A sexually transmitted disease (STD), also known as sexually transmitted infection (STI) or venereal disease (VD), is an illness that has a significant probability of transmission between humans or animals by means of sexual contact, including vaginal

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Introduction

• A sexually transmitted disease (STD), also known
  as sexually transmitted infection (STI) or
  venereal disease (VD), is an illness that has a
  significant probability of transmission between
  humans or animals by means of sexual contact,
  including vaginal intercourse, oral sex, and anal
  sex.

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Sexually Transmitted Infections

• Yeasts and fungi
• Candida albicans
• Candida glabrata
• Candida tropicalis
• Parasites
• Trichomonas vaginalis
• Entamoeba histolytica
• Giardia intestinalis
• Ectoparasites
• Sarcoptes scabiei
• Phthirus pubis

• Bacterial
• Neisseria gonorrhoeae
• Treponema pallidum
• Chlamydia trachomatis
• Haemophilus ducryei (chancroid)
• Lymphogranuloma
• Mycoplasma
• Viruses
• Herpes simplex II
• Hepatitis B
• Hepatitis C
• HIV
• Papillomavirus

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Genus Trichomonas

• Its includes a group of flagellated protozoa It
  infect humans and animal
• Human Trichomonads
• 3 species of trichomonads found in human.
• Two are normally harmless.

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• Pentatrichomonas hominis
• T. tenax
• T. vaginalis which is a serious sexually
  transmitted pathogen.

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Trichomonas vaginalis

• It is the etiological agent of trichomoniasis.
• Trichomoniasis is a common sexually transmitted
  disease with a worldwide distribution.
• transmittable, sexually and through contact with
  toilet seats and towel.
• T. vaginalis despite it name, infect both men and
  women.
• In females the organism inhabits the vagina and
  urethra
• In males it is found in the urethra, prostate or,
  seminal vesicles.

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• The life cycle consist only of a trophozoite
  stage which is transmitted by direct contact
  during sexual intercourse
• both sexes equally susceptible

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T. Vaginalis trophozoite

• Fgflagella
• Bbbasal body
• Nunucleus
• Axaxostyle
• umundulating membrane
• Cycytostomal groove
• Cscosta

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• (B) T. vaginalis on the surface of a vaginal
  epithelial cell prior to ameboid transformation.

5 µm
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• (C) Ameboid morphology of T. vaginalis as seen in
  cell culture.

5 µm
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Life cycle flagella are found in the genital
tract. Transmission during dealings with
contaminated matters (clothes, cotton..etc.
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• Sign and symptoms
• T. vaginalis causes different manifestation in
  men and women.
• Women are more likely to exhibit symptoms which
  tend to persist longer
• Incubation period is 4-28 days.
• In female ranges from asymptomatic, to mild or
  moderate irritation, to extreme vaginitis
• 10 - 50 asymptomatic
• The commonest symptoms vaginal discharge, vulval
  itching, dysuria, or offensive odor , rare
  abdominal discomfort
• Vaginal discharge up to 70 - varying in
  consistency from thin and scanty to profuse and
  thick the classical discharge of frothy yellow
  occurs in 10-30 of women
• Extreme cases associated with vulvitis and
  vaginitis
• 2 strawberry cervix appearance to the naked
  eye.
• Higher rates are seen on colposcopic examination.
  
• 5-15 no abnormalities on examination.
• In male 50-90 are asymptomatic
• mild dysuria or pruritus
• minor urethral discharge

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Focus on pathogen T. vaginalis

• females get a disintegration of vaginal
  epithelial lining. Natural flora (bacteria ) keep
  the pH of the vagina at 4-4.5 and ordinarily this
  discourages infections.
• T. vaginalis can survive at a low pH.
• Once established it causes a shift toward
  alkalinity (pH 5-6) which further encourages its
  growth. There is a tendency to explain
  stillbirths, spontaneous abortions, morbidity to
  women who have vaginitis.
• Induces vaginal pH change, erosion of normal
  mucosa in women

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Physical Examination

• Pelvic examination
• Inspection of external genitalia.
• Speculum examination
• insertion and visualization of vagina and cervix,
  obtaining swabs and slide specimens.

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Vaginitis - Trichomoniasis

• Profuse, frothy discharge,
• yellow-greenish in color
• foul odor, vulvar pruritus
• Patchy vaginal erythema and
• (strawberry cervix)

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• Diagnosis
• 1-Specimens
• vaginal discharge
• urine sediment
• prostatic secretion
• 1.Vaginal pH
• 2. Whiff test
• 3.Wet mount
• 4. Pap smear
• 5. Culture
• 6. Direct immunoflouresence assay
• 7. Polymerase chain reaction
• 8. Evaluation for other STDs

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• Potassium hydroxide amine test (Whiff test)

Upon application of 10 potassium hydroxide (KOH)
to a vaginal swab sample, a fishy odor is
released, which can suggest trichomoniasis or
bacterial vaginitis.
Whiff test 10 KOH
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• Phylum Ciliophora
• Possess cilia simple cilia or compound ciliary
  organelles during some part of their life cycle
• Most species have 2 kinds of nuclei macronuclei
  and micronuclei
• Some members of the phylum engage in sexual
  reproduction, involving conjugation, autogamy,
  and ctyogamy
• Most ciliates are free-living however, a few
  groups are commensals or parasitic

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• Family Balantidiidae, which includes only one
  genus and species (Balantidium coli) are found
  in the intestinal tract of arthropods and some
  vertebrates, including mammals
• Pathogens of humans, dogs and monkeys
• Swine are non-pathogenic carrier
• Mostly infect at Cecum,large intestine
• Balantidium coli cause Balantidiosis Ciliary
  dysentery
• Balantidiosis is most often found in tropical
  regions throughout the world
• It is not a common human disease the infection
  rate is less than 1
• Pigs are a good source of infection for humans
  in areas where they share habitation
• Cyst transmission (fecal oral)

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• Balantidium trophozite

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Balantidium coli cyst
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Life Cycle

• Both asexual and sexual reproduction present
• Asexual by binary fission
• Sexual by conjugation
• Conjugation two opposite mating types pair
  exchange genetic material

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Pathogenesis

• Balantidium coli produces proteolytic enzymes
  that break down and digest the intestinal
  epithelium.Colon ulceration develops which
  allows for infiltration by lymphocytes and
  leukocytes.Hemorrhaging and secondary bacterial
  infections will develop next.Perforation of the
  large intestine and appendix will occur.

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• Clinical Signs
• Mild infections occur with diarrhea,
• Abdominal pain
• Alternating periods of constipation
• Ulceration of the gut wall
• Diagnosis
• Cysts-formed stools
• Active trophs-diarrheic stools

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Control

• Eradication of fecal contamination of food and
  water.
• Cysts killed by boiling
• Resistant to low doses chlorine (halide tablets)
• Avoid practices that allow fecal-oral contact
• Improved sanitation in institutions.