SEXUALLY TRANSMITTED DISEASES

The term sexually transmitted disease (STD) is used to refer to a condition passed from one
person to another through sexual contact. You can contract an STD by having unprotected
vaginal, anal, or oral sex with someone who has the STD. An STD may also be called a sexually
transmitted infection (STI) or venereal disease (VD).

That doesn’t mean sex is the only way STDs are transmitted. Depending on the specific STD,
infections may also be transmitted through sharing needles and breastfeeding.

General Symptoms of STDs in men

It’s possible to contract an STD without developing symptoms. But some STDs cause obvious
symptoms. In men, common symptoms include:

1. Pain or discomfort during sex or urination

2. Sores, bumps, or rashes on or around the penis, testicles, anus, buttocks, thighs, or
bleeding from the penis
3. Painful or swollen testicles

General Symptoms of STDs in women

In many cases, STDs don’t cause noticeable symptoms. When they do, common STD symptoms
in women include:

1. Pain or discomfort during sex or urination

2. Sores, bumps, or rashes on or around the vagina, anus, buttocks, thighs or bleeding from
the vagina
3. Itchiness in or around the vagina

Types of STDs

Many different types of infections can be transmitted sexually. The most common STDs are
described below.

CHLAMYDIA

Chlamydia is caused by the bacteria Chlamydia trachomatis, and can be transmitted through
vaginal, anal or oral sex. Many people infected with chlamydia will have no symptoms. Infection
often causes inflammation at the site of infection. Chlamydia can be easily treated and cured with
antibiotics. It’s the most commonly reported STD among Americans.

Symptoms of Chlamydia

1. Pain or discomfort during sex or urination

2. Green or yellow discharge from the penis or vagina
3. Pain in the lower abdomen

1
If left untreated, chlamydia can lead to:

1. Infections of the urethra, prostate gland, or testicles

2. Pelvic inflammatory disease
3. Infertility

If a pregnant woman has untreated chlamydia, she can pass it to her baby during birth. The baby
may develop:

1. Pneumonia
2. Eye infections
3. Blindness

Antibiotics can easily treat chlamydia.

HPV (human papillomavirus)

Human papillomavirus (HPV) is a virus transmitted through genital contact. HPV can infect the
genital areas of men and women, as well as the mouth and throat. While most people will never
develop symptoms and most infections go away by themselves, HPV can cause genital warts and
certain types of cancer. A vaccine is highly effective in preventing certain strains of HPV.

The most common symptom of HPV is warts on the genitals, mouth, or throat.

There’s no treatment for HPV. However, HPV infections often clear up on their own. There’s
also a vaccine available to protect against some of the most dangerous strains, including HPV 16
and HPV 18.

SYPHILIS

Syphilis is caused by the bacteria Treponema pallidum, and is transmitted primarily through
sexual contact when an open sore or ‘chancre’ is present during early stages of syphilis infection.
In later stages, syphilis decreases in infectiousness, but can cause significant cardiovascular and
neurological damage. Treatment for syphilis is highly effective and affordable with appropriate
antibiotics.

Later symptoms of syphilis can include: rash, fatigue, fever, headaches, joint pain, weight loss,
hair loss.

If left untreated, late-stage syphilis can lead to:

1. Loss of vision
2. Loss of hearing
3. Loss of memory
4. Mental illness
5. Infections of the brain or spinal cord
6. Heart disease and death

2
Fortunately, if caught early enough, syphilis is easily treated with antibiotics. However, syphilis
infection in a newborn can be fatal. That’s why it’s important for all pregnant women to be
screened for syphilis. The earlier syphilis is diagnosed and treated, the less damage it does. Find
the information you need to recognize syphilis and stop it in its tracks.

HIV

HIV can damage the immune system and raise the risk of contracting other viruses or bacteria
and certain cancers. If left untreated, it can lead to stage 3 HIV, known as AIDS. But with
today’s treatment, many people living with HIV don’t ever develop AIDS.

In the early or acute stages, it’s easy to mistake the symptoms of HIV with those of the flu. For
example, the early symptoms can include: fever, chills, aches and pains, swollen lymph nodes,
sore throat, headache, nausea, rashes

These initial symptoms typically clear within a month or so. From that point onward, a person
can carry HIV without developing serious or persistent symptoms for many years. Other people
may develop nonspecific symptoms, such as: recurrent fatigue, fevers, headaches, stomach issues

There’s no cure for HIV yet, but treatment options are available to manage it. Early and effective
treatment can help people with HIV live as long as those without HIV.

Proper treatment can also lower your chances of transmitting HIV to a sexual partner. In fact,
treatment can potentially lower the amount of HIV in your body to undetectable levels. At
undetectable levels, HIV can’t be transmitted to other people.

Without routine testing, many people with HIV don’t realize they have it. To promote early
diagnosis and treatment, it recommended that everyone between the ages of 13 and 64 be tested
at least once. People at high risk of HIV should be tested at least once a year, even if they don’t
have symptoms.

GONORRHOEA

Gonorrhoea is caused by the bacteria Neisseria gonorrhoeae, and is primarily transmitted

through sexual contact (involving the anus, penis, vagina, mouth or throat). Sometimes infection
does not produce any symptoms. Gonorrhoea is treated with a single dose of antibiotics usually
given as an injection, however drug-resistant strains are increasing.

Symptoms when present may include:

i. a white, yellow, beige, or green-colored discharge from the penis or vagina pain or
discomfort during sex or urination
ii. more frequent urination than usual
iii. itching around the genitals and sore throat

If left untreated, gonorrhoea can lead to:

i. infections of the urethra, prostate gland, or testicles

3
 ii. pelvic inflammatory disease
iii. infertility

It’s possible for a mother to pass gonorrhoea onto a newborn during childbirth. When that
happens, gonorrhoea can cause serious health problems in the baby. That’s why many doctors
encourage pregnant women to get tested and treated for potential STDs.

Gonorrhoea can usually be treated with antibiotics.

TRICHOMONIASIS

Trichomoniasis is caused by a protozoan parasite Trichomonas vaginalis, and is most commonly

transmitted sexually through penis-to-vagina or vulva-to-vulva contact. Infection often has no
symptoms, but women are more likely than men to get symptoms, ranging from mild irritation to
severe inflammation. Trichomoniasis is simple to cure with a single dose of appropriate
antibiotics.

Symptoms do develop, they may include:

i. discharge from the vagina or penis

ii. burning or itching around the vagina or penis
iii. pain or discomfort during urination or sex
iv. frequent urination

In women, trich-related discharge often has an unpleasant or “fishy” smell. If left untreated, trich
can lead to: infections of the urethra, pelvic inflammatory disease, infertility. Trich can be treated
with antibiotics.

HERPES

Genital herpes is caused by the herpes simplex-2 virus (HSV-2), and is primarily transmitted by
skin to skin contact. There is no cure for herpes and is a life-long infection that periodically
causes outbreaks. A herpes outbreak causes genital ulcers (or sores) and inflammation. While
there is no cure, treatment is available to reduce symptoms and decrease the risk of transmission
to a partner.

Herpes is the shortened name for the herpes simplex virus (HSV). There are two main strains of
the virus, HSV-1 and HSV-2. Both can be transmitted sexually. It’s a very common STD among
people ages 14 to 49.

HSV-1 primarily causes oral herpes, which is responsible for cold sores. However, HSV-1 can
also be passed from one person’s mouth to another person’s genitals during oral sex. When this
happens, HSV-1 can cause genital herpes. HSV-2 primarily causes genital herpes.

The most common symptom of herpes is blistery sores. In the case of genital herpes, these sores
develop on or around the genitals. In oral herpes, they develop on or around the mouth.

4
Herpes sores generally crust over and heal within a few weeks. The first outbreak is usually the
most painful. Outbreaks typically become less painful and frequent over time.

If a pregnant woman has herpes, she can potentially pass it to her fetus in the womb or to her
newborn infant during childbirth. This so-called congenital herpes can be very dangerous to
newborns. That’s why it’s beneficial for pregnant women to become aware of their HSV status.

There’s no cure for herpes yet. But medications are available to help control outbreaks and
alleviate the pain of herpes sores. The same medications can also lower your chances of passing
herpes to your sexual partner.

Effective treatment and safe sexual practices can help you lead a comfortable life with herpes
and protect others from the virus. Get the information you need to prevent, recognize, and
manage herpes.

GENERAL STD PREVENTION

Avoiding sexual contact is the only fool-proof way to avoid STDs. But if you do have vaginal,
anal, or oral sex, there are ways to make it safer.

When used properly, condoms provide effective protection against many STDs. For optimal
protection, it’s important to use condoms during vaginal, anal, and oral sex. Dental dams can
also provide protection during oral sex.

Condoms are generally effective at preventing STDs that spread through fluids, such as semen or
blood. But they can’t fully protect against STDs that spread from skin to skin. If your condom
doesn’t cover the infected area of skin, you can still contract an STD or pass it to your partner.

Condoms can help protect against not only STDs, but also unwanted pregnancy.

Regular STD screening is a good idea for anyone who’s sexually active. It’s particularly
important for those with a new partner or multiple partners. Early diagnosis and treatment can
help stop the spread of infections.

Before having sex with a new partner, it’s important to discuss your sexual history. Both of you
should also be screened for STDs by a healthcare professional. Since STDs often have no
symptoms, testing is the only way to know for sure if you have one.

When discussing STD test results, it’s important to ask your partner what they’ve been tested for.
Many people assume their doctors have screened them for STDs as part of their regular care, but
that’s not always true. You need to ask your doctor for specific STD tests to ensure you take
them.

If your partner tests positive for an STD, it’s important for them to follow their healthcare
provider’s recommended treatment plan. You can also ask your doctor about strategies to protect
yourself from contracting the STD from your partner. For example, if your partner has HIV, your
doctor will likely encourage you to take pre-exposure prophylaxis (PrEP).

5
If you’re eligible, you and your partner should also consider getting vaccinated for HPV and
hepatitis B.

By following these strategies and others, you can lower your chances of getting STDs and
passing them to others.

6
 ARTHROPODS OF MEDICAL IMPORTANCE

Arthropods are small invertebrate animals with jointed legs. Instead of having an internal
skeleton made of bone, they have an external shell-like skeleton made of a tough, rigid material
called chitin. Their body parts and appendage segments are joined by flexible membranes which
allow the various parts to move.

The majority of arthropods are not harmful to humans. However, a number of species are
considered medically important because they can cause annoyance, physical discomfort, or
disease in humans. Arthropods of medical importance include insects (class Insecta) and
arachnids (class Arachnida). Of the arachnids, only mites and ticks (order Acarina) are vectors of
diseases. Of the insects, five groups are of medical importance: true flies (order Diptera), true
bugs (order Heteroptera, or Hemiptera), lice (order Anoplura), fleas (order Siphonaptera), and
cockroaches (order Dictyoptera).These arthropods can be put into four main categories:

1. Harmful cause nuisance, discomfort, and/or blood-loss by their bites (mosquitos, bugs,
fleas); or cause nuisance by their mere presence (gnats).
2. Ectoparasites live and feed permanently on the exterior of the host without transmitting
germs (head lice, pubic lice, scabies mites).
3. Mechanical transporters transmit disease passively, by picking up infections from faeces,
and then contaminating human food so that disease is contracted orally (flies,
cockroaches).
4. Vectors actively transmit parasitic disease-causing organisms. The pathogen develops
and multiplies in the vector, and is transmitted to humans via the arthropod's bite or
excreta (mosquitos, tsetse-flies, body lice, fleas).

LICE

7
Three types of sucking lice are important for human health: Pediculus humanus capitis (head
louse), P. humanus humanus (body louse) and Pthirus pubis (crab louse). Lice spend all of their

life on one very specific host and both male and female feed on blood and leave one host only to
transfer to another.

Head Lice

In the developed world, 2 to 10% of children are infested with head lice. Light infestations cause
moderate itching of the scalp due to sensitization to louse saliva. Heavy infestations may result in
fever, aches and secondary infections. Diagnosis is based on finding live lice or empty egg shells
(nits measuring 0.8 x 0.3 mm) attached to hair, often behind the ears. Topical application of
soothing lotions relieves irritation. Hair should be washed with shampoo containing 1% benzene
hexachloride (Kwell). Application of a mixture of pyrentins (0.2%) and pipronyl butoxide (2%)
or copper oleate may be as effective and less toxic than benzene hexachloride.

Body Lice

The body louse is similar to the head louse except that it is found on the body and clothes.
Diagnosis is based on finding eggs or nits (eggs) in seams of clothing. Symptoms and treatment
are the same as those for head lice.

Pubic Lice

Pubic lice also known as crab lice, infest widely-spaced coarse hair in the pubic area in adults or
eye lashes in children. Transmission in adults is usually by sexual contact. Diagnosis is based on
finding lice or nits in the infested area; crab lice may be difficult to see at the base of the hair.
The pubic area is treated in the same manner as the infested head. Nits and lice may be removed
from eye lashes with forceps. Ointments with physostigmine (0.25%) or yellow mercury oxide
are effective.

FLEAS

8
Most fleas are of clinical significance to man because they are vectors for other parasites.
However, the jigger flea or chigoe (Tunga penetrans) is a serious pest in the tropical and

subtropical regions of the Americas and Africa. Diagnosis of tungiasis is rare in North America.
An epidemiological study in a traditional fishing village in Ceará State, north-eastern Brazil
found about 51% of the population was infested.

Both sexes feed on blood. The female flea, after insemination, burrows itself in the skin of the
toes and the sole of the foot. The female swells to the size of a pea, produces eggs and dies in the
tissue. There is local reaction to the bite and the eggs and dead flea produce reaction. The
infested tissue can get infected and gangrenous; auto-amputation is not uncommon. Treatments
are symptomatic: infestation may be physically removed; secondary infections are treated
appropriately. Shoes should be worn in infested areas.

Tungiasis from a dog. Tunga penetrans may also pose significant problems in dogs but
infestation tends to be sporadic,geographically isolated,or related to special environmental
circumstances. The impregnated Tunga female attaches firmly to the dog,usual areas being the
interdigital spaces,under the pads, and the scrotum. The presence of a number of adult
[Link] in the the paws can be crippling, and the damage to the skin can facilitate the entry
of other pathogens leading to secondary infection and ulceration.
LOCUSTS

These insects are most important to man as a species, because of their potential to wreak havoc
on crops. However, a less known hazard is the potential for sensitisation (usually of laboratory
workers) to antigenic constituents of the body of the insect. This can result in occupational
asthma.

9
MITES

Scabies mite (Sarcoptes scabei) is the cause of scabies and is distributed worldwide. Epidemics
of the disease may occur for long periods but mites may be common at all times in very poor
communities with inadequate washing facilities. The mite transmitted by contact burrows into
the skin on the webbing side of fingers, later spreading to the wrists, elbows and the rest of the
body. The buttocks, women's breasts and external genitalia may be involved.

The mite tunnels itself through the upper layer of the skin depositing eggs. Larvae escape the
tunnel and wander on the skin and start new burrows and mature there to continue the cycle.
Scabies itch is due to the sensitization of the patient to the mite and eggs and is characteristically
nocturnal. Septic pustules may develop after scratching, if the hygiene is poor. Diagnosis is made
by the characteristic rash and by smearing black ink on the skin and observing burrows when the
ink is wiped away. Microscopic examination of a skin scraping shows the mites. Treatment
involves swabbing of the whole body from the neck down with 1% malathion or benzene
hexachloride (crotamiton for infants). Topical steroids must not be used. If possible, the whole
family should be treated. Contact with an infested person should be avoided. Clothes should be
washed in hot water.

CHIGGERS

Chiggers are an important group of ectoparasites affecting humans. They attach to the skin in the
ankles, waistline, armpits and perianal area after the host walks through a grassy environment.
Contrary to popular belief, these mite larvae do not feed on blood and do not burrow into the
skin. They pierce the skin near a hair follicle and feed on partially digested skin cells using
enzymes in the chigger's saliva.

10
They then drop off the host. The host reacts to the mouth parts and saliva of the mite, however,
and after a few hours an erythematous papule appears (figure 8) that is highly pruritic. The
intensity of the eruption depends on the sensitivity of the host and may be followed by fever.

Treatment with a local anesthetic is useful. Insect repellents (DEET) may be effective in
avoiding chigger bites. In south Asia, chiggers are the vectors for scrub typhus (Orientia
tsutsugamushi), a rickettsial disease that can (rarely) be life-threatening.

BOT FLY AND TUMBU FLY - Myiasis

Myiasis is the parasitism of a vertebrate host by the larva of a dipteran fly. It frequently occurs in
domestic and wild animals and therefore is important in veterinary medicine. Human cases are
rare but occur especially in tropical countries. In the United States, the most common agents of
myiasis are Dermatobia hominis (bot fly, berne) and Cordylobia anthropophaga (tumbu fly). The
former occurs in central (particularly Mexico and Belize) and south America and some
Caribbean islands such as Trinidad, while the latter occurs in tropical Africa. The larvae of both
of these flies are obligate parasites of mammals.

The human bot fly has a very interesting life cycle. The female fly captures a mosquito and lays
its eggs on its abdomen. When the released mosquito takes a blood meal (usually on the face,
scalp or extremities), the body heat of the mammal causes the eggs to hatch into a first instar
larva, which drops onto the skin of its host. The larva either enters the skin via the puncture
wound made by the mosquito or actively penetrates the skin where it takes up residence in sub-
cutaneous tissue. Here, the larva matures through second and third instars over a period of one or
two months. The larvae are difficult to remove because of backward facing barbs. When they are
mature, the larvae emerge and fall to the ground where they pupate into the adult fly and the life
cycle repeats. The adult fly only lives a few days and does not feed.

11
The initial symptom of the presence of a bot fly is a cutaneous nodule that contains one larva
(although this is not initially visible). The nodule is often called a warble or a furuncle and
myiasis is often referred to as a furunculous disease. Unlike a puncture wound of a mosquito, the
infected nodule discharges blood or serum continually because the larva needs to keep the wound
open in order to breath. There is often pruritus and sometimes intense periodic shooting pain that
occurs when the larva moves or matures to another instar. As the larva grows, movement can
often be seen below the surface of the serosanguineous effusion. There may also be local
lymphadenopathy, and fever and malaise if a secondary bacterial infection develops.

Treatment entails removal of the larva, although some patients prefer to allow the larva to
develop and emerge naturally. In the case of Dermatobia hominis, the Achilles heel is the need
for the larva to breath air through the open wound. Cutting off the parasite's air supply is most
often done by applying a thick layer (at least 5mm) of Vaseline, although nail polish, adhesive
tape and even bacon have been reported to be used. Because of the lack of oxygen, the larva will
usually emerge and can be pulled the remaining way out with forceps. However, it often takes a
day for the larva to come far enough out to be grabbed with forceps. Surgery is not usually
necessary unless the larva dies in situ and cannot be removed.

12