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SEXUALLY TRANSMITTED INFECTIONS

• Normal vaginal discharge in a non pregnant is small


in quantity and white to colourless
• During pregnancy there is increased vaginal
discharge which is known as Leucorrhea
• RX is counseling and advice on personal hygiene
Pathological vaginal discharges
• In all cases there is abnormal increase of vaginal
discharge
• Trichomoniasis causes a classic frothy yellow- green
discharge, with a fishy smell, itching of the vulva
• Gonorrhea produces a thin mucoid slightly yellow
pus discharge with no smell
• Chlamydia may cause a non itchy, thin
colourless discharge
• Candidiasis-intense vulval pruritus,soreness
with often a thick white curdy discharge
Differential diagnosis
Ca of the cx especially in older women who are
multiparous- causes a blood stained smelly
discharge
Bacterial infections include:
Chlamydia, Gonorrhea and syphilis
Trichomoniasis
• Is almost exclusively sexually transmissible
• It is caused by infection with the parasite trichomonas
vaginalis, around or oval flagellated protozoan
• It has been linked with a small risk of preterm
delivery and low birth weight and an increase in the
risk of HIV via sexual intercourse
• It may be acquired perinatally and occurs in about 5%
of babies born to infected mothers
Clinical signs and symptoms
• Burning sensation of the vulva sometimes with
itching, dysuria
• A greenish vaginal discharge containing small
bubbles or having a foamy appearance
• An inflammatory reaction on the vaginal walls and
cervix presenting with red patches or dots
• A vague lower abdominal pain may be present
RX;
-Metronidazole 5-7 days
-Clotrimazole pessaries daily for 7 days
-Treat partners and advise against coitus until Rx is
completed
Chlamydia
• the most prevalent bacterial STI ,most common
cause of PID, is as a result of the Chlamydia
trachomatis bacterium, which can infect the urethra
and cervix.
• The disease is easily treated, but like other STIs,
chlamydia tends to be silent and therefore go
undiagnosed until it becomes more serious than in its
early stages.
• 3in 4 women and one in two men have no symptoms.
• In 40 % of cases, by the time a female seeks medical
attention, the disease has progressed to a PID, a major
cause of female infertility and pelvic pain
Symptoms
Always asymptomatic in≈ 80% of cases. Some women
may have:
• Purulent vaginal discharge
• Post coital or intermenstrual bleeding
• Lower abdominal pain
• Mucopurulent cervitis and/ or contact bleeding
• Mild dysuria
• Progression to PID
• Rx- Macrolides e.g. Erythromycin
• Tetracyclines & floroquinolones are currently
contraindicated in pregnancy
• TEO for opthalmia neonatorum
Gonorrhea
• Chlamydia infection is sometimes confused with
gonorrhea, another bacterial infection. Not only do
they share many of the same symptoms, the two
diseases can occur together.
• Gonorrhea usually begins in the urethra or the cervix.
However, the rapidly proliferating Neisseria
gonorrhoea bacterium can migrate to the uterus and
the fallopian tubes, giving rise to PID.
• The infection, like chlamydia, may also involve the
rectum
symptoms
• yellow or bloody vaginal discharge
• Lower abdominal pain
• Dysuria
• Intermenstrual bleeding & menorrhagia
• Fever
• Progression to PID
Incidence in pregnancy is low 1 to 5%
Maternal gonococcal infection is associated with:
spontaneous abortion, very low birth weight,
PROM, chorioamnitis, preterm delivery,
postpartum endometritis and pelvic sepsis
Diagnosis and RX:

• A dx is made by endocervical and rectal swabs


for culture and sensitivity
• RX: Azithromycin, ceftriaxone
• TEO for opthalmia neonatorum prophylaxis
Syphilis
• caused by Treponema pallidum bacteria
• It can also be congenitally transmitted
• It is a complex systemic disease that can involve
almost any organ in the body
• Syphilis in pregnancy and congenital syphilis remain
a major cause of fetal and neonatal loss in developing
countries
• Every pregnant woman should be screened for
syphilis
stages
• Stage 1: Primary Syphilis
• Initial symptoms typically occur 2 to 6 weeks after
exposure and last 4 to 6 weeks.
• Painless chancre on the vulva, vagina, cervix or
around the mouth
• Inflamed lymph nodes
Stage 2: Secondary Syphilis
• Symptoms typically occur one to six weeks after the
chancre heals and last three to six months
• Light rash with brown sores roughly the size of a
penny, typically on the palms of the hands and soles
of the feet; may also cover the rest of the body
• Sores in or around the genitals or anus
• Mild fever
• Fatigue
• Headaches
• Sore throat
• Patchy hair loss
• Appetite loss
• Weight loss
Stage 3: Tertiary Stage
• Symptoms typically occur anywhere from 3 years to
more than 20years after the onset of infection
.
• Syphilis in multiple systems, including the heart and
blood vessels, skin, bones and brain.
• untreated syphilis may result in spontaneous
abortion, preterm birth, still birth, neonatal deaths and
significant infant morbidity
• Congenital syphilis in majority of live born infected
infants do not have any signs & symptoms at birth
will present over weeks, months or years
• Investigations- RPR,TPHA
• Rx: erythromycin
Viral infections
• Genital Warts
• Caused by HPV 6 &11
• Genital warts may cause physical discomfort, are
disfiguring and are psychologically distressing
• Most cases can be managed with topical treatment of
the warts, i.e. podophylum paint though the lesions
tend to return & is contraindicated in pregnancy
• It is advised that no RX is given during pregnancy.
Other alternatives are:
-cryosurgery (freezing),
-electrocautery (burning).
A C/S can be done if warts are extensive
Genital Herpes
• HSV-2 is the most common cause of genital
herpes and is sexually transmitted
• HSV infection may be asymptomatic, but
painful, vesicular or ulcerative lesions of the
skin and mucous membranes occur frequently
• Dysuria, vaginal or urethral discharge, fever,
myalgia
• Dx- viral cultures from open leisions can be
done
• Rx-Acyclovir 200mg every 5hrs for 5days
Prevention of STIs
• Give health education about STIs
• Provide specific education on the need for
early reporting and compliance with
treatment.
• Ensure notification and treatment of sexual
partners.
• Counsel patient on risk reduction, eg. Practice
of safe sex by using condoms, remaining
faithful to one sexual partner, personal
hygiene.
• Provide condoms

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