Question

Select a sexually transmitted infection (STI) and do research on it. Write a 3-5 page paper about the condition/issue. In the paper discuss the concepts below:

• What is the pathophysiology of one STI
• What is the etiology of the selected STI
• What are the clinical manifestations of the selected STI
• What is the treatment for the selected STI

I need 3 pages please

Answer 1

The Sexually transmitted infection that I have chosen for research is GONORRHOEA.

GONNORHEA: It is caused by infection with Neisseria Gonnorhea and may involve columnar epithelium in the lower genital tract, rectum, pharynx and eyes. Transmission is usually the result of vaginal, anal or oral sex. Gonococcal conjunctivitis may be caused by accidental infection from contaminated fingers. Also, if a mother hhas gonorrhoea and she is untreated at the time of delivery, the baby will contract the infection resulting in OPTHALMIA NEONATORUM. In some cases we see childres beyond neonatal period suffering from Gonnorhea which indicates sexual abuse of a children.

PATHOPHYSIOLOGY OF GONORRHOEA:

The pathophysiology of Neisseria Gonnorhea and  relative virulence of different subtypes depend on the antigenic characteristics of the respective surface proteins. Viruilence factors of the gonococcus include:

1) PILI : Neisseria Gonnorhea has complex genes coding for their PILI. These genes undergo multiple recombinations, resulting in the production of PILI with hypervariable amino acid sequences. These changing antigens in the pili prtect bacteria from our anti-bodies as well as from vaccines aimed at producing antibodies directed against the pili.

The PILI adhere to host cells allowing the gonococus to cause disease. They also serve to prevent phaggocytosis , probably by holding the bacteria so close to host cells that macrophages or neutrophils are unable to attack.

2) OUTER MEMBRANE PROTEIN PORINS : (PorA and PorB, formerly called protein 1) appear to promote invasion into epithelial cells.

3) Opa proteins : Are another class of outer membrane proteins that promote adherence and invasion into epithelial cells, these are so names as their expression results in opaque colonies.

Overall, the PILI , PORINS and Opa proteins allow the gonococci to bind to a fallopian tube non- ciliated epithelial cell. The gonococcal endotoxin (LPS) then destroys the cilia on neigboring cells. The gonococus is then taken up by endocytosis, transported in the endocytotic vacuole (where it multiplies) and is released into the subepethelial space , where it can cause more systemic infection.

ETIOLOGY OF GONNORHEA:

GONNORHEA is caused due to bacteria NEISSERIA GONORRHOEA (also known as GONOCOCCUS) in men and women who have unprotected sex. Neisseria Gonnorhea is a GRAM NEGATIVE BACTERIA. It can also be caused in a baby whose mother have active untreated infection of Gonnorhea at the time of delivery. GONNORHEA is the second most common sexually transmitted disease in world.

CLINICAL MANIFESTATIONS OF GONNORHEA:

The incubation period is usually 2-10 days.

Genitourinary symptoms in Women are as follows:

1. Vaginal discharge is the most common symptom. The discharge is thin, purulent and mildly odorous. Discharge is due to inflammation of cervix due to infection (endocervicitis) .

2. Dyspareunia, that is pain while having intercourse.

3. Intermenstrual bleeding, may be indicative of Pelvic Inflammatory disease (PID).

4. Mild lower abdominal pain.

5. Fever and chills if infection spread to pelvis (Pelvic Inflammatory Disease) .

•About 80% of women who have Gonnorhea are asymptomatic.

Genitourinary symptoms of Men in Gonnorhea are as follows:

1. Burning sensation on urination due to urethritis.

2. Serous discharge after few days which gets more profuse, purulent and at times with a tinge of blood in it.

3. Acute epididymitis, usually unilateral.

4. Rectal infection is usually asymptomatic but may present with anal discomfort, discharge or rectal bleeding, tenesmus.

5. Urethral stricture which is uncommon but may present with decreased urine stream.

COMPLICATIONS OF GONNORHEA:

1.Pharyngeal gonorrhoea is the result of receptive Orogenital sex and is usually symptomless.

2. Gonococcal conjunctivitis is an uncommon complication presented with purulent discharge from eyes , severe inflammation of conjunctiva and edema of eyelids, pain and photophobia.

3. Gonococcal OPTHALMIA NEONATORUM presents with purulent conjunctivitis and edema of eyelids.

4. Disseminated gonococcal infection (DGI) is rare and affects women with asymptomatic genital infection. Symptoms include arthritis of one joint or more , pustular skin lesion and fever.

5. Gonococcal endocarditis may also occur as a complication but rarely.

INVESTIGATION FOR GONNORHEA:

1. SMEAR taken from infected site shows GRAM NEGATIVE DIPLOCOCCI on Microscopy.

2. Pharyngeal smears are difficult to analyse due to presence of other DIPLOCOCCI , so the diagnosis must be confirmed by culture or NAAT ( Nucleic Acid Amplification Test).

TREATMENT OF GONNORHEA:

1. ANTIBIOTICS -

• Ceftriaxone 500 mg IM or

• Cefixime 400 mg stat or

• Ciprofloxacin 500 mg orally stat or

• Ofloxacin 400 mg orally stat or

• Amoxicillin 3 g plus Probenecid 1g orally stat.

For a pregnant and breastfeeding mother:

Antibiotics -

• Ceftriaxone 500 mg IM stat or

• Cefixime 400 mg stat or

• Amoxicillin 3 g plus Probenecid 1 gm orally stat or

• Spectinomycin 2 g IM stat.