妇产科之性传播疾病

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1、妇产科学第19章性传播疾病【教学目标】了解淋病、梅毒及病毒和沙眼衣原体感染的生殖道炎症的发病原因、传播途径、临床表现及诊断治疗和预防措施。【教学重点】淋病、梅毒及病毒和沙眼衣原体感染的生殖道炎症的传播途径、临床表现及诊断治疗和预防措施。【教学难点】淋病、梅毒及病毒和沙眼衣原体感染的生殖道炎症的发病原因、传播途径。SexuallyTransmittedDiseasesBacterialinfections:ChlamydiatrachomatisNeisseriagonorrhoeae(GO)SyphilisViralinfections:Herpesg

2、enitalisHumanpapillomavirus(HPV)Humanimmunodeficencyvirus(HIV)Chlamydiavaginitis[E]ChlamydiatrachomatisSalpingitis(Peritonitis,infertility,etopicpregnancy,prematurelabor,stillbirthpossible)[S]Oftensymptomfree,associatedwithotherpathogensofvaginitis(GO,vaginosis),Dysuria,pollaki

3、suria,whiteglassingdischarge.ChlamydiashouldbesuspectedinanypatientwithacutePID,possibleGOortrichomonasvaginitis[D]Intracelluarinclusion,immunologywithmonoclonalantibody.[T]Azithromycin1goral,singledoseDoxycycline100mgbidfor7d,Minocine?Ofloxacin100mgtidfor7dErythromycin500mgqidf

4、or7d.forpregnantpatientsGonorrhea(GO)[E]Gramnegativegonococci(Diplococci),OptimalpH7.2,incubationtime:ca.1w.[S]50-80%womenwithGOareasyptomatic.Acuteinfectioninurethra,cervix,Skne’sglands,Bartholin’sglands,evtlrectum.ConfinedinthemucosaonlyProfusepurulenturethralandvaginaldischar

5、ge,urethralburning,dysuria,bladderirritability,inflammationofurethra,cervix,Skene’sandBartholin’sglands.Co-infectionwithotherSTDiscommon.CausingrecurrentPID,chronicpelvicpainorinfertilityduetotubaldamageorhydrosalpinxformation.Womenwithahistoryofsalpingitis7~10Xectopicpregnancy

6、Iftreatmentoftheacutephasedelayedorinadequate,GOviaascendingsurfacespreadingusuallytowardtheendorafterthenextmenstrualperiodAcutesalpingitisandpelvicperitonitis.Accompanysymptom:Condylomataacuminata.[D]Historyofexposure,microscopy,culture,PCRELISA..[T]Ceftriaxone1giv+Doxycyclin

7、e100mgbidfor7d.Failureisrareandafollowupcultureisnotnecessary.Forpregnantpatients.Ceftriaxone250mgi.m.assingledose+Erythromycine500mgqidoral.for7d.Syphilis[E]Treponemapallidumbydirectgenitalororal-genitalcontactwithanactivelyinfectedsexualpartner.Followingtransfusionwithbloodfro

8、maninfecteddonorTransplacentalspread:Motherfet