Chancroid:
Cause: Chancroid is caused by a pleomorphic gram-negative rod called Haemophilus ducreyi.
Symptoms: this ulcerative disease usually beings as a soft apule, or bump, at the point of contact and develops into a “soft chancre” (in contrast to the hard symphilis chancre), which is very painful in men but may be unnoticed in women. Inguinal lymph nodes can become very swollen and tender.
Epidemiology: Chancroid is very common in the tropics and subtropics and is becoming more common in the U.S.
Transmission: Chancroid is transmitted exclusively through direct contact, especially sexually. The disease is associated with sex workers and poor hygiene. Uncircumcised men seem to be more commonly infected than those who have been circumcised. People may carry this bacgerium asymptomatically.
Chlamydai:
Chlamydai is the most common reportable infectious diasese in the U.S. Annually, more than 1 million cases are reported, but the actual infection rate may be 5-7 times more. Chlamydia trachomatis affects mostly young women, but it can occur in both men and women and in all age groups. It’s not difficult to treat, but if left untreated it can lead to more-serious health problems. See Mayo Clinic
The sequences of bothChlamydia trachomatisandChlamydiapneumoniaehave been determined with the hope that a comparison between the two genomes will significantly enhance the understanding of both pathogens.
signs and symptoms:
Chlamydia doesn’t usually cause any symptoms. So you may not realize that you have it. People with chlamydia who have no symptoms can still pass the disease to others. If you do have symptoms, they may not appear until several weeks after you have sex with an infected partner. See MedlinePlus
In males, the bacterium can cuase an inflmmation of the urethra. The symptoms mimic gonorrhea; discharge and painful urination. Females who experince symptoms have cervicitis, a discharge, and often sapingitis.
Certain strains of C. trachatis can invade the lymphatic tissues, resulting in alymphogramuloma venereum. The condition is accompannied by headache, fever, and muscle aches. The lymph nodes near the lesion begin to fill with granuloma cells and become enlarged and tender. These “nodes” can cause long term lymphatic obstruction that leads to chronic, deforming edema of the genitalia or anus. The disease is endemic to South America, Afica and Asia, but occasionally occurs in other parts of the wrold.
Babis born to mothers with chlamydia can develop eye infections and also pneumonia if they become infected.
causative agent: C. trachamatis is a very small gram negative bacterium. It lives inside host cells as an ogligate intracellular parasite.
-ransmission: The microbe shows an astoundingly borad distribution within the population and incidence is rising. Adolescent women are more likely than older women to harbor the bacterium because it prefers to infect cells that are prevalent on the adoslescent cervix. It is transmitted sexually.
Immune Response: The first and most important immune response to Chlamydia infection is a local one, whereby immune cells such as leukocytes are recruited to the site of infections, and subsequently secrete pro-inflammatory cytokines and chemokines such as interferon gamma. Immune cells also work to initiate and potentiate chronic inflammation through the production of reactive oxygen species (ROS), and the release of molecules with degradative properties including defensins, elastase, collagenase, cathespins, and lysozyme. This long-term inflammation can lead to cell proliferation (a possible precursor to cancer), tissue remodeling, and scarring, as well as being linked to the onset of autoimmune responses in genetically disposed individuals. See RedGrove
Detection: is with PCR or ELISA.
Prevention: avoiding contact with infected tissues and secretions or barrier protection is the only means of prevention.
Treatment: Chlamydia is treated with antibiotics. The recommended antibiotic treatment is doxycycline taken twice a day for seven days or azrithromycin taken in one single dose. Other alternative medications may be used but are not as effective as azrithromycin and doxycycline. Persons being treated for chlamydia should not have sexual intercourse for seven days after single dose therapy (azrithromycin) or until completion of all seven days of antibiotics (doxycycline). Patients can be re-infected if their sex partners are not treated. See NY State Dept Health
Gonorrhea:
gonorrhea has been known as an STD since ancient times.
signs and symptoms: In the male, infection of the urethra elicity urethritis, painful urination, and a yellowish discharge, although a relatively large number of ases are symptomatic. In ost cases, infection is limited to the distal uronetical tract, but it can occasionally spread from teh urethra to the prostate gland and epididymis. See WebMD.
In the female, it is likely that both the urinary and genital tracts will be infected during sexual intercourse. A mucopurlent (containing mucos and pus) or bloody vaginal discharge occurs in a minortiy of the cases, along with painful urination if the urethra is affected.
Causative agent: N. gonorrhaeae is a pyogenic (pus forming) gram-negative diplococcus. It apepars as paris of kidney bean shaped bacterial, with their flat sides touching.
Transmission: gonorrhea is a strictly human infection that ranks among the most common STDs.
Diagnosis: Specific microbiologic diagnosis of N. gonorrhoeae infection should be performed for all persons at risk for or suspected of having gonorrhea; a specific diagnosis can potentially reduce complications, reinfections, and transmission. Culture, NAAT, and POC NAAT, such as GeneXpert (Cepheid), are available for detecting genitourinary infection with N. gonorrhoeae; culture requires endocervical (women) or urethral (men) swab specimens. Culture is also available for detecting rectal, oropharyngeal, and conjunctival gonococcal infection. NAATs and POC NAATs allow for the widest variety of FDA-cleared specimen types, including endocervical and vaginal swabs and urine for women, urethral swabs and urine for men, and rectal swabs and pharyngeal swabs for men and women. See CDC
Prevention/screening: no vaccine is available. Using condoms is an effective way to avoid transmission.
Annual screening for N. gonorrhoeae infection is recommended for all sexually active women aged <25 years and for older women at increased risk for infection (e.g., those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI) (149). Additional risk factors for gonorrhea include inconsistent condom use among persons who are not in mutually monogamous relationships, previous or coexisting STIs, and exchanging sex for money or drugs. Clinicians should consider the communities they serve and consult local public health authorities for guidance regarding identifying groups at increased risk. Gonococcal infection, in particular, is concentrated in specific geographic locations and communities. MSM at high risk for gonococcal infection (e.g., those with multiple anonymous partners or substance abuse) or those at risk for HIV acquisition should be screened at all anatomic sites of exposure every 3–6 months (see Men Who Have Sex with Men). At least annual screening is recommended for all MSM. Screening for gonorrhea among heterosexual men and women aged >25 years who are at low risk for infection is not recommended (149). A recent travel history with sexual contacts outside the United States should be part of any gonorrhea evaluation. See CDC
—Vaccination:
——NGoXIM is a prophylactic vaccine against gonorrhea which has gained funding from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). NGoXIM candidates uses Intravacc’s outer-membrane vesicle (OMV) platform technology and Therapyx GneX12 sustained-release microspheres to deliver recombinant human IL-12 intranassaly. OMVs are speherical buddings that are rleased spontaneously on the oter membrane of many Gram-negative bacteria during growth. Such vesicles present surface antigens in a native conformation and have natural properites such as immunogenicity, self-adjuvation and uptake by immune cells. Those features make OMVs a good basis for vaccines against pathoglenic bacteria. The OMVs for the gonorrhea vaccine are dervied form genetically modified Neisseria gonorrhaeae. An intranasal vaccine also causes an immune response in other mucosal tissues such as the genital tract, thus hleping to endure induction of an immune resonse at the site of potential infection as with gonorrhea.
Symptoms: Urethral infections caused by N. gonorrhoeae can produce symptoms among men that cause them to seek curative treatment soon enough to prevent sequelae, but often not soon enough to prevent transmission to others. Among women, gonococcal infections are commonly asymptomatic or might not produce recognizable symptoms until complications (e.g., PID) have occurred. PID can result in tubal scarring that can lead to infertility or ectopic pregnancy. See CDC
Treatment: treatment includes treating chlamydia also since N. gonorrhaeae is freqeuntly coinfected with Chlamydia. CDC recommends a single dose of 500 mg of intramuscular ceftriaxone. Alternative regimens are available when ceftriaxone cannot be used to treat urogenital or rectal gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease. The CDC has this bacterium in its Urgent Trheat category for antibiotic resistance. See CDC
Syphilis:
cause: Treonema pallidum which is a spirochete, regularly coiled cell with a gram-negative cell wall. See CDC
Symptoms: Untreated symphilis is marked by distinct clinical stages designated as primary, secondary and tertiary symphilis. The disease also has latent periods of varying duration during which it is quiescent. The primary stage is marked by the appearance of a hard chancre at the site of entry of the pathogen. Because these culcers tend to be pianless, they may escape notice, especially when they are on internal surfaces. The chancre heals spontaneously without scarring in 3-6 weeks. About 3-6 weeks after the chancre heals, the secondary stage appears. By then, many systems of the body ahve been invaded and simptoms include fever, ehadache and sore throat, followed by lymphadenopathy and peculiar red or brown rash that breaks out on all skin surfaces including the palms of the hands and soles of the feet. A person’s hair often falls out. Like the chancre, the lesions contain viable spirochetes and disappear spontaneously in a few weeks. The major complications at this stage occur in the bones, hair follicles, joints, liver, yes and brain. See Web MD–Transmission: Human appear to be the sole natural hosts and source of T. pallidum. The bacterium is extremely fastidious and sensitive and cannot survive for long oustide the host, being rapidly destroyed by heat, drying, disinfectants, soap, hogh oxygen tension and pH changes. It survives a few minutes to hours when protected by body secretions and about 36 hours in sotred blood. The risk of infection from an infected sexual partner is 12-20% per encounter.
Diagnosis: There is a rapid plasmin reagin (RPR) test which is coupled with an immunoassay specific for treponemal antigens.
Prevention: People identified as being at risk fo syphilis are given immediate prophylactive penicilline in a single long acting dose. The barrier effect of a condom provides excellent proteciton during the primary phase. Protective immunity apparently does arise in humans, allowing the prospect of an effective immunization program in the future, although no vaccine exists currently.
Treatment: Syphillis can have very serious consequences if left untreated. Current recommendations are for ciprofloxacin or levofloxacin. See Mayo Clinic. See Drugs.com. History of treatment
Treatment for STDs, Generally:
Doxycline: is used a PrEP or PEP to prevetn infections such as malaria and lyme disease and is now used to prevent STIs. Doxycline is a braod spectrum tetracycline antimicrobial. It is well absorbed and toelrated with a half-life of about 12 hours. Adverse effects most associated with doxycline include photosensitivty and gastrointestinal symptoms, including esophageal erosion and ulceration. Most adverse effects resolve with discontinuation of the medication. See CDC
Doxycline is the recommended treatment regiment for chalmydia and an alternative treatment for syphilis in nonpregnant patients with severe penicillin allergy or when penicillin is not available. Although currently not a recommended treatment for gonorhhea because of elevated antimicrobial resistance, it remains effective aginst many strains of No. gonorrhaeae in the US. See CDC
—Doxycycline Posexposure Prophylaxis: No vaccines and few chemoprophylaxis options exist for tghe prevention of bacterial sexually transmitted infections (STIs) (specifically synphilis, chlamydia, and gonorrhea). These infections have increased in the US and disproportionately affect gay, bisexual and other men who ahve sex with men (MSM) and transgender wormen (TGW).
The CDC recommends the use of doxycline postexposure prophylaxis (doxy PEP) as a novel STI prevention strategy for MSM and TGW who have had a bacterial STI (specifically syphilis, chamydia or gonorrhea) diagnosed in the past 12 months. CDc recommends that providers offer persons in these groups a preseription for doxy PEP to be self adminsitered within 72 horus after having oral, vaginal, or anal sex. The recommended dose of doxy PEP is 200 mg and should not exceed a maximum dose of 200 g every 24 hours. See CDC
Postexposure prophylaxis (PEP) involves taking a medication to prevent an infection after a possible exposure and is a common strategy for prevention of HIV and other infections. PEP is a form of chemoprophylaxis and is distinct from pre-exposure prophylaxis (PrET), which involves taking a medication before exposure occurs.