性传播疾病(八年制)课件.ppt

1、性传播疾病：是指以通过性行为为主要主要传播途径的一组传染病性传播感染(sexually transmitted infections STIs):重视无症状感染。目前列入性传播疾病的病种已达20多种。 1999年WHO建议采用Intimate contact: body contact, kissing.sexually transmitted disease STDGonorrhea 淋病 Syphilis 梅毒 Condyloma acuminata 尖锐湿疣Genital chlamydial infection 衣原体感染Genital herpes 生殖器疱疹AIDScontent艾

2、滋病（包括HIV感染者）梅毒淋病中华人民共和国传染病防治法中华人民共和国传染病防治法国家必须上报的三种性病国家必须上报的三种性病（乙类）（乙类）1、性接触传播2、间接接触传染3、血液和血液制品传播4、母婴垂直传播5、医源性传播6、器官移植、人工授精等传播STD-传播途径病名病名 病原微生物病原微生物淋病 淋病奈瑟菌梅毒 梅毒螺旋体尖锐湿疣 人类乳头瘤病毒生殖器疱疹 单纯疱疹病毒支原体 解脲支原体沙眼衣原体 沙眼衣原体艾滋病 人类免疫缺陷病毒STD-病原体第一节 淋 病 Gonorrhea淋病奈瑟菌淋病奈瑟菌为为革兰染色阴性革兰染色阴性双球双球菌菌离开人体不易存活离开人体不易存活一般消毒剂可杀灭

3、一般消毒剂可杀灭对柱状上皮、移行上对柱状上皮、移行上皮有特殊的亲和力皮有特殊的亲和力易隐藏并侵袭泌尿、易隐藏并侵袭泌尿、生殖系统粘膜生殖系统粘膜宫颈、尿道、尿道旁腺、前庭大腺宫颈、尿道、尿道旁腺、前庭大腺 子宫内膜、输卵管、盆子宫内膜、输卵管、盆 腔腔 播散淋病播散淋病 黏附黏附菌毛菌毛膜蛋白膜蛋白并被其吞饮并被其吞饮脂多糖内毒素脂多糖内毒素炎症反应炎症反应摧毁摧毁 性接触传播性接触传播 间接接触传染间接接触传染 产道感染产道感染 ，新生儿眼结膜炎，新生儿眼结膜炎淋病-传播途径Latent period: 1Latent period: 1 10 days, 10 days, average:

4、 3 average: 3 5 days5 daysAfter exposure to an infected partner:After exposure to an infected partner: men: 20 men: 20 50% 50% become infected become infected women: 60 women: 60 90%90%Gonorrhea manifestation下生殖道感染下生殖道感染（无并发症淋病）（无并发症淋病） Uncomplicated gonococcal Uncomplicated gonococcal infectioninfe

5、ction上生殖道感染上生殖道感染（女性并发症淋病）（女性并发症淋病） Complicated gonococcal Complicated gonococcal infectioninfection播散性淋病播散性淋病 Disseminated gonococcal Disseminated gonococcal infectioninfectionGonorrhea manifestation 下生殖道淋病下生殖道淋病Vulva (including Bartholins gland) , vagina, cervix, and urethra may be inflamed图1 ：女性淋

6、病女性淋病图2：淋菌性宫颈管炎淋菌性宫颈管炎图3：淋菌性前庭大腺炎淋菌性前庭大腺炎Endometritis, salpingitis and peritonitisPelvic pain, cervical motion and adnexal tenderness, adnexal mass, and the presence of fever上生殖道淋病上生殖道淋病1%3%Polyarthralgia (关节炎关节炎）, tenosynovitis(腱鞘炎腱鞘炎）Endocarditis and meningitis (脑膜炎脑膜炎） have been describedIn the f

7、ormer : SepticemiaIn the latter: gonorrhea cultured from joint aspirates 播散性淋病播散性淋病1、有不良性接触史；有不良性接触史；2、临床表现：临床表现：脓性分泌物，脓尿脓性分泌物，脓尿3、实验室检查：实验室检查：分泌物涂片检查（检出率4060%） Gram stained smear: intracellular Gram stained smear: intracellular gram-gram-negative diplococcinegative diplococci分泌物淋菌培养培养（检出率8090.5%）核酸

8、检测:PCR（检出率8497%） PCR high false positive rate PCR high false positive rate淋病诊断淋病诊断Must be suspected of having other STIsMust be suspected of having other STIs eg, syphilis, HIV, and chlamydial infection eg, syphilis, HIV, and chlamydial infectionDual therapyDual therapy : esp for chlamydial infectio

9、n : esp for chlamydial infection 2040%，（2040% 合并合并CTCT) eg, doxycycline eg, doxycycline( (多西环素）多西环素） azithromycin azithromycin（阿奇霉素）（阿奇霉素）Sexual partnersSexual partners be treated with a similar be treated with a similar antibiotic regimenantibiotic regimen淋病治疗淋病治疗原则：及时、足量、规范用药药物：首选第三代头孢菌素（the 3rd g

10、eneration of the 3rd generation of cephalosporin)cephalosporin)：头孢曲松钠(菌必治)治愈标准治愈标准：临床症状完全消失，治疗后47天取宫颈管分泌物涂片及培养为阴性Discharge smear Discharge smear and and culture after 4-7days culture after 4-7days of treatment : (-)of treatment : (-)淋病治疗淋病治疗Uncomplicated gonococcal infectionUncomplicated gonococcal

11、infectionCeftriaxonCeftriaxon（头孢曲松）（头孢曲松） 250mg im ( 250mg im (single dosesingle dose) )CefiximeCefixime( (头孢克肟）头孢克肟） 400mg po (single dose) 400mg po (single dose)CefotaximeCefotaxime（头孢噻肟）（头孢噻肟） 1g im (single dose)1g im (single dose)Spectinomycin(大观霉素）大观霉素）淋病治疗淋病治疗complicated gonococcal infection :

12、complicated gonococcal infection : CeftriaxonCeftriaxon 500mg, im 500mg, im 1010d d Spectinomycin Spectinomycin( (大观霉素）大观霉素）2g im qd2g im qd +Metronidazole 400mg bid +Metronidazole 400mg bid 1010 d d or +doxycycline100mg bid or +doxycycline100mg bid 1010 d dDisseminated gonococcal infectionDissemina

13、ted gonococcal infection Ceftriaxon Ceftriaxon 1g, im,1g, im,iv iv 1010 d d Ceftizoxime Ceftizoxime（头孢唑肟钠）（头孢唑肟钠） 1g 1g iv iv 10 10 d d淋病治疗淋病治疗Early stage: abortionEarly stage: abortionLate stage: chorioamnionitis, Late stage: chorioamnionitis, PROMPROM, preterm birth, , preterm birth, IUGRIUGR，conj

14、unctivitis of infantconjunctivitis of infant，keratitis keratitis of infantof infant分娩时产程延长；分娩后产褥感染，淋病播散分娩时产程延长；分娩后产褥感染，淋病播散新生儿新生儿:淋菌结膜炎、肺炎，甚至出现淋菌败血症，围产儿淋菌结膜炎、肺炎，甚至出现淋菌败血症，围产儿 死亡率增加死亡率增加Gonorrhea in pregnancyGonorrhea in pregnancy1.分娩方式 如无产科指征均可阴道分娩。未治疗的孕妇（非剖宫产指征）应立即按前述方案治疗2.淋菌孕妇娩出的新生儿，1%硝酸银液滴眼硝酸银液滴眼

15、预防眼炎，头孢曲松钠25mg50mg/kg肌注或静脉注射 预防：预防：对高危病人，产前常规筛查淋菌，妊娠早、中、晚期作宫颈分泌物涂片或培养Gonorrhea in pregnancy Syphilis由由苍白密螺旋体苍白密螺旋体引起的引起的慢性全身性传播性疾病慢性全身性传播性疾病早期侵犯生殖器所属淋早期侵犯生殖器所属淋巴结及全身皮肤、粘膜巴结及全身皮肤、粘膜淋巴结淋巴结晚期侵犯心血管、神经晚期侵犯心血管、神经系统、骨骼等器官系统、骨骼等器官梅毒螺旋体（渡银染色，油镜梅毒螺旋体（渡银染色，油镜）syphilisCause by treponema pallidum latent syphilis

16、 syphilischancre: chancre: an indurate, firm an indurate, firm painless ulcer with raised painless ulcer with raised bordersborders Groin lymph nodesGroin lymph nodes: Enlarge, : Enlarge, firm, and painlessfirm, and painless（单侧或单侧或 双侧腹股沟淋巴结肿大）双侧腹股沟淋巴结肿大）潜伏期约潜伏期约1090天，多数天，多数在在6周内。一般周内。一般36周自愈，周自愈，故不易

17、被发现故不易被发现梅毒硬下疳梅毒硬下疳Primary syphilis 一期梅毒一期梅毒 全身出现各种皮疹，全身出现各种皮疹， 26周消退周消退, 25%的患的患者常因病损轻微而被忽视者常因病损轻微而被忽视Spirochetes spread hematogenouslySpirochetes spread hematogenouslyDermatitis: diffuse, bilateral, symmetric, Dermatitis: diffuse, bilateral, symmetric, papulosquamous (papulosquamous (丘疹鳞屑性）丘疹鳞屑性）

18、Patchy alopecia ( Patchy alopecia (斑丘）斑丘） Mucous patches ( Mucous patches (扁平湿疣）扁平湿疣） Hepatitis, nephritis Hepatitis, nephritisSecondary syphilis 二期梅毒二期梅毒 梅毒扁平湿疣梅毒扁平湿疣表现为永久性皮肤黏膜损害表现为永久性皮肤黏膜损害Skin or bone (gummasSkin or bone (gummas树胶肿）树胶肿）cardiovascular system cardiovascular system nervous systemner

19、vous systemTertiary syphilis 三期梅毒三期梅毒 传播途径：传播途径：通过皮肤或粘膜通过皮肤或粘膜破口破口侵入机体侵入机体 1、性接触传播、性接触传播2、间接感染、间接感染3、血液和血液制品传播、血液和血液制品传播4、母婴垂直传播：患病孕妇通过胎盘感染胎、母婴垂直传播：患病孕妇通过胎盘感染胎儿，新生儿在分娩通过软产道时受传染儿，新生儿在分娩通过软产道时受传染syphilis对胎儿及婴幼儿影响对胎儿及婴幼儿影响 流产、死胎、死产；早产；流产、死胎、死产；早产； 先天梅毒儿先天梅毒儿syphilis先天梅毒儿（胎传梅毒儿）先天梅毒儿（胎传梅毒儿）病死率、致残率高早期皮肤大

20、疱、皮疹、鼻炎及鼻塞、肝脾肿大、淋巴结肿大等晚期楔状齿、鞍鼻、间质性角膜炎、骨膜炎、神经性耳聋等先天梅毒早期表现（皮疹）先天梅毒早期表现（皮疹）syphilis1. Identification of the organism（病原学检查病原学检查） T pallidum can be identified by darkfield examination of specimens from cutaneous lesions2. Serologic tests（血清学检查血清学检查） Nontreponemal test ( (非梅毒螺旋体抗原试验）：非梅毒螺旋体抗原试验）： VDRL（性病

21、研究实验室试验） RPR（快速血浆反应素环状卡片试验） for screening TRUST（甲苯胺红血清不加热试验）诊断-实验室检查梅毒螺旋体抗原试验梅毒螺旋体抗原试验 ( (treponemal antibody test ） 主要用于主要用于证实试验证实试验 TP-PA（梅毒螺旋体颗粒凝集试验） TPHA（梅毒螺旋体血凝试验） FTA-ABS （荧光密螺旋体抗体吸收试验） More sensitive and specificdiagnosis原则原则：早期诊断、及时治疗、用药足量、疗早期诊断、及时治疗、用药足量、疗程规范程规范药物药物： 首选青霉素（普鲁卡因青霉素、卞星青霉素) 若青

22、霉素过敏，改用红霉素等治疗1. Benzathine penicillin G（苄星青霉素苄星青霉素） 240240万万u u 分两臀肌注分两臀肌注 qwqw2-3W2-3W PG( (青霉素青霉素) ) 60-8060-80万万u im qdu im qd1515天天2.红霉素红霉素 0.5 q6h0.5 q6h1515天天 Ceftriaxon（头孢曲松头孢曲松）1g im /iv qd10 Tetracycline hydrochloride,500mg qid15 Doxycycline (多西环素）多西环素）100mg bid 15Early syphilis(早期梅毒及接触者早期梅

23、毒及接触者)1.青霉素治疗（均需皮试）青霉素治疗（均需皮试） Benzathine penicillin G 240240万万u u im qwqw 3 3 PG 0.8 million im qd202. Tetracycline hydrochloride, 500mg qid30Doxycycline 100mg bid 30late syphilis注意事项：注意事项： 治疗期间避免性生活，治疗期间避免性生活，性伴侣性伴侣同时检查及治疗同时检查及治疗治愈标准治愈标准： 临床治愈：各种损害消退，症状消失。临床治愈：各种损害消退，症状消失。 血清学治愈：抗梅毒治疗后血清学治愈：抗梅毒治疗后

24、2年内，梅毒血清年内，梅毒血清学试验转为阴性，脑脊液检查阴性学试验转为阴性，脑脊液检查阴性梅毒第第1年，每年，每3月一次；月一次；第第23年，每年，每6月一次。月一次。内容：全身内容：全身,生殖器生殖器,血清学检查血清学检查Syphilis-随访随访Condyloma acuminata由人类乳头瘤病毒由人类乳头瘤病毒 （human papilloma virus，HPV）感染引起感染引起鳞状上鳞状上皮疣状增生皮疣状增生病变的性传播病变的性传播疾病疾病HPV属双环属双环DNA病毒病毒,其分其分化繁殖需鳞状上皮存在化繁殖需鳞状上皮存在.人类乳头瘤病毒（透射电子显微镜）Condyloma acum

25、inata有100多个型别，生殖道尖锐湿疣主要与低危型HPV6、11型有关。 Low risk: Low risk: type type 6, 11, 6, 11, 40,42,43,44, 6140,42,43,44, 61 High risk: 16, 18, 31, 33,35, 39, 45, 56, 58 High risk: 16, 18, 31, 33,35, 39, 45, 56, 58 (responsible for CIN, cervical cancer) (responsible for CIN, cervical cancer)The warts tend to o

26、ccur in areas most The warts tend to occur in areas most directly by coitus:directly by coitus: posterior fourchette( posterior fourchette(阴唇系带阴唇系带）, vulva, vagina , , vulva, vagina , cervix and around anus cervix and around anus HPV传播途径传播途径1、性接触传播2、间接感染3、新生儿在分娩通过患病母亲软产道时受传染Condyloma acuminata临床表现临床

27、表现 潜伏期潜伏期3周周8月，平均月，平均3个月个月 图 外阴尖锐湿疣外阴尖锐湿疣图 宫颈阴道尖锐湿疣宫颈阴道尖锐湿疣尖锐湿疣尖锐湿疣3-5%aqueous acetic 3-5%aqueous acetic acid solution test:acid solution test: （醋酸白试验）外阴尖锐湿疣醋酸白试验尖锐湿疣-实验室检查2、病理组织学检查Koilocytosis Koilocytosis ( (挖空细胞）挖空细胞）DyskeratosisDyskeratosis（角化不良）（角化不良）Parakeratosis Parakeratosis ( (角化不全）角化不全）3 3

28、、Colposcopy Colposcopy 4 4、PCRPCR（核酸检测（核酸检测- -鉴定及分型）鉴定及分型） HCII1、妊娠期尖锐湿疣生长迅速、妊娠期尖锐湿疣生长迅速2、妊娠期疣体组织脆弱，阴、妊娠期疣体组织脆弱，阴道分娩时易导致大出血道分娩时易导致大出血3、 Infect delivery tract（通（通过软产道感染），幼儿期有过软产道感染），幼儿期有发生喉乳头瘤的可能发生喉乳头瘤的可能妊娠合并尖锐湿疣妊娠合并尖锐湿疣 modality modalityEfficacy(%)Efficacy(%)Recurrence riskRecurrence riskImiquimod 5

29、% creamImiquimod 5% cream咪喹莫特霜咪喹莫特霜33-7233-7213-1913-19Podophyllin 10-25%Podophyllin 10-25%（鬼臼）（鬼臼）32-7932-7927-6527-65Podofilon 0.5% Podofilon 0.5% 足叶草毒素足叶草毒素45-8845-8833-6033-60Trichloroacetic acid80-90%Trichloroacetic acid80-90% 81813636CryotherapyCryotherapy63-8863-8821-3921-39Electrodesiccation

30、 or Electrodesiccation or cauterycautery（电凝或电烧灼）（电凝或电烧灼）94942222laserlaser43-9343-9329-9529-95interferoninterferon44-6144-610-670-67ReactivationReactivation of subclinical infection of subclinical infection (more often) (more often) ReinfectionReinfection by a sex partner by a sex partner妊娠36周前孕妇患尖锐

31、湿疣， Trichloroacetic Trichloroacetic acid and electrocoagulation may be usedacid and electrocoagulation may be used 物理及手术治疗。分娩方式:阴道分娩:妊娠近足月或足月孕妇患尖锐湿疣， 病灶局限于局限于外阴者外阴者，物理或手术治疗后可阴道分娩剖宫产:病灶广泛或病灶堵塞软产道者，应行剖宫产终止妊娠Condyloma acuminata in pregnancy Genital chlamydial infectionthe columnar and transitional the

32、columnar and transitional epithelium epithelium of genitourinary tract is of genitourinary tract is principal site of invasion principal site of invasion (without (without deep tissue invasion)deep tissue invasion)cervix, and urethra may be inflamedcervix, and urethra may be inflamedDischarge: mucop

33、urulent exudatesDischarge: mucopurulent exudatesSymptoms are not severe. Symptoms are not severe. Collect the sample from the Collect the sample from the endocervical canal with a endocervical canal with a small cotton swabsmall cotton swabNo symptomsNo symptomsCervicitisCervicitisEndometritisEndome

34、tritisSalpingitis: Salpingitis: one of the etiology of infertility one of the etiology of infertility Clinical manifestation因因衣原体衣原体热休克蛋白与输卵管热休克蛋白有相似性，感染后引起的交热休克蛋白与输卵管热休克蛋白有相似性，感染后引起的交叉免疫反应可损伤输卵管；叉免疫反应可损伤输卵管；若长期反复感染，其所致的迟发超敏反应若长期反复感染，其所致的迟发超敏反应可加重输卵管损伤；常导致严重输卵管黏膜结构破坏、功能丧失，并可加重输卵管损伤；常导致严重输卵管黏膜结构破坏、功能

35、丧失，并可引起盆腔广泛粘连可引起盆腔广泛粘连1. Giemsa stain of purulent dischargeDiagnosis 2. Cell culture: is not yet widely available. Cell culture: is not yet widely available3. Fluorescent antibody test: common used3. Fluorescent antibody test: common used direct smear, direct smear,4. 4. PCRPCR5. Serology tests5. Se

36、rology tests， ELISAELISADiagnosisThe antibiotic must have powerful penetrative The antibiotic must have powerful penetrative ability and long half timeability and long half timeCervicitis:Cervicitis: doxycycline doxycycline: : 100mg bid 100mg bid 7-10 days7-10 days azithromycin: 1g one dose azithrom

37、ycin: 1g one dose Clarithromycin Clarithromycin( (克拉霉素）克拉霉素）500mg bid 500mg bid 10 d10 d levofloxacin levofloxacin、erythromycinerythromycinPID: PID: treat for 14 days treat for 14 daysTreatment abortion, chorioamnionitis, PROM, abortion, chorioamnionitis, PROM, preterm birth, preterm birth, neonatal

38、 conjunctivitis and pneumonia neonatal conjunctivitis and pneumonia Genital chlamydial infection in pregnancy Genital herpesLatent period: 2-20 daysLatent period: 2-20 daysHerpes tend to occur in :Herpes tend to occur in : Vulvar surfaces, vagina , cervix and around anus Vulvar surfaces, vagina , ce

39、rvix and around anusPainful ulcers Painful ulcers distributed in small patchesdistributed in small patchesUrinary symptomsUrinary symptomsIn severe infection, fever, malaise, and bilateral In severe infection, fever, malaise, and bilateral inguinal adenopathy can developinguinal adenopathy can devel

40、opRecurrence genital herpes: symptoms are mild Recurrence genital herpes: symptoms are mild Clinical manifestation1.Cytological study: （嗜酸性包涵体） Papanicolaou smear Wright-Giemsa staindiagnosisHSV-Ag detectHSV-Ag detect（常用快速诊断方法）（常用快速诊断方法）Virus cultureVirus culturePCR (HSV-DNA)PCR (HSV-DNA)Serology te

41、stsSerology tests， ELISAELISA (HSV -IgG (HSV -IgG、IgM)IgM)diagnosisAcyclovir 400mg tidAcyclovir 400mg tid 7-10 days7-10 daysFamciclovir 250mg tidFamciclovir 250mg tid 7-10 days7-10 daysAcyclovir ointmentAcyclovir ointment（软膏（软膏) )treatmentNewborn mortalityNewborn mortalityNeurologic ocular sequelaeNeurologic ocular sequelae abortion, preterm birth abortion, preterm birthGenital herpes and pregnancythank you for you attention