, many
cultures thought the disease was a curse or punishment from the
gods.
Consequently, leprosy was left to be “treated” by priests or holy
men, not physicians.
Risk factors:
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At highest risk are those living in endemic areas with
poor conditions such as inadequate bedding,
contaminated water, and insufficient diet, or other
diseases that compromise immune function.
Professional studies show little evidence that HIV is
an important factor in increasing the risk of leprosy
infection
According to The Leprosy Mission Canada, most
people-–about 95% of the population-–are naturally
immune to the disease
Risk factors:
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Several genes have been associated with a
susceptibility to leprosy.
Name
Locus
OMIM
Gene
LPRS1
10p13
609888
LPRS2
6q25
607572
PARK2, PACRG
LPRS3
4q32
246300
TLR2
LPRS4
6p21.3
610988
LTA
LPRS5
4p14
613223
TLR1
LPRS6
13q14.11
613407
Signs and Symptoms of Leprosy:
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Skin lesions are the
primary external sign of
Hansen’s disease, but
these are quite subtle
and appear in a slow
pace that they may not
be noticeable at first.
Certain symptoms are
similar with those with
syphilis, leptospirosis
and tetanus.
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Skin lesions are the primary
external sign.
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Left untreated, leprosy can be
progressive, causing
permanent damage to the skin,
nerves, limbs, and eyes.
Contrary to folklore, leprosy
does not cause body parts to
fall off, but tissues can become
numb and other microbes can
invade them as secondary
infections when the disease
weakens the body's defences.
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Signs and Symptoms of Leprosy:
Aside from skin lesions other early symptoms are:
 Numbness
 Inability to identify temperature
 Lost of sensations of touch
As the disease progresses other sign may occur like:
 Painless ulcers
 Hypopigmented macules or having flat and pale areas of skin
 Eye damage like less blinking and dryness
 Facial disfigurement
There are two main classification of
leprosy lesions:
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The Ridley-Jopling system is composed of six forms or
classifications, listed below according to increasing
severity of symptoms:
1.
Indeterminate leprosy: a few hypopigmented macules; can
heal spontaneously, persists or advances to other forms
2.
Tuberculoid leprosy: a few hypopigmented macules, some are
large and some become anesthetic (lose pain sensation); some
neural involvement in which nerves become enlarged;
spontaneous resolution in a few years, persists or advances to
other forms
3. Borderline tuberculoid leprosy: lesions like tuberculoid leprosy but
smaller and more numerous with less nerve enlargement; this
form may persist, revert to tuberculoid leprosy, or advance to
other forms
4. Mid-borderline leprosy: many reddish plaques that are
asymmetrically distributed, moderately anesthetic, with regional
adenopathy (swollen lymph nodes); the form may persist,
regress to another form, or progress
5. Borderline lepromatous leprosy: many skin lesions with macules
(flat lesions) papules (raised bumps), plaques, and nodules,
sometimes with or without anesthesia; the form may persist,
regress or progress to lepromatous leprosy
6. Lepromatous leprosy: Early lesions are pale macules (flat areas)
that are diffuse and symmetric; later many M. leprae organisms
can be found in them. Alopecia (hair loss) occurs; often patients
have no eyebrows or eyelashes. As the disease progresses,
nerve involvement leads to anesthetic areas and limb weakness;
progression leads to aseptic necrosis (tissue death from lack of
blood to area), lepromas (skin nodules), and disfigurement of
many areas including the face. The lepromatous form does not
regress to the other less severe forms. Histoid leprosy is a
clinical variant of lepromatous leprosy that presents with clusters
of histiocytes (a type of cell involved in the inflammatory
response) and a grenz zone (an area of collagen separating the
lesion from normal tissue) seen in microscopic tissue sections.
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The 2009 WHO classifications are simply
based on the number of skin lesions as
follows:
Paucibacillary leprosy: skin lesions with no
bacilli (M. leprae) seen in a skin smear
Multibacillary leprosy: skin lesions with
bacilli (M. leprae) seen in a skin smear
How is leprosy transmitted?
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M. leprae are spread
person to person by nasal
secretions or droplets.
Infected droplets can
infect others by entering
breaks in the skin.( but M.
leprae apparently cannot
infect intact skin).
Rarely, humans get
leprosy from the few
animal species mentioned
above (Nine-Banded
Armadillo, some primates)
Treatment:
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The majority of cases (mainly clinically diagnosed)
are treated with antibiotics.
Since 1982, the WHO has recommended a 6-12
month course of multidrug therapy (MDT), which it
provides free throughout the world. Patients are
given a cocktail of 3 strong antibiotics (dapsone,
rifampicin and clofazimine) which can completely
cure the tuberculoid form of the disease within six
months and the more infectious lepromatous form
within two years.
Vaccines for leprosy are being tested but aren't yet
in general use.
Treatment:
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Surgery is
individualized for each
patient with the goal to
attempt cosmetic
improvements and, if
possible, to restore limb
function and some
neural functions that
were lost to the
disease.
Thank you for attention!
Good bye.