Sexually Transmitted Diseases What’s New?

Sexually Transmitted Diseases What’s New?
By:Linda Creegan, FNP
California STD/HIV Prevention Training Center


Common STDs

* Humanpapilloma Virus
* Trichomoniasis
* Chlamydia
* Genital herpes
* Gonorrhea
* Hepatitis B
* Syphilis

Overview of Complications of Sexually Transmitted Diseases

Fetal Wastage*
Low Birthweight*
Congenital Infection*
Upper Tract Infection
Systemic Infection
STDs
Infertility
Ectopic Pregnancy*
Chronic Pelvic Pain
HIV Infection*
Cervical Cancer*
* Potentially Fatal
Increased Transmission of HIV in the Presence of Other STDs
* Transmission increased 3-5 times
* Increased susceptibility
* Increased infectiousness
Chlamydia
Gonorrhea
Risk Factors
Recommendations
Syphilis
P&S Syphilis
Genital Herpes
Herpes simplex virus type 2
Genital Warts
What’s New with Chlamydia Infection?
Chlamydia Infections in Women and Neonates
Genital Chlamydia in Women: Complications
Untreated genital CT infection
Ectopic pregnancy
Infertility
Chronic pelvic pain
Public Health Approaches to Chlamydia Control
Chlamydia Screening & Treatment
CT Screening Cost-Effective
Chlamydia Screening Recommendations
Chlamydia Testing Current Diagnostic Methods
Chlamydia Testing Nucleic Acid Amplification Tests
Hybrid Capture
Genital Chlamydia Diagnostic Tests
Sensitivity
Urine-Based CT Tests
Cost Effectiveness of NAAT
Chlamydia Follow-up
Is Test-of-Cure Necessary?
Chlamydia Partner Management
What’s New with Gonorrhea?
Gonorrhea Infection
Gonorrhea Clinical Presentation
Gonorrhea Complications
Gonorrhea Diagnosis
Gonorrhea Anal and Pharyngeal Infections
Gonorrhea Treatment
Uncomplicated Genital and Rectal Infections,
Non-Pregnant Adults
GC Partner Management
Use of Fluoroquinolones to Treat GC Infection:Recommendations
GC LCR Screening
Gonorrhea Screening Recommendations
What’s New with Syphilis?
Syphilis Elimination Public Health Importance
National Plan for Syphilis Elimination Five Key Strategies
Understanding STD Trends in MSM
Syphilis Management in HIV Co-Infected Patients
Syphilis Diagnostic Testing
Syphilis New Therapies
What’ s New with Genital Herpes?
Herpes: Overview
Genital Herpes Infection Epidemiology
HSV-2 Seropositivity
Human Herpesvirus Family
Genital Herpes Transmission
Genital Herpes Natural History
Genital Herpes Categories of Infection
Genital Herpes First Clinical Episodes
Genital Herpes Reactivation of Virus
Genital Herpes Educating to Recognize Symptoms
Genital Herpes Patient’s Perception of Etiology
Genital Herpes Asymptomatic Shedding
Genital Herpes Spectrum of Presentations
Neonatal Herpes Infection
Herpes Transmission in Pregnancy
Herpes Diagnostic Tests
Herpes Diagnosis Serologic Tests
HSV Serology Testing
Genital Herpes Principles of Treatment
Antiviral Medications for Uncomplicated HSV
Genital Herpes What’s New in Treatment?
Genital Herpes Treatment in Pregnancy
Genital Herpes Vaccine Development
Dermal HPVs
Thin-Layer Pap Preparations
ThinPrep Pap Specimen Collection
ThinPrep Pap Test
HPV DNA Tests
Utility of HPV Testing
Conduct HPV test on stored specimen
HPV Disease Management of HIV Infected MSM
Prevention of Genital HPV Infection and Sequelae:
Abnormal Flora in Bacterial Vaginosis (BV)
BV: Complications in Pregnancy
BV: Diagnostic Criteria
Amsel Criteria
BV: Screening in Pregnancy
BV: Treatment Non-Pregnant Women
Trichomoniasis
Trichomoniasis: Diagnosis
Culture System for T. vaginalis
Trichomoniasis Treatment During Pregnancy
Recommended regimen:
Trichomoniasis
Role in Urethritis

Sexually Transmitted Diseases What’s New?.ppt

Read more...

Forensic Serology

Forensic Serology

Forensic serology is the application of the study of blood, semen, saliva and other body fluids, to legal matters. The field generally is comprised of the detection of enzymes and antigens, as in the identification of seminal stains or blood typing (ABO and secretor status) and DNA typing (by PCR or RFLP analysis).

The serology section of a forensic laboratory may deal with any or all of the following:
* blood typing
* characterization of unknown blood
* blood spatter analysis for crime reconstruction
* paternity testing
* semen identification in rape cases
* DNA techniques used for identification

The Composition of Blood
Blood is a mixture of many components:
cells inorganic substances (salts)
enzymes water
proteins
Forensic Characterization of Bloodstains
Three questions that must be answered by the forensic investigator:
1) Is it blood? Use presumptive tests:
Kastle-Meyer
Leuchomalachite Green
Luminol
2) Is it human blood?
Precipitin Test
3) Can it be associated with an individual?
DNA

Is It Blood? Presumptive Tests for Blood

Luminol
* Red blood cells contain hemoglobin (Hb) – the protein responsible for transporting oxygen
* Each Hb contains four iron (Fe) containing hemes
False Positives
Precipitin Test Procedure
* animal (usually a rat or rabbit) is injected with human blood
* animal’s blood forms antibodies
* antibodies are harvested from animal’s blood serum (“antiserum”)
* in a test tube, an extract from the suspected bloodstain is addedto the antiserum
* if a precipitate forms where the two meet, it is human blood

Confirmatory Tests
Blood Typing: Antigens
Blood Typing Example
A sample of unknown blood is mixed with three anti-sera samples:
Tube 1 (Anti-A): No reaction
Tube 2 (Anti B): No reaction
Tube 3 (Anti Rh): Cloudy reaction
Characteristics of Blood
CLASS
Species
Type
Disease
Rh factor
INDIVIDUAL
DNA
Bloodstain Analysis
Categories of Bloodstains:
Passive (dripping)
Transfer (smearing)
Projected
Projected Bloodstain Analysis
Two Important Determinations:
a. direction of spatter
b. angle of impact with surface
Forensic Characterization of Semen
Many crimes involve sexual assault. Forensic Investigators may need to search for semen stains at a crime scene. Bedding, clothing, carpets, cushions, vehicle seats, etc.

Seminal Fluid contains:
* water, spermatozoa, enzymes, inorganic salts
Presumptive Tests

Confirmatory Test Required
Microscopic examination of sperm
False Positives
Forensic Characterization of Saliva

Forensic Serology.ppt

Read more...

Male Reproductive Problems

Male Reproductive Problems
By:Fertilization Specialists
Joshua Prince
Preston Moore
Candace Lindler

Infertility
* Infertility is the inability of a couple to become pregnant

Treatment
Normospermia with functional defects
Asthenospermia and teratozoospermia
Oligospermia
Untreatable subfertility
Reversible toxin effects
Disorders of sexual function
Gonadotropin deficiency
Obstructive azoospermia
Sperm autoimmunity
Treatable conditions
Primary seminiferous tubule failure
Untreatable sterility
FREQUENCY (%)

TYPE OF INFERTILITY
Table 1. Classification Of Male Infertility By Effectiveness Of Medical Intervention To Improve Natural Conception Rate
* Sperm count equals the number of sperm per cm3 or cc
* The average has dropped in the past 20 years
* 85-90% are treated with medication or surgery
* Lifestyle changes

Normal Reproduction
* Ovulation
* Spermatogenesis
* Sperm meets with egg in fallopian tube
* Fertilization
* Implantation

Male Reproductive System
Female Reproduction System
Normal Spermatogenesis
Testes
* Spermatogonium (2N)
Differentiation
* Primary Spermatocyte (2N)
Meiosis I
* Secondary Spermatocytes
Meiosis II
* Spermatids
Differentiation
* Spermatozoa
Spermatogenesis
* Seminferous Tubules
90% of the testis
* Thousands of sperm per second although spermatogenesis 8-10 weeks
* Stored for months
* Degraded and deposited into the circulatory system if not ejaculated
Klinefelter Syndrome
* XXY instead of XX or XY
* usually male
* lower levels of testosterone
* improper formation of semineferous tubules

Bilateral Anorchia
* vanishing testes syndrome
* testes originally present but reabsorbed before or after birth
Oligospermia
* having too few sperm
* due to:
fever
excessive alcohol
smoking
varicocele
orchitis

Azoospermia
* total lack of sperm in ejaculate
* due to:
fever
undescended testicle
obstructions of seminal vesicles
testicle infection

Cryptorchidism
* 30% of males born premature
* 3% of males carried to term
* Predisposes the person to risk of torsion
* Androgen receptor
* Bilateral has six times the impact on infertility
* Increase in Temperature
* Testicular atrophy
* Treated at Childhood

Abnormalities
* Testicular torsion
of the spermatic cord cuts off the venous drainage, leading to hemorrhagic infarction
It is the twisting of the spermatic cords
Immediate treatment
* Testicular cancer

Illnesses
* Acute
* Chronic
Orchitis
STDs
* Fibropapilloma
Stimulants
Age
Gynecomastia
* Testicular Failure
* Androgen receptors
* Cirrhosis
* Tumors
* Illegal steroid
* Feminine characteristics

Examination
* Inflammation would cause pain
* Lack of hair
* Normal volume equals 15 to 35 ml
* Small is equal to 5 ml or less and would also signal androgen deficiency
* Hard lumps would signal tumors
* Softness would signal reduced spermatogenesis

Varicoceli
* Enlarged and twisted varicose veins
* 15-20% of men
* Elevates the temperature
* Obstructs passage of semen
* Obstructs oxygen supply
Environmental
* Polychlorinated biphenyls
* Testosterone
* Free Radicals
* Emotional stress

Physical Obstruction to Gamete Movement
* Blocked or absent seminal ducts
* Seminal fluid disorders
* Retrograde ejaculation
* Inability to ejaculate

Blocked or Absent Ducts
* Bilateral congenital absence of the vas deferens
* Obstruction of the epididymis or vas deferens
* Mechanical blockage during hernia repairs
* Blocked seminal vesicles

Seminal Fluid Disorders
* Absent antioxidant factors
* Abundant circulating free radicals

Retrograde Ejaculation
* Reverse ejaculation into the bladder
* Causes:
o Prostate surgery
o Certain medications
o Diabetes
o Spinal cord injuries
Inability to Ejaculate
* Erectile dysfunction
o Diabetes
o Prostate surgery
o Urethra surgery
o Blood pressure medications

Hormonal Obstruction to Gamete Movement
* Endocrine disorders
* Steroids
* Unexplained low levels of needed hormones

Endocrine Disorders
* Pituitary disorder
* Feminization
* Kallmann’s syndrome
* Hypothyroidism
* Other Causes

Improper Fusion of Sperm and Egg
* Antisperm Antibodies
o Immobilization
o Agglutinating
o Sperm-cervical mucus interaction
o Penetration of the egg
o Sperm fertilization
o Zygote development
Improper Fusion of Pronuclei
Miscarriage
Chemical Miscarriage
Molar Pregnancy
References

http://www.wernermd.com/Azoospermia.html
http://www.howtomakeafamily.com/experts/lewis/male_factor_infertility.htm
http://infertility.health-info.org/male-infertility/male-infertility-sperm-disorders.html
http://www.merck.com/mmhe/sec21/ch240/ch240e.html
http://www.resolve.org/site/PageServer?pagename=lrn_jfm_mfed
http://www.resolve.org/site/PageServer?pagename=lrn_jfm_mfaa
http://upload.wikimedia.org/wikipedia/commons/b/b5/Gray8.png
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=dbio.section.1412
http://www.nature.com/ncb/journal/v3/n2/full/ncb0201_e59.html
http://www.babycenter.com/0_molar- pregnancy_1363614.bc?Ad=com.bc.common.AdInfo%40575bc872
http://www.wdxcyber.com/chemical_pregnancies.html
http://www.merck.com/mmpe/print/sec19/ch282/ch282f.html
http://uk.answers.yahoo.com/question/index?qid=20061208102440AA2g80G
http://www.varicocelespecialists.com/faq3.htm
http://www.endotext.org/male/male7/maleframe7.htm
http://copa.org/med/sperm.htm
http://www.ivf.com/shaban.html
http://www.ucalgary.ca/UofC/eduweb/virtualembryo/spermatogenesis.html

Male Reproductive Problems.ppt

Read more...