This lecture is structured in a Reproductive Medicine (RM) presentation format, specifically designed for a medical school curriculum. It utilizes high-yield information, clinical algorithms, and 2024–2025 global health updates (CDC/WHO).
Module: Reproductive Medicine & Infectious
Diseases
Target Audience: Medical Students (Clinical Years)
[Graph Description: Global STI Incidence Trends] * X-Axis: 2015–2025 (Provisional) * Y-Axis: Millions of cases * Trend Line 1 (Syphilis): Significant upward trajectory (+700% increase in congenital syphilis over the last decade). * Trend Line 2 (Gonorrhea): Stabilizing but showing increased drug resistance. * Trend Line 3 (Chlamydia): Highest absolute volume, slight decline in 2024 due to improved screening/treatment.
Key Figures (WHO 2025): * 1 Million+ new curable STIs acquired daily. * 374 Million new infections annually (Chlamydia, Gonorrhea, Syphilis, Trichomoniasis).
| Category | Pathogens | Primary Presentation |
|---|---|---|
| Bacterial | N. gonorrhoeae, C. trachomatis, T. pallidum | Urethritis, Cervicitis, Ulcers (Chancre) |
| Viral | HIV, HSV-1/2, HPV, HBV, Mpox | Blisters, Warts, Systemic illness |
| Parasitic | Trichomonas vaginalis, Phthirus pubis | Frothy discharge, “Strawberry cervix” |
| Fungal | Candida albicans (Opportunistic) | Pruritus, Curd-like discharge |
Medical students should focus on Syndromes rather than just pathogens: 1. Urethral/Vaginal Discharge: Gonorrhea, Chlamydia, Trichomoniasis. 2. Genital Ulcers: Syphilis (painless), Herpes (painful), Chancroid. 3. Pelvic Pain: Pelvic Inflammatory Disease (PID) – a critical complication. 4. Genital Growths: HPV (Condyloma acuminata), Molluscum contagiosum.
[Figure 1: Stages of Syphilis Clinical Timeline] * Primary: Painless Chancre (3–6 weeks). * Secondary: Palmar/Plantar rash, Lymphadenopathy, Condyloma lata. * Latent: Asymptomatic phase. * Tertiary: Gummas, Neurosyphilis, Cardiovascular syphilis.
Management (2024 Shortage Update): * First-line: Penicillin G Benzathine (Bicillin L-A) IM. * Note: Due to global shortages of Bicillin in 2024, the FDA has authorized temporary importation of alternatives like Extencillin.
Neisseria gonorrhoeae: Gram-negative diplococci. Chlamydia trachomatis: Obligate intracellular bacterium.
[Clinical Plot: Co-infection Rates] * A pie chart showing that ~30-40% of patients with Gonorrhea are co-infected with Chlamydia. * Clinical Pearl: Always treat for Chlamydia when Gonorrhea is diagnosed unless ruled out by NAAT.
Diagnosis: Nucleic Acid Amplification Test (NAAT) – Gold Standard (Urine/Vaginal/Rectal).
Patient: 24-year-old male, “John.” * Chief Complaint: “Burning during urination and green-yellow discharge for 3 days.” * History: Unprotected sex with a new partner 10 days ago. * Examination: Urethral meatus erythema; purulent discharge.
The Student’s Role (RIME): * Reporter: “The patient presents with acute mucopurulent urethritis following unprotected sexual contact.” * Interpreter: “The likely diagnosis is Gonococcal Urethritis, given the purulent nature, though Non-gonococcal Urethritis (NGU) is a differential.” * Manager: “I will order a urine NAAT, treat with Ceftriaxone 500mg IM + Doxycycline 100mg BID for 7 days, and initiate partner notification.”
| Disease | Treatment of Choice | Alternative |
|---|---|---|
| Gonorrhea | Ceftriaxone 500mg IM (single dose) | Gentamicin + Azithromycin |
| Chlamydia | Doxycycline 100mg BID x 7 days | Azithromycin 1g (single dose) |
| Trichomoniasis | Metronidazole 500mg BID x 7 days | Tinidazole 2g single dose |
| Genital Herpes | Acyclovir/Valacyclovir | Famciclovir |
Prevention Strategies: 1. HPV Vaccination: Recommended at age 11–12. 2. Barrier Protection: Consistent condom use. 3. Expedited Partner Therapy (EPT): Treating the partner without an exam (legal in most regions).
References: 1. CDC Sexually Transmitted Infections Surveillance, 2024 (Provisional). 2. WHO Global STI Strategy 2022–2030 (2025 Updates). 3. StatPearls: Sexually Transmitted Infections (2024).