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)