1.What is STD? Traditional STDs are diseases transmitted through genital intercourse, including: syphilis, gonorrhea, soft chancre, and venereal lymphogranuloma, also known as classical STDs (VD). Sexually transmitted diseases (STD): Diseases associated with sexual intercourse or sexual activity. Sexually transmitted infections (STI): infections related to sexual intercourse or sexual activity. 2, the harm of STD STD can cause including acute diseases, chronic diseases, complications, sequelae, certain tumors (such as: Kapoji sarcoma, cervical cancer, penile cancer, etc.), and even death. The danger of STDs to individuals: various complications, sequelae of damage The danger of STDs to families: spread spouses / partners, children, affecting family health and family happiness The danger of STDs to society: some STD patients are prone to psychological disorders and even revenge psychology, and even lead to a variety of criminal offences 3, common types of sexually transmitted diseases gonorrhea: syphilis: condyloma acuminata: genital herpes: chlamydia trachomatis infection of the reproductive tract Others: such as viral hepatitis B, pubic lice, AIDS, etc. a. Gonorrhea is caused by infection with Neisseria gonorrhoeae, a gram-staining negative diplococcus, mainly transmitted through sexual contact, and its most common clinical manifestation is septic inflammation of the urinary-genital system. 1. uncomplicated gonorrhea: urethritis, cervicitis, proctitis 2. complicated gonorrhea: epididymitis, vesiculitis, prostatitis, pelvic inflammatory disease 3. other parts of gonorrhea: pharyngitis, ophthalmitis 4. disseminated gonorrhea: arthritis, septicemia, encephalitis Treatment: use drugs such as ceftriaxone. Must be treated simultaneously with sexual partners! b. Syphilis Syphilis is a chronic, systemic sexually transmitted disease caused by pale spirochete infection. It is divided into acquired syphilis and fetal syphilis (congenital syphilis), acquired syphilis and divided into early syphilis, late syphilis. 1, early syphilis: the disease period within two years, including stage I syphilis, stage II syphilis, latent syphilis. 2, late syphilis: the disease period in more than two years, including late benign syphilis, cardiovascular syphilis, neurosyphilis, late-stage latent syphilis. 3, fetal syphilis is divided into early fetal syphilis, late fetal syphilis. Stage I syphilis Epidemiological history: history of multiple sexual partners, unsafe sex or sexual partner infection Clinical manifestations: painless genital ulcers (hard chancre), enlarged inguinal or proximal lymph nodes Laboratory tests: dark field microscopy, serological tests Treatment: procaine penicillin, benzathine penicillin, ceftriaxone and other drugs Stage II syphilis Epidemiological history: history of multiple sexual partners, unsafe sex or sexual partner infection, or history of blood transfusion History Clinical manifestations: 1. skin lesions: syphilitic macules, papules and flat warts, syphilitic pustules, mucosal syphilitic rash, syphilitic alopecia; 2. systemic symptoms: fever, generalized lymph node enlargement, bone pain, liver and kidney function impairment. Syphilitic alopecia: diffuse hair loss, patchy alopecia, loss of outer 1/3 of eyelashes and eyebrows Late syphilis Epidemiologic history: history of multiple sexual partners, unsafe sex or sexual partner infection, or history of blood transfusion Clinical manifestations: nodular syphilis rash, dendritic swelling, bone syphilis, cardiovascular syphilis, neurosyphilis Laboratory tests: serologic testing, histopathologic examination Clinical manifestations of neurosyphilis should be distinguished from those of HIV patients Neurological abnormalities Neurosyphilis Epidemiological history: history of multiple sexual partners, unsafe sex or sexual partner infection, or history of blood transfusion Clinical manifestations: syphilitic meningitis, meningeal vascular syphilis, paralytic dementia, spinal cord consumption Laboratory tests: serological tests, cerebrospinal fluid examination Treatment: high-dose penicillin or ceftriaxone and other drugs are required, benzathine penicillin alone should not be used! Occult syphilis Epidemiological history: history of multiple sexual partners, unsafe sex or sexual partner infection, or history of blood transfusion. Clinical manifestations: early-onset occult syphilis, late-onset occult syphilis Laboratory tests: serological test (+), cerebrospinal fluid examination (-) Epidemiological history of fetal syphilis: the birth mother is a syphilis patient Clinical manifestations: early fetal syphilis: syphilis rash, laryngitis, osteitis, hepatosplenomegaly, generalized lymph node enlargement, anemia Late fetal syphilis: inflammatory damage, landmark damage Occult fetal syphilis: no clinical manifestations Laboratory tests: serological test (+), cerebrospinal fluid test (-). Commonly used serologic tests for syphilis: Non-syphilis spirochete antigen test (anti-cardiolipin antibody) 1, Rapid plasma reactin (RPR) 2, Unheated serum reactin (USR) 3, Venereal disease research laboratory test (VDRL) Syphilis spirochete antigen test 1, Syphilis spirochete hemagglutination test (TPHA) 2, Syphilis spirochete particle agglutination test (TPPA) 3, Fluorescent spirochete antibody Several problems in syphilis diagnosis and treatment: a) False negative syphilis serologic reaction: early stage of hard chancre, pre-banding phenomenon, early treatment after infection and some late syphilis, technical operation or reagent problems. b) False positive syphilis seropositivity: 1) Acute biological false positive (hepatitis, tuberculosis, chickenpox, etc.) 2) Chronic biological false positive (chronic nephritis, immune diseases) Serological changes after syphilis treatment: under normal circumstances the titer gradually decreases, but two conditions should be noted: 1) serum fixation 2) serum relapse (this titer > 4 times the last titer) c. Condyloma acuminatum Condyloma acuminatum is caused by human papilloma The most common cause of HPV infection is cauliflower-like swellings in the anus and external genitalia, which are mainly transmitted by sexual intercourse, but there are other ways to cause infection. Epidemiologic history: history of multiple partners, unsafe sex or sexual partner infection, pediatric patients usually have HPV-infected biological mothers, and it should be noted that a small number of young children are sexually victimized. Clinical manifestations: (a) Incubation period: generally 3 weeks-8 months Signs and symptoms: (b) Clinical types: papular, cauliflower, keratinized warts, flat-topped papules or plaques Laboratory tests: HPV6, HPV11, HPV16, HPV18 are the most common differential diagnoses: pseudo warts, flat warts (stage 2 syphilis rash), penile pearl warts (benign lesions), etc. Differentiate! Treatment: laser, freezing, electrocautery, cytotoxic drugs can be applied externally, but it is very easy to recur! Squamous carcinoma in situ (SCCIS) and invasive squamous carcinoma (SCC) of the anogenitalia: HPV infection of the anus and genitalia epithelial tissue causes a series of changes collectively known as squamous intraepithelial damage (SIL), histological examination: from mild dyskeratosis to SCCIS with varying severity, involving the cervix and anus with a rash at high risk of transformation into invasive SCC. It is usually caused by HPV16 , HPV18 , HPV31 and HPV33 types. d. Genital herpes Genital herpes (GH): an inflammatory, recurrent disease caused by herpes simplex virus (HSV) infection of the genitourinary and perianal skin mucosa. HSV is a DNA virus, belonging to the subfamily a of human herpes viruses, divided into HSV-1 and HSV-2. Common problems in the diagnosis and treatment of genital herpes: a) Diagnosis and treatment of incipient and recurrent GH (omitted): refer to treatment of herpes simplex. b) Treatment of genital herpes simplex in pregnancy (omitted) c) HSV infection in newborns: 1) skin, eye and oral involvement 2) central nervous system involvement 3) disseminated infection d) HSV-1 and HSV-2 can alternate Several issues that should be focused on in genital herpes: 1 in 6 people in the world have HSV-2 genital herpes; patients with genital herpes in the asymptomatic phase can still emit the virus and infect others; genital herpes can be transmitted through genital intercourse or oral sex, and condoms do not provide complete protection against herpes infection; genital herpes does not affect fertility or cause cervical cancer. f. Genital tract Chlamydia trachomatis (CT) infection Epidemiological history: history of multiple sexual partners, unsafe sex or sexual partner infection, history of Chlamydia trachomatis infection in newborns whose mothers are infected. Clinical manifestations: (limited and invasive infections) Male specific infections: urethritis, epididymitis, arthritis Female specific infections: cervicitis, urethritis, pelvic inflammatory infections Intersexual infections: proctitis, neonatal pneumonia Laboratory tests: Reiter syndrome (RS): the onset is mostly associated with chlamydial infection RS is a peripheral arthritis associated with urethritis and/or cervicitis, lasting more than One month, often in combination with overflowing purulent cutaneous keratosis, circumpapillary glans, conjunctivitis, and stomatitis. The typical triad is: urethritis, arthritis, and conjunctivitis Treatment: antibiotics are usually ineffective; glucocorticoids, nonsteroidal anti-inflammatory drugs, and Avelox g. Reproductive tract mycoplasma infections The mycoplasmas associated with human disease are: Ureaplasma urealyticum (Uu), Mycoplasma humanum (Mh), and Mycoplasma genitalium (Mg). Diseases associated with mycoplasma infections: 1, gonococcal urethritis and mucopurulent cervicitis 2, prostatitis and epididymitis 3, sterility and infertility 4, pelvic inflammatory disease 5, others: acute pyelonephritis, abortion, etc. Treatment of mycoplasma infections of the reproductive tract: Ureaplasma urealyticum (Uu): macrolide sensitive, clindamycin, etc. ineffective Mycoplasma histolytica (Mh): quinolone sensitive, macrolide ineffective Reproductive Mycoplasma (Mg): tetracycline, macrolide sensitive Treatment of mycoplasma-resistant patients (omitted) I. Other sexual infections: soft chancre, venereal lymphogranuloma, bacterial vaginosis, vulvovaginal candidiasis, infectious molluscum, pubic lice, scabies mites, etc. Viral hepatitis, cytomegalovirus, HIV infection (AIDS), etc.