Biology 216
Lect 14 (STDs)
I. STD or VD - require direct transfer, killed outside body
II.Overview - Baron Chapter 97
A. Etiology and Symptoms - each unique and
		 clinical presentation helpful
	1. Gonorrhea - Neisseria gonorrhoeae
		Purulent exudate; Usually local uncomplicated; 
		Asymptomatic females
		300,000 per year reported in US 
		(probably much higher)
		Used to be approx 1,000,000/yr - safer sex?
	2. Non-gonococcal urethritis -
		 Chlamydia trachomatis (same as GC)
		Now reportable - incidence approx
		 twice GC (probably much higher)
	3. Syphilis - Treponema pallidum
		Primary chancre, Secondary rash, Tertiary, 
		Systemic, Congenital.
		15,000 per year in US
	4. HSV2 - Herpes Simplex Virus 2 - 
		painful blisters, recurrence
		Not reportable, but probably higher than Chlamydia
	5. HIV - Depressed CMI, Opportunistic infections 
		(Pneumocystis, Kaposi, Myco)
		Wasting.
		Nearly 50,000 per year in US
	6. Non-specific vaginosis - Gardnerella vaginalis
		Normal flora imbalance, discharge, odor
		Males asymptomatic
		Lead to premature birth and low birthrate
B. Lab - based on symptoms
	1. Gonorrhea - Gram neg intracellular diplococci;
		Culture
		DNA hybridization to rRNA 
		(Direct from specimen or culture)
	2. Chlamydia - Fl-Ab; ELISA; not cultured 
		DNA luminescent rRNA probe
	3. Syphilis - Serological - Nonspecific, then specific
	4. HSV2 - Culture most sensitive (CPE  in 24 hr or EIA);
		Less sensitive: Fl-Ab, Latex aggl for Ag, 
		Intranuclear inclusions and 
			multinucleate giant cells
	5. HIV - Serology (ELISA, then Western to comfirm)
	6. Vaginosis - KOH odor test, clue cells 
		(wet or stained) - Lactobacillus?
		Culture
C. Treat - Antibiotics for bacterial 
	(GC, chlamydia, syph primary and second)
	Viral - no cure
	HSVII - Acyclovir (nucleotide analogues) 
		affect viral specific enzyme
	HIV - AZT and protease inhibitors 
		(block processing of surface proteins)
D. Vaccines - none