bts prezentare synevo
TRANSCRIPT
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BOLI CU TRANSMITERE SEXUALAPREZENTARE DE CAZ
DR. VIOLETA CRISTEADR. MIRELA LIVADARIUDR.MARILENA FRUNZOI
Laborator Synevo Bucuresti
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Definitii• Bolile cu transmitere sexuala (BTS) – grup de afectiuni
de etiologie variata, care se transmit preponderent prin contact sexual (manifestarile apar mai ales la nivel ano – rectal)
• BTS – boli infectioase care se transmit in timpul unui contact sexual neprotejat sau rau protejat, de la partenerul bolnav la cel sanatos
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Prevalenta• Cele mai raspandite boli transmisibile de pe glob• In tarile dezvoltate ~ 1% din prezentarile la
medic• In tarile in curs de dezvoltare – intre primele 5
cauze de morbiditate• >50% dintre cei afectati, au intre 15 – 30 ani
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GLOBAL ESTIMATESWHO estimates that 340 million new cases of STIshave occurred worldwide in 1999.The largestnumber of new infections occurred in the region ofSouth and Southeast Asia, followed by sub-SaharanAfrica and Latin America and the Caribbean.However, the highest rate of new cases per 1000population has occurred in sub Saharan Africa.
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Etiologie• Bacteriana: - Neisseria gonorrhoeae - Chlamydia trachomatis - Treponema pallidum - Haemophilus ducrey• Virala: - Virusul imunodeficientei umane - Herpes simplex - Papilomavirus - virusul hepatitei B - Citomegalovirus
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Etiologie• Parazitara: - Trichomonas vaginalis - Sarcoptes scabie - Pthirus pubis (paduchii lati)• Fungi: Candida albicans – cel mai frecvent
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Sindroame in BTS1. Sdr. ulceros genital – nonveziculara). La barbati: prezenta de ulceratii la nivelul - penis - scrot - rectb). La femei: prezenta de ulceratii la nivelul - labii - vagin - rect - in ambele cazuri cu/fara adenopatie inghinala
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Sindroame in BTS• Orienteaza catre: - sifilis - sancru moale - limfogranulomatoza veneriana - herpes genital atipic
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Sindroame in BTS2. Sdr. ulceros genital – vezicular: - existenta veziculelor la nivelul organelor genitale sau anal
la ambele sexe - tipic pentru HERPES GENITAL3. Sdr. uretral: secretie uretrala cu/fara disurie - mai frecvent: - Neisseria gonorrhoeae - Chlamydia trachomatis - posibil: -Trichomonas vaginalis - Ureaplasma urealyticum - Mycoplasma hominis
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Sindroame in BTS4. Sdr. vaginal: - modificari ale secretiei vaginale (consistenta,
culoare, miros) + dureri pelvine - frecvent: - vaginoza bacteriana - candidoza vulvo – vaginala - trichomoniaza
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Sindroame in BTS5. Sdr. pelvin inflamator:• - durere abdominala inferioara asociata cu: - dureri la
contactul sexual - durere la palparea abdomenului inferior - temperatura >38°C• - agenti patogeni posibili: - Neisseria gonorrhoeae - Chlamydia trachomatis - bacterii anaerobe
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Complicatii• Cancer de col uterin• Salpingita• Avorturi spontane• Sarcina ectopica• Dureri cronice pelvine
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Complicatii Functie de agentul cauzal:- Chlamydiaza poate da: - sterilitate prin salpingita la femei - sterilitate prin epididimita la barbati - BIP la ~ 20% dintre femeile infectate- Gonoreea poate da: - BIP la ~ 30% dintre femeile infectate - orbire la nou - nascut- Chlamydia + Gonococ = BIP la ~ 40% dintre femeile
infectate
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Complicatii Functie de agentul cauzal:- Treponema pallidum: - sifilis congenital – importanta cauza de
morbiditate si mortalitate la copii - la adulti – tulburari cardiace, neurologice etc.
cu posibil exitus
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Complicatii Influentate de agentul cauzal:- inf. bacteriene, parazitare, fungice – curabile cu tratament
adecvat- Inf. virale – de obicei incurabile, dar controlabile, cu aparitia
de complicatii in timp Gravitatea evolutiilor si complicatiilor depinde de: -
rapiditatea depistarii infectiei - inceperea precoce a tratamentului
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Obiective OMS
• Scaderea prevalentei BTS prin intreruperea transmisibilitatii• Scaderea duratei perioadei de infectiozitate (prin tratament
adecvat si rapid instituit)• Prevenirea dezvoltarii complicatiilor la persoanele infectate
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Obiective OMS
• Preventie primara: - educatie pentru sanatate - sex protejat - abstinenta• Preventie secundara: - tratarea persoanelor infectate
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Important
• Persoanele asimptomatice, purtatoare = rezervor de infectie
• Contactii bolnavilor cu BTS – greu de identificat si tratat (de obicei sunt neinformati de partener: frica, inconstienta)
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Gonoreea (Blenoragia)• Cunoscuta din antichitate, dar descrisa in 1879 de
Neisser care descopera agentul cauzal• 1988 Leistikov si Lőffler – reusesc multiplicarea
bacteriei pe diferite medii de cultura• Incidenta – insuficient evaluata, cauzata de: - cazuri atipice clinic - confuzii cu uretrite de alte etiologii - rata scazuta de vindecari spontane, cu recaderi sau
reinfectii - automedicatia
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Gonoreea (Blenoragia)• Agent etiologic = Neisseria gonorrhoeae• Incubatia ~ 3 zile (1 – 14 zile)• Simptomatologie: - femei: - 9 din 10 sunt asimptomatice - secretie vaginala mai abundenta, alb– galbuie - dureri pelvine - disurie - sangerari intre menstruatii (metroragie) - barbati: apar manifestari frecvente sub forma de: - disurie - polakiurie - scurgere uretrala alb - galbuie
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Gonoreea (Blenoragia)• Complicatii: - locale: - epididimita - prostatita - edem penian - abcese periuretrale - limfangita - boala inflamatorie pelvina - stricturi uretrale - sterilitate
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Gonoreea (Blenoragia)• Complicatii: - generalizate (septicemice): - inf. gonococica generalizata (mai frecvent
la femei) - artrita - dermatita - tenosinovita
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Gonoreea (Blenoragia)• Complicatii la gravide: - risc crescut de avort spontan - ruptura precoce a membranelor - nastere prematura - mortalitate perinatala crescuta• Complicatii la nou – nascut: - conjunctivita - mai rar: artrita, septicemie
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Gonoreea (Blenoragia)• Tratament: - cu antibiotice si sub supravegherea medicului - corelat cu – evolutia bolii - complicatiile aparute - asocierea cu alti agenti patogeni - scurt (doza unica), dar au aparut tulpini rezistente la
antibiotice. Rezistenta la Penicilina este dobandita prin mutatii cromozomiale (multipla, cu nivel mic de rezistenta per etapa).
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CHLAMYDIAZA• Incidenta > decat a gonoreei• Frecvent asociata cu alte infectii uro – genitale:
gonoree, trichomoniaza etc.• Frecvent asimptomatica: - ~70% dintre femei - ~40% dintre barbati
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CHLAMYDIAZA• Agent etiologic: Chlamydia trachomatis• Transmitere:
– la adulti: exclusiv sexual (oral, vaginal, anal)– la copii: se pune problema unui abuz– la nou – nascut: de la mama infectata (in timpul nasterii)
• Incubatie: 7 – 21 zile• Simptomatologie:
– la femei: secretie vaginala mai abundenta sangerari vaginale anormale (menstruatii neregulate) dureri pelvine disurie dispareunie- la barbati: secretie uretrala purulenta (“picatura matinala”) disurie
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CHLAMYDIAZA• Diagnostic:
– Culturi de celule (metoda laborioasa)– Detectare imunoenzimatica a antigenului Chlamydia
in produs patologic– Detectarea AND – ului bacterian prin biologie
moleculara – PCR – (metoda foarte scumpa)– Teste serologice: detectarea in serul pacientilor a
anticorpilor specifici
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CHLAMYDIAZA• Complicatii: - la femei: - boala inflamatorie pelvina - sarcina ectopica - avort spontan - nastere prematura - salpingita - sterilitate - la barbati: - epididimita - prostatita - sterilitate
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CHLAMYDIAZA• Complicatii: - artrita reactiva = raspuns mediat imunologic care apare al
distanta de un focar inflamator - 1/3 din cazuri apare in cadrul sdr. Reiter
(artrita reactiva, conjunctivita, uretrita) - Sdr. FIT – HUGH – CURTIS = infectie propagata pana la
ficat (hematogen/limfatic) → perihepatita si aderente diafragmatice. Clinic – femeie tanara cu dureri in hipocondrul drept.
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CHLAMYDIAZA• Tratament: - antibiotic - tratati ambii (toti) parteneri(i), chiar si cei asimptomatici Pe perioada tratamentului - abstinenta La sfarsitul tratamentului – necesara retestare
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PREZENTARE DE CAZ Pacient G.G., 22 ani, sex masculin Istoricul bolii: in urma cu 2 saptamani:- disurie- polakiurie- secretie uretrala alb – galbuie, abundenta Medic de familie: adm. tratament cu CIPRINOL tb. 500 mg, 1 la 12 ore, 10 zile,
pentru posibila infectie urinara Dupa cele 10 zile simptomatologia persista. Solicitari la laboratorul SYNEVO:- Secretie uretrala (examen microscopic pe frotiu si culturi bacteriene)- Antigen Chlamydia din secretie uretrala- Anticorpi Chlamydia: Ig A si Ig G
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PREZENTARE DE CAZ• Examenul microscopic pe frotiu releva:- celule epiteliale - rare- PMN – foarte frecvente- Trichomonas vaginalis – absent- levuri – absente- flora microbiana – foarte frecventi coci Gram
negativi, in diplo (“boabe de cafea”), intra- si extra leucocitari, unii capsulati.
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PREZENTARE DE CAZ
• Culturile bacteriene au evidentiat: - pe mediul Columbia agar cu sange – colonii gri,
mici, bombate, lucioase, nehemolitice - pe mediul Chocolate agar – colonii de acelasi
aspect
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PREZENTARE DE CAZ• Frotiul efectuat din cultura – arata coci Gram negativi, in
“boabe de cafea”, similari cu cei prezenti pe frotiul efectuat din produsul patologic
• Reactia oxidazei – pozitiva (+++)• SUSPICIUNE: NEISSERIA GONORRHOEAE• DIAGNOSTIC: infectie cu Neisseria gonorrhoeae,
confirmata prin identificarea microorganismului izolat pe trusa API NH si determinare de antigen gonococic.
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PREZENTARE DE CAZ• Antibiograma: - Ceftazidim – sensibil - Ceftriaxon – sensibil - Cefuroxim – sensibil - Ciprofloxacin – rezistent - Penicilina – intermediar - Tetraciclina – intermediar
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PREZENTARE DE CAZ
• Determinarea antigenului Chlamydia in secretie uretrala = POZITIV
• Determinarile imunologice arata: - Ac Chlamydia Ig A – POZITIV (absorbanta 2.620
fata de cut – off: 0,811) - Ac Chlamydia Ig G – POZITIV
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PREZENTARE DE CAZ
• CONCLUZIE: Pacientul G.G. prezinta infectie mixta
Chlamydia - Gonococ
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SFATURI DE FINAL• Screening Chlamydia trachomatis – pentru toate cazurile
de infertilitate• Alte cazuri pozitive de inf. cu Chlamydia – investigate si
pentru posibila prezenta a inf. pereche “inf. gonococica”• Ambele infectii NU creaza imunitate• Important de diagnosticat orice BTS, pentru instituirea unui
tratament rapid si corect (ATENTIE – la cazurile asimptomatice!)