Manifestations of Congenital Syphilis-Infection Transmitted from mother to fetus

Congenital Syphilis names the transplacental infection from a syphilitic mother to the fetus.
In case of infected mother during pregnancy the placenta appears enlarged and pale and this can determinate abortion,stillbirth (give birth to a death fetus) or the baby survives and develops two groups of manifestations:

1.Early Manifestations:
These type of manifestations develop during the first two years of life often between the 2nd and 10th week and are common to those with the secondary stage of disease.Appears:
-skin rash
-mucus patches (found in the mucus membranes of the mouth and anus)
-generalized lymph node enlargement (lymph node-small ball shaped organ of the immun system,distributed widely throughhout the body)
-radiating scars at the angles of mouth and anus
-syphilitic inflamation of organs that can result in pneumonia alba (pale lungs) and syphilitic cirrhosis
-retardation of bone growth.

2.Late Manifestations (2-30 years):
-Hutchinson's Teeth-the permanent central incisors are short,notched and widely separated
-deafness
-sabre tibia (the tibia is thickened and brent)
-saddle nose
-neurosyphilis.

Syphilis-Modes of Transmission and stages of disease

Syphilis is one of the sexually transmitted diseases.Is an acute disease that becomes chronic and disabling if is not treated.

Modes of Transmission:
1.Contact with open lesion of infected person:common mode of infection is venereal infection by sexual contact and kissing (Atention!: the infection in the secondary stage reach the mucous of the mouth).
2.Exposure to infected blood by:
-using blood contaminated syringes and needles for inoculation of medicines or taking blood sample or by intravenous drug abuse.
-blood transfusion without precaution.
professional exposure of medical and paramedical and laboratory workers t infected blood.
3.Congenital Infection "inutero infection": transplacental infection from the 4th month of pregnancy to the end of delivery.
4.Contaminated articles and fomites::towels,clothing,drinking,cups and others are potentially infectious  but their role is minor.
Period of Infectivity: Untreated cases are infectious during the primary and secondary stages of disease of varied period,usually 2-4 years.
Exit of Infection: the organisms exit in exudate of skin and mucous membrane lesions,blood and body fluids.
Incubation period: 3 weeks on the average.

Untreated cases pass through three basic Clinical Stages over many years:

1.Primary Syphilis:  "Chancre" is the first manifestation that appears at the portal of entry usually on geniatlia and occasionally on other parts in nonveneral infection.
"Chancre" is indurated,firm,painless,highly infectious ulcer with enlarged lymph nodes and disappears spontaneously in 4-6 weeks.

2.Secondary Syphilis: this stage is characterised by:
-generalised skin rash
-patchy lesions of mucous membranes specially on mouth and genitalia.They are highly infectious.
-involvement of eyes and other pars of the body.The secondary stage syphilis disappear spontaneous after weeks or months,followed by a latent period of years before the 3rd stage appears.

3.Symptomatic Syphilis: involves different parts of the body leading to cardiovascular syphilis and neurosyphilis.

Priapism (painful erection)-Serious cause of permanent impotance

Priapism is a painful medical condition in which the erect penis does not return to the its falccid state,despite of both physical and psycological stimulation,within four hours.

Is a continuous painful erection without sexual excitation.In this case the blood vassel dilatate,increasing the blood flow into the penis giving a continuosly painful erection,this can lead to ischemia and permanent impotence and as complication the ischemia can result in gangrene,for which could necessitate penis removal.

Priapism is considered a medical emergency and an early treatment is necessary for a functional recovery.

Priapism can be also caused by reactions to medications like intra-venous injection for dysfunctional erection,antidepressants,anticoagulants,alcohol and cocaine.
Priapism is associated with leukemia and neurological disease.

The Treatment should be started as early as possible whitin the first 24 hours.
The treatment most be given by a qualified medical practitioner,and consists in:
-intracorporial injection of adrenaline or ephedrine
-evacuation of the penile blood.

GONORRHOEA-Sexually Transmitted Disease

Gonorrhoea is an acute infectious sexually transmitted disease (venereal disease) that becomes chronic if neglected or improperly treated.

Source of Infection: human.
If is untreated remains infectious so long the organisms find exit in discharges of involved mucous membranes,may be for years.
Spcific chemotherapy eliminates infection whithin days.

Transmission:direct sexual contact only.
Incubation period: 3 or 4 days,usually.

Symptoms:

1.Clinical Picture: caused by involvement of the mucous membranes of genitourinary tract.
2.Acute picture:In males:acute anterior urethritis whit purulent discharge.
In female case:urethritis or cervicitis whit discharge.
And as extragenital manifestation: arthritis.
3.Chronic Picture:if case is neglected or improperly treated infection extends to other parts of genitourinary tract and becomes chronic.

Diagnosis:
Acute gonorrhoea is suspected by purulent urethral discharge and history of sexual exposure,to be confirmed by lboratory examination:
-film of pus from urethra or cervix to demonstrate intracellulr gonococci.
-culture of pus if is necessary.
For chronic cases:complement fixation test.

Atention: No aquired immunity after attack and so the same person is exposed to reinfection and repeated attacks.

Prevention:
General preventive measuress of venereal infection (avoid changing sexual partners,use the condom for protected sex).
Specific prevention: chemoprophylaxis by oral penicillin (400 000 units) just before or after exposure.

Control:
-case-finding:early diagnosis is valuable to limit spread of infection and prevent becoming chronic.
-health education of the public,specially young dults so as to seek medical care once suffering.
Some cases may be shy to consult the physician and so has to be encouraged to seek care.

Read on this blog :GONORRHEA SYMPTOMS AND TREATMENT
http://lifemedicalassistance.blogspot.com/2010/6/gonorrhea-and-treatment.html

AIDS Symptoms,Manifestation

Cases that shows varied manifestations may be grouped into:
-AIDS related complex
Secondary pathological conditions

1.AIDS related Complex :manifestations are caused by HIV.
The case shows nonspecific symptoms,of low-grade fever,fatigue,diarrhea and loss of weight,and persistent generalized lymphadenopathy,specially in children.

2.Secondary pathological conditions:
Arise from immun dysfunction.
-Infection:cases of AIDS are susceptible to varied infections,as the respiratory,that may be life-treatening.
-Autoimmune and neurologic disorders.
-Malignancy:sarcomas.

Immune deficiency is irreversible and threatens life.Disease is fatal within years,usually from:
-secondary infection,specially the viral.
-malignancy.

Diagnosis:
Clinical manifestations are nonspecific,undiagnostic.
AIDS however may be suspected in high-risk individuals suffering for long from vague disease,not responding to given treatment,to be confirmed by laboratory diagnosis.
Laboratory Diagnosis: based on presence of viruses and formation of HIV antibodies.Blood testing of the infected becomes positive 1-3 monthafter infection.

Genital Infections-Genital Herpes

The changing sexual habits in the last few decades have been associated with an increased incidence of genital herpes.
Genital herpes is important not only because of its increasing incidence but also because of the physical and psychological trauma it can induce,the risk of serious complications including a possible link with cervical cancer and risk of maternal transfer to neonates.
Disseminated herpes in the newborn is certainly one of the most severe of all manifestations of herpes infections.Prematurity and spontaneous abortion have also been associated whit active maternal genital herpes.
Herpes simplex genitalis is most often caused by infection whit herpes simplex virus type 2,which has usually been sexually transmitted by an infected partner,but may possibly be trasmitted by orogenital contact.
Herpes simplex virus type 1 infection accounts for an increasing proportion of cases.Genital diseases caused by either of these viral types are clinically indistinguishable.As with other herpes infections,the virus replicates in the epithelium,giving rise to painful symptoms and signs.This typically follows a course which commences with redness and inflammation,leading to formation of vesicles which progress to multiple,small and shallow ulcers found on the labia and around the introitus and resolve with crusting and healing.This cycle may take up to 3 weeks in a primary infection.
After the primary infection the virus remains quiescent in the sacral ganglia and can re-emerge to cause recurrence at a later time.
The symptoms of recurrent genital herpes tend to milder and of shorter uration and are ofetn precede by prodromal phase consisting of cutaneous itching or burning and redness in the affected region.
The frequency of recurrences can vary from days to years.

Diagnosis and management:
When genital herpes is suspected it is important to confirm the diagnosis with laboratory culture.The natural history of the disease should be explained and advice given on genital hygiene.It is obviously important to trace sexual partners and would be wise to inform the obstetrician if the patient is pregnant.
Preparation including saline,gentian violet,ether and boric acid have been used for the topical treament of genital herpes.
Antiviral agents such as idoxuriene have also been tried but the results from controlled therapeutic trials have so far shown little clinical benefit from topical application of such drugs.
Many antiviral agents are toxic if ingested.
A standard cours of treatment is for 5 days,five times daily,but in the initial disease or severe recurrence the treatment may be extended up to 10 days.
Acryclovir cream is well tolerted and affective for out-patient management of genital herpes.The cream seems suitable patient initiated treatment which is important in a condition where recurrences are most effectively treated if the therapy is initiated at the first indication of recurrence.
If the secondary infection is present it should be treated.patient should be advised to have regular  cervical smears and to avoid intercourse when lesions are present.

AIDS (Acquired Immune Deficiency Syndrome)-Modes of Transmission

AIDS is a disease of the immune system that results in the development of either lifethreatening opportunistic infections or the development of unusual malignant manifestation of both.
Although AIDS is classified as an infectious disease,its transmission would seem to require sexual contact or direct entry of virus-infected blood or blood products into the circulation.There is a little evidence that AIDS is transmitted by any non-sexual form or person-to-person contact.
The first recognize case of AIDS occured in male homosexuals and this individuals constitute the main risk group(about three-quarters of reported cases occur in homosexual or bisexual males).
AIDS has been diagnosed in female sexual partners of affected males and in Africa the condition would seem to be spread predominantly by heterosexual intercorse,or by exposure to blood through insect bites or scarification.
A retrovirus known as human T-cells lympotropic virus type III(HTLV III) was identified as the probable cause of AIDS.This virus has been repeatedly isolated from the blood ,semen or saliva of affected individuals.
Although the HTLV-III virus has been identified as the probable agent causing AIDS and AIDS related illness,some individuals who have been exposed to ,or are infected by,the virus do not show an evidence of such disease.
This suggests either a long incubation period or the operation of the other factors during the incubation period,which together with the HTLV-III virus,precipitate the loss of cell-mediate immunity.
One possible factor is seminal fluid,which is thought to have a physiological role as an immunological agent after normal heterosexual intercourse.Repeated exposure to this immunosuppresive agent after intercourse,in conjunction with a virus-infected ejaculate,would certainly explain the high-risk category of homosexual or bisexual males.

Sexual contact during and after pregnancy

Although it is often suggested that the sexual contact to be discontinued during the first 3 months and during the last 2 months of pregnancy,is no contraindication of the sexual contact at any stage in normal pregnancy.
The alleged riscks are abortion,premature labour and the introduction of bacteria to cause subsequent puerperal sepsis.
These are theoretical and few women come to harm.
Coitus need be banned for a period of time when the women has threatened to abort or is an habitual aborter.
During pregnancy,however the woman rarely has much sexual desire and a dominant progesterone may play a part in this too.
The possible dengers are puerperal infection and injury to the soft and vascular vaginal walls.There is little risk of either after the fourteenth day and some authorities go so far as to advice intercourse from that time onwards,arguing that it assists involtion and restores muscle tone.
A more resonable view is that if the couple are desirous,sexual contact may be resumed 4 weeks after delivery-provided that the lochial discharge has ceased and that vaginal and perineal tears have healed and are not tender.

Impotence

Male impotence is much more common that is generally supposed.It may be constant or occasional and it seen in varying degrees.Some men find themselves impotent with one woman and not with another.Most impotent men have good spermatogenesis and are potentially fertile.
Clinical types:
-absence of sexual desire and consequently of erection
-failure to obtain an erection
-weak and fleeting erection which subsides before penetration is complete
-normal erection and penetration but failure to emit semen.This condition of partial impotence is difficult to diagnose and the couple are ofthen unaware of it themselves.
Causes:
Ofthe there is more then one factor operating and in nearly all cases a vicious cicle is quickly established.
Impotence resuts in loss of self-esteem and this in turn causes impotence.The more a man fails the more likely he is to fail.
Impotence slightly low levels of testosterone in the plasma.The administartion of testosterone in this case never restores potency so is just a theory.There is little evidence to support this or the idea that a hormone deficiency plays any part in impotence which is not caused by an endocrine disorder.
Impotence is physiological before puberty and with advancing years.Too-frequent coitus at any age temporarily diminishes desire and capacity.Sexual capacity in the male is usually quite strong up to the age of 50 years but thereafter slowly weakens.But a man of 80 years and more can be surprisingly potent.
Some men have minimal sex drive and some may even be completely unresponsive sexually.A man with minimal or no sex drive is not necessarily timis and undersized,he is often physically well built and handsome.
From overexcitement or anxiety coitus may fail.The stress on any problem creates inhibition which prevent ejaculation despite normal penetration or erection loss.
Organic causes:
These account for only 5% of cases of male impotence:
-general ill health,debility.physical and mental exhaustion
-castration(even this does not always cause impotence)
-hypoplasia of the testes
-complete testicular failure
-an endocrine disease(for exemple diabetes)
-depression
-generalized vascular disease.

Drugs which sometimes destroy libido and encourage impotence include certain hypotensive agents and narcotics,depressants and tranquillizers.

Treatment:
This must be proceded by diagnosis and this means clinic hystory,examination and investigation to exclude an organic cause.If nocturnal erection occur an organic cause is excluded.If is not an organic problem than the man need psychiatric treatment and support.
An hormone therapy is used too.Androgens by mouth,by injection or by implant are indicated only when there is clear evidence of hormone deficiency and sometimes are useful in agening men.