性传播疾病(八年制)课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,性传播疾病(八年制)课件,性传播疾病：是指以通过性行为为,主要,传播途径的一组传染病,性传播感染,(,s,exually,t,ransmitted,i,nfection,s,STIs,):,重视,无症状感染,。目前列入性传播疾病的病种已达,20,多种。,1999,年,WHO,建议采用,Intimate contact:,body contact, kissing.,sexually transmitted disease,STD,性传播疾病：是指以通过性行为为主要传播途径的一组传染病sex,Gonorrhea,淋病,Syphilis,梅毒,Condyloma acuminata,尖锐湿疣,Genital chlamydial infection,衣原体感染,Genital herpes,生殖器疱疹,AIDS,content,Gonorrhea 淋病 content,艾滋病（包括,HIV,感染者）,梅毒,淋病,中华人民共和国传染病防治法,国家必须上报的三种性病,（乙类）,艾滋病（包括HIV感染者）国家必须上报的三种性病（乙类）,三种性病发病率,（,1/10,万）,HIV,淋病 梅毒,1990 0 6.95 0.09,1997 0.15 13.77 1.77,2000 0.20 18.64 5.08,2006 2.42 12.14 12.8,2008 0.76 9.9 19.49,摘自中国疾病控制中心,2009,年中国卫生统计数据,性传播疾病(八年制)课件,我国性病流行的发展阶段,第一阶段,(1977,年,1985,年,),：传入阶段。由海外传入至,沿海开放城市,第二阶段,(1985,年,1988,年,),：逐渐蔓延阶段,.,由沿海开放城市向,内陆城市,蔓延。至,1988,年全国,30,个省（市、区）均报告发现性病病例,第三阶段,(1989,年,1992,年,),：由,城市向农村,地区蔓延,第四阶段,(1993,今,),：流行,我国性病流行的发展阶段,1,、性接触传播,2,、间接接触传染,3,、血液和血液制品传播,4,、母婴垂直传播,5,、医源性传播,6,、器官移植、人工授精等传播,STD-,传播途径,1、性接触传播STD-传播途径,病名,病原微生物,淋病 淋病奈瑟菌,梅毒 梅毒螺旋体,尖锐湿疣 人类乳头瘤病毒,生殖器疱疹 单纯疱疹病毒,支原体 解脲支原体,沙眼衣原体 沙眼衣原体,艾滋病 人类免疫缺陷病毒,STD-,病原体,病名 病原微生物STD-病原体,第一节 淋 病,Gonorrhea,第一节 淋 病,淋病奈瑟菌,为,革兰染色阴性,双球菌,离开人体不易存活,一般消毒剂可杀灭,对柱状上皮、移行上皮有特殊的亲和力,易隐藏并侵袭泌尿、生殖系统粘膜,淋病奈瑟菌,性传播疾病(八年制)课件,宫颈、尿道、尿道旁腺、前庭大腺,子宫内膜、输卵管、盆,腔 播散淋病,黏附,菌毛,膜蛋白,并被其吞饮,脂多糖内毒素,炎症反应,摧毁,Mechanism,宫颈、尿道、尿道旁腺、前庭大腺 子宫内膜、输卵管,性接触传播,间接接触传染,产道感染 ，新生儿眼结膜炎,淋病,-,传播途径,淋病-传播途径,Latent period: 1,10 days,average: 3,5 days,After exposure to an infected partner:,men: 20,50%,become infected,women: 60,90%,Gonorrhea manifestation,Latent period: 1 10 days, G,下生殖道感染,（无并发症淋病）,Uncomplicated gonococcal infection,上生殖道感染,（女性并发症淋病）,Complicated gonococcal infection,播散性淋病,Disseminated gonococcal infection,Gonorrhea manifestation,下生殖道感染（无并发症淋病）Gonorrhea manife,下生殖道淋病,Vulva (including Bartholins gland) , vagina, cervix, and urethra may be inflamed,图,1,：,女性淋病,图,2,：,淋菌性宫颈管炎,图,3,：,淋菌性前庭大腺炎,下生殖道淋病图1 ：女性淋病图2：淋菌性宫颈管炎图3,Endometritis, salpingitis and peritonitis,Pelvic pain, cervical motion and adnexal tenderness, adnexal mass, and the presence of fever,上生殖道淋病,Endometritis, salpingitis and,1%3%,Polyarthralgia,(,关节炎,）, tenosynovitis,(,腱鞘炎,）,Endocarditis and meningitis,(,脑膜炎,）,have been described,In the former,: Septicemia,In the latter,: gonorrhea cultured from joint aspirates,播散性淋病,1%3%播散性淋病,1,、,有不良性接触史；,2,、,临床表现：,脓性分泌物，脓尿,3,、,实验室检查：,分泌物涂片检查（检出率,40,60%,）,Gram stained smear: intracellular,gram-negative diplococci,分泌物淋菌,培养,（检出率,80,90.5%,）,核酸检测,:PCR,（检出率,84,97%,）,PCR high false positive rate,淋病诊断,1、有不良性接触史；淋病诊断,Must be suspected of having other STIs,eg, syphilis, HIV, and chlamydial infection,Dual therapy,: esp for chlamydial infection,20,40%,，,（,20,40%,合并,CT,),eg, doxycycline,(,多西环素）,azithromycin,（阿奇霉素）,Sexual partners,be treated with a similar antibiotic regimen,淋病治疗,Must be suspected of having ot,原则：及时、足量、规范用药,药物：首选第三代头孢菌素,（,the 3rd generation of cephalosporin),：,头孢曲松钠,(,菌必治,),治愈标准,：临床症状完全消失，治疗后,4,7,天取宫颈管分泌物涂片及培养为阴性,Discharge smear,and,culture after 4-7days of treatment : (-),淋病治疗,原则：及时、足量、规范用药淋病治疗,Uncomplicated gonococcal infection,Ceftriaxon,（头孢曲松）,250mg im (,single dose,),Cefixime,(,头孢克肟）,400mg po (single dose),Cefotaxime,（头孢噻肟）,1g im (single dose),Spectinomycin(,大观霉素）,淋病治疗,Uncomplicated gonococcal infec,complicated gonococcal infection :,Ceftriaxon,500mg, im ,10,d,Spectinomycin,(,大观霉素）,2g im qd,+Metronidazole 400mg bid ,10,d,or +doxycycline100mg bid ,10,d,Disseminated gonococcal infection,Ceftriaxon,1g, im,iv,10,d,Ceftizoxime,（头孢唑肟钠）,1g,iv,10,d,淋病治疗,complicated gonococcal infecti,Early stage: abortion,Late stage: chorioamnionitis,PROM, preterm birth,IUGR,，,conjunctivitis of infant,，keratitis,of infant,分娩时产程延长；分娩后产褥感染，淋病播散,新生儿:,淋菌结膜炎、肺炎，甚至出现淋菌败血症，围产儿,死亡率增加,Gonorrhea in pregnancy,Early stage: abortionGonorrhea,1.,分娩方式,如无产科指征均可阴道分娩。未治疗的孕妇（非剖宫产指征）应立即按前述方案治疗,2.,淋菌孕妇娩出的新生儿，,1%,硝酸银液滴眼,预防眼炎，头孢曲松钠,25mg,50mg/kg,肌注或静脉注射,预防：,对高危病人，产前常规筛查淋菌，妊娠早、中、晚期作宫颈分泌物涂片或培养,Gonorrhea in pregnancy,1.分娩方式Gonorrhea in pregnancy,第二节,梅 毒,Syphilis,第二节 梅 毒,由,苍白密螺旋体,引起的慢性全身性传播性疾病,早期侵犯生殖器所属淋巴结及全身皮肤、粘膜淋巴结,晚期侵犯心血管、神经系统、骨骼等器官,梅毒螺旋体（渡银染色，油镜）,syphilis,由苍白密螺旋体引起的慢性全身性传播性疾病梅毒螺旋体（渡银染色,Cause by treponema pallidum,latent syphilis,syphilis,Cause by treponema pallidumsyp,chancre:,an indurate, firm painless ulcer with raised borders,Groin lymph nodes,: Enlarge, firm, and painless,（,单侧或,双侧腹股沟淋巴结肿大）,潜伏期约,10,90,天，多数,在,6,周内。一般,3,6,周自愈，,故不易被发现,梅毒硬下疳,Primary syphilis,一期梅毒,chancre: an indurate, firm,全身出现各种皮疹，,2,6,周消退,25%,的患者常因病损轻微而被忽视,Spirochetes spread hematogenously,Dermatitis: diffuse, bilateral, symmetric, papulosquamous (,丘疹鳞屑性）,Patchy alopecia (,斑丘）,Mucous patches (,扁平湿疣）,Hepatitis, nephritis,Secondary syphilis,二期梅毒,全身出现各种皮疹， 26周消退, 25%的患者常因病损轻微,性传播疾病(八年制)课件,性传播疾病(八年制)课件,性传播疾病(八年制)课件,梅毒扁平湿疣,梅毒扁平湿疣,表现为永久性皮肤黏膜损害,Skin or bone (gummas,树胶肿）,cardiovascular system,nervous system,Tertiary syphilis,三期梅毒,表现为永久性皮肤黏膜损害Tertiary syphilis,传播途径：,通过皮肤或粘膜,破口,侵入机体,1,、性接触传播,2,、间接感染,3,、血液和血液制品传播,4,、母婴垂直传播：患病孕妇通过胎盘感染胎儿，新生儿在分娩通过软产道时受传染,syphilis,传播途径：通过皮肤或粘膜破口侵入机体 syphilis,对胎儿及婴幼儿影响,流产、死胎、死产；早产；,先天梅毒儿,syphilis,对胎儿及婴幼儿影响syphilis,先天梅毒儿（胎传梅毒儿）,病死率、致残率高,早期,皮肤大疱、皮疹、鼻炎及鼻塞、肝脾肿大、淋巴结肿大等,晚期,楔状齿、鞍鼻、间质性角膜炎、骨膜炎、神经性耳聋等,先天梅毒早期表现（皮疹）,syphilis,先天梅毒儿（胎传梅毒儿）病死率、致残率高先天梅毒早期表现（皮,1. Identification of the organism,（,病原学检查,）,T pallidum can be identified by darkfield examination of specimens from cutaneous lesions,2. Serologic tests,（,血清学检查,）,Nontreponemal test,(,非梅毒螺旋体抗原试验）：,VDRL,（性病研究实验室试验）,RPR,（快速血浆反应素环状卡片试验）,for screening,TRUST,（甲苯胺红血清不加热试验）,诊断,-,实验室检查,1. Identification of the orga,梅毒螺旋体抗原试验,(,treponemal antibody test,）,主要用于,证实试验,TP-PA,（,梅毒螺旋体颗粒凝集试验,）,TPHA,（,梅毒螺旋体血凝试验,）,FTA-ABS,（荧光密螺旋体抗体吸收试验）,More sensitive and specific,diagnosis,梅毒螺旋体抗原试验 (treponemal antibo,原则,：,早期诊断、及时治疗、用药足量、疗程规范,药物,：,首选青霉素,（,普鲁卡因青霉素、卞星青霉素,),若青霉素过敏，改用红霉素等,治疗,原则：早期诊断、及时治疗、用药足量、疗程规范治疗,1.,Benzathine penicillin G,（,苄星青霉素,）,240,万,u,分两臀肌注,qw2-3W,PG,(,青霉素,),60-80,万,u im qd15,天,2.,红霉素,0.5 q6h15,天,Ceftriaxon,（,头孢曲松,）,1g im /iv qd10,Tetracycline hydrochloride,500mg qid15,Doxycycline (,多西环素）,100mg bid 15,Early syphilis,(,早期梅毒及接触者,),1. Benzathine penicillin G（苄星青,1.,青霉素治疗（均需皮试）,Benzathine penicillin G,240,万,u,im,qw3,PG 0.8 million im qd20,2. Tetracycline hydrochloride, 500mg qid30,Doxycycline 100mg bid 30,late syphilis,1.青霉素治疗（均需皮试）late syphilis,注意事项：,治疗期间避免性生活，,性伴侣,同时检查及治疗,治愈标准,：,临床治愈：各种损害消退，症状消失。,血清学治愈：抗梅毒治疗后,2,年内，梅毒血清学试验转为阴性，脑脊液检查阴性,梅毒,注意事项：梅毒,第,1,年，每,3,月一次；,第,2,3,年，每,6,月一次。,内容：全身,生殖器,血清学检查,Syphilis-,随访,Syphilis-随访,第三节,尖锐湿疣,Condyloma acuminata,第三节 尖锐湿疣,由人类乳头瘤病毒,（,human papilloma virus,，,HPV,）,感染引起,鳞状上皮疣状增生,病变的性传播疾病,HPV,属双环,DNA,病毒,其分化繁殖需鳞状上皮存在,.,人类乳头瘤病毒（透射电子显微镜）,Condyloma acuminata,由人类乳头瘤病毒 （human papil,有,100,多个型别，生殖道尖锐湿疣主要与低危型,HPV6,、,11,型有关。,Low risk:,type,6, 11,40,42,43,44, 61,High risk: 16, 18, 31, 33,35, 39, 45, 56, 58,(responsible for CIN, cervical cancer),The warts tend to occur in areas most directly by coitus:,posterior fourchette(,阴唇系带,）, vulva, vagina , cervix and around anus,HPV,有100多个型别，生殖道尖锐湿疣主要与低危型HPV6、11型,传播途径,1,、性接触传播,2,、间接感染,3,、新生儿在分娩通过患病母亲软产道时受传染,Condyloma acuminata,传播途径Condyloma acuminata,临床表现,潜伏期,3,周,8,月，平均,3,个月,图,外阴尖锐湿疣,图,宫颈阴道尖锐湿疣,尖锐湿疣,临床表现 潜伏期3周8月，平均3个月图 外阴尖,性传播疾病(八年制)课件,3-5%aqueous acetic acid solution test:,（醋酸白试验）,外阴尖锐湿疣醋酸白试验,尖锐湿疣,-,实验室检查,3-5%aqueous acetic acid soluti,2,、病理组织学检查,Koilocytosis,(,挖空细胞）,Dyskeratosis,（角化不良）,Parakeratosis,(,角化不全）,3,、,Colposcopy,4,、,PCR,（核酸检测,-,鉴定及分型）,HC,II,2、病理组织学检查,1,、妊娠期尖锐湿疣生长迅速,2,、妊娠期疣体组织脆弱，阴道分娩时易导致大出血,3,、,Infect delivery tract,（通过软产道感染），幼儿期有发生喉乳头瘤的可能,妊娠合并尖锐湿疣,1、妊娠期尖锐湿疣生长迅速妊娠合并尖锐湿疣,modality,Efficacy(%),Recurrence risk,Imiquimod 5% cream,咪喹莫特霜,33-72,13-19,Podophyllin 10-25%,（鬼臼）,32-79,27-65,Podofilon 0.5%,足叶草毒素,45-88,33-60,Trichloroacetic acid80-90%,81,36,Cryotherapy,63-88,21-39,Electrodesiccation or cautery,（电凝或电烧灼）,94,22,laser,43-93,29-95,interferon,44-61,0-67,modalityEfficacy(%)Recurre,Reactivation,of subclinical infection,(more often),Reinfection,by a sex partner,性传播疾病(八年制)课件,妊娠,36,周前孕妇患尖锐湿疣，,Trichloroacetic acid and electrocoagulation may be used,物理及手术治疗。,分娩方式,:,阴道分娩,:,妊娠近足月或足月孕妇患尖锐湿疣， 病灶,局限于,外阴者,，物理或手术治疗后可阴道分娩,剖宫产,:,病灶广泛或病灶堵塞软产道者，应行剖宫产终止妊娠,Condyloma acuminata in pregnancy,妊娠36周前孕妇患尖锐湿疣， Trichloroacetic,第四节,生殖道衣原体感染,Genital chlamydial infection,第四节 生殖道衣原体感染,性传播疾病(八年制)课件,性传播疾病(八年制)课件,the columnar and transitional epithelium,of genitourinary tract is principal site of invasion,(without deep tissue invasion),cervix, and urethra may be inflamed,Discharge: mucopurulent exudates,Symptoms are not severe. Collect the sample from the endocervical canal with a small cotton swab,the columnar and transitional,性传播疾病(八年制)课件,No symptoms,Cervicitis,Endometritis,Salpingitis:,one of the etiology of infertility,Clinical manifestation,因,衣原体,热休克蛋白与输卵管热休克蛋白有相似性，感染后引起的交叉免疫反应可损伤输卵管；,若长期反复感染，其所致的迟发超敏反应可加重输卵管损伤；常导致严重输卵管黏膜结构破坏、功能丧失，并可引起盆腔广泛粘连,No symptomsClinical manifesta,性传播疾病(八年制)课件,性传播疾病(八年制)课件,1. Giemsa stain of purulent discharge,Diagnosis,1. Giemsa stain of purulent di,2,. Cell culture: is not yet widely available,3. Fluorescent antibody test: common used,direct smear,4.,PCR,5. Serology tests,，,ELISA,Diagnosis,2. Cell culture: is not yet w,The antibiotic must have powerful penetrative ability and long half time,Cervicitis:,doxycycline,:,100mg bid 7-10 days,azithromycin: 1g one dose,Clarithromycin,(,克拉霉素）,500mg bid 10 d,levofloxacin,、,erythromycin,PID:,treat for 14 days,Treatment,The antibiotic must have power,abortion, chorioamnionitis, PROM,preterm birth,neonatal conjunctivitis and pneumonia,Genital chlamydial infection in pregnancy,abortion, chorioamnionitis,第五节 生殖器疱疹,Genital herpes,第五节 生殖器疱疹,性传播疾病(八年制)课件,Latent period: 2-20 days,Herpes tend to occur in :,Vulvar surfaces, vagina , cervix and around anus,Painful ulcers,distributed in small patches,Urinary symptoms,In severe infection, fever, malaise, and bilateral inguinal adenopathy can develop,Recurrence genital herpes: symptoms are mild,Clinical manifestation,Latent period: 2-20 daysClini,Cytological study:,（嗜酸性包涵体）,Papanicolaou smear,Wright-Giemsa stain,diagnosis,Cytological study: （嗜酸性包涵体）di,HSV-Ag detect,（常用快速诊断方法）,Virus culture,PCR (HSV-DNA),Serology tests,，,ELISA,(HSV -IgG,、,IgM),diagnosis,HSV-Ag detect（常用快速诊断方法）diagnos,Acyclovir 400mg tid7-10 days,Famciclovir 250mg tid7-10 days,Acyclovir ointment,（软膏,),treatment,Acyclovir 400mg tid7-10 dayst,Newborn mortality,Neurologic ocular sequelae,abortion, preterm birth,Genital herpes and pregnancy,Newborn mortalityGenital herpe,thank you for you attention,thank you for you attention,