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Sexually Transmitted Diseases - Part 1: DR Clarissa Lister

The document discusses sexually transmitted infections (STIs), including chlamydia and gonorrhea. It notes that over 1 million new STI cases occur worldwide each year, with non-specific urethritis and chlamydia being the most common. STIs are caused by bacteria, viruses, or other pathogens and are transmitted through sexual or vertical contact. Dentists play a role in detecting and educating patients about STIs. Chlamydia is the most common STI in the US and gonorrhea is the second most common. They often present asymptomatically but can cause infections like urethritis, cervicitis, and conjunctivitis in newborns if left untreated.

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105 views20 pages

Sexually Transmitted Diseases - Part 1: DR Clarissa Lister

The document discusses sexually transmitted infections (STIs), including chlamydia and gonorrhea. It notes that over 1 million new STI cases occur worldwide each year, with non-specific urethritis and chlamydia being the most common. STIs are caused by bacteria, viruses, or other pathogens and are transmitted through sexual or vertical contact. Dentists play a role in detecting and educating patients about STIs. Chlamydia is the most common STI in the US and gonorrhea is the second most common. They often present asymptomatically but can cause infections like urethritis, cervicitis, and conjunctivitis in newborns if left untreated.

Uploaded by

andreas kevin
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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S E X U A L LY T R A N S M I T T E D

D I S E A S E S – PA RT 1
D R C L A R I S S A L I S T E R
PRE-TEST
TIME
1. 10 questions
2. 1 minute per question
3. Take note specific questions you are unsure
about so we can discuss
PLAN AND LEARNING OUTCOMES
• General
Learning Outcomes
• Importance in Dentistry 1. Describe the epidemiology of STIs
• Non-specific urethritis 2. Explain the prevention of STIs
3. Describe the background information, clinical
• Chlamydia features, general management, and dental aspects of
non-specific urethritis, chlamydia and gonorrhea.
• Gonorrhea
STI - BACKGROUND
• Concern because: >1million cases / yr worldwide (World Health Organization)
• Non-specific urethritis & chlamydia most common
• Caused by Take note
• Bacteria: gonorrhea, chlamydia, chancroid, syphilis Ix: investigate for other STIs
Mx: contact tracing and treat
• Virus: genital herpes, genital warts, HIV / AIDS partner if infected!
• Others: trichomoniasis (protozoan)
• Multiple infections are common
STI - PREVENTION
• Disease spread through
• Sexual contact: vaginal, anal, oral
(direct contact, blood, saliva)
• Mother to fetus
• Prevention
• Abstinence – only sure way
• Monogamous
• Condom use
STI - DENTISTRY
• STIs may have oral manifestations -> detect and refer
• Patients may be asymptomatic -> dentists need to adhere to standard precautions
• Important: diagnosis, education, information of where to access treatment
NON-SPECIFIC URETHRITIS
• Urethritis not caused by chlamydia or gonorrhea
• Possible causative organisms: Mycoplasma genitalium or Ureaplasma urealyticum
• Clinical presentation: dysuria, underwear stains
• Dx: smear showing polymorphonuclear leukocytes
• Rx: doxycycline / azithromycin
CHLAMYDIA - BASICS
• Epidemiology: 1st most common STI in America
• Organism: Chlamydia trachomatis (gram -, obligate intracellular bacterium)
• Obligate intracellular: cannot replicate outside host cells
• Primary sites of infection: urethra, cervix, rectum, oropharynx
CHLAMYDIA – CLINICAL
P R E S E N TAT I O N
• Asymptomatic for 2/3 female,1/2 male
• Symptoms 2-3wks post-exposure
• Urethritis: urethral discharge, dysuria (painful sensation during urination) *male may have
epididymitis -> infertility
• Cervicitis: discharge and dyspareunia (pain on sexual intercourse)
• Pelvic inflammatory disease (PID): ascending spread to endometrium, fallopian tubes,
ovaries, pelvic peritoneum Cx: tubal scarring leading to infertility or ectopic pregnancy
• Baby: premature delivery, conjunctivitis, chlamydial pneumonia
CHLAMYDIA – CLINICAL
P R E S E N TAT I O N
• Severe but rare: Reactive arthritis, lymphogranuloma venereum (STI 3 lecture)

Can’t see, can’t pee, can’t climb a tree


C H L A M Y D I A – C O N T.
• Ix:
• Gold standard: NAAT (Nucleic Acid Amplification Test)
• Male sample: first-void urine
• Female: vulvovaginal swab
• Other samples: swabs anus, throat
• Culture: will be negative as chlamydia is intracellular
• Test for other STIs
• Mx:
• Azithromycin 1g STAT
• Contact tracing & Rx partner if patient confirmed chlamydia (treat and test approach)
• CDC recommends yearly screening for sexually active women 25yo and below or older with new/multiple sexual
partners
GONORRHEA - BASICS
• Epidemiology: 2nd most common STI in America (1st in Chlamydia)
• Organism: Neisseria gonorrhea (gram -, diplococci)
• More invasive at:
• Columnar epithelial (urethra and cervix)
• Transitional epithelial (pharynx and rectum)
• Less invasive at stratified squamous epithelium (skin and oral cavity)
• Primary sites of infection: urethra, cervix, rectum, oropharynx
GONORRHEA
GONORRHEA – CLINICAL
P R E S E N TAT I O N
• Male:
• Urethritis: purulent urethral discharge, dysuria
• Spread to epididymis, prostate, seminal vesical, bladder
• Epididymitis: may cause infertility

• Female: mostly asymptomatic


• Cervicitis*: purulent discharge, dyspareunia
• Urethritis (less common)
• PID
• To baby: perinatal conjunctivitis, arthritis of newborn (untreated can cause blindness / joint infection)
• Both
• Anorectal gonorrhea (usually less severe than genital): purulent discharge, soreness, pain
• Oropharyngeal: asymptomatic / mild sore throat /
G O N O R R H E A – C O N T.
• Ix:
• Gold standard: NAAT
• Culture: to test for antimicrobial sensitivity
• Test for other STIs
• Mx:
• IM Ceftriaxone 1g STAT
• Contact tracing and treat affected
G O N O R R H E A – D E N TA L
C O N S I D E R AT I O N S
• Symptomatic pharyngitis -> refer to physician for further evaluation
• Treated gonorrhea: little risk! Dental care can be done days later.
• No evidence that oral gonococcal infections can be transmitted to the dentist by coughing and
droplet infection, or by saliva.
• Patient education about STIs!!
SUMMARY
• >1million new cases of STIs each year.
• STI spread by sexual contact (vaginal, rectal, oral) and have vertical transmission (pass to fetus).
Spread by direct contact, saliva, blood.
• Dentists play important role to detect, diagnose, refer, educate patients regarding STIs
• Non-specific urethritis is not caused by chlamydia or gonorrhea.
• Chlamydia is #1 STI and gonorrhea #2. Mostly asymptomatic but may cause urethritis, cervicitis,
rectitis, pharyngitis for gonorrhea, conjunctivitis in fetus and more.
P O S T- T E S T T I M E !
W H AT A R E
YOU
THANKFUL
FOR?
RESOURCES
• Chapter 32: Sexual (reproductive health)
(starts on pg 730)

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