Comprehensively explores sexually transmitted diseases, from epidemiology, causative pathogens, clinical impact, and immunology, to management strategies utilizing new strategies of genomics and next-generation diagnostic tools
Sexually transmitted infections (STI) are very common worldwide. More than 20 different STIs have been identified, and about 19 million men and women are infected each year in the United States alone. This book looks at the complete picture of common STIs - how they form, evolve, and transmit, as well as how they can be treated and managed with modern techniques, medicines, and tools.
Diagnostics to Pathogenomics of Sexually Transmitted Infections runs the spectrum of discussion ranging from introduction of causative pathogen, their pathogenesis to epidemiology, immunology, to anatomy and physiology of human genitalia and management strategies. The book offers in-depth chapter coverage on effect of probiotics on reproductive health; mucosal immunity in sexually transmitted infections; the role of circumcision in preventing STIs; Human Immunodeficiency Virus (HIV); genital herpes; molluscum contagiosum; genital warts; chlaymydia trachomatis; donovanosis; gonorrhoea; treponematoses; genital mycoplasms; bacterial vaginosis; vulvovaginal candidiasis; chlaymydia; scabies; chancroid, yeast infections; and more.
- Comprehensively compiles most of the major sexually transmitted infections
- Presents updated information on clinical aspects of sexually transmitted infections
- Examines the priorities in pathogenesis of human sexually transmitted infections and discusses new strategies of genomics and next-generation diagnostic tools used for detection of such pathogens
- Explores the future of rapid molecular diagnostic techniques and the challenges posed in the diagnosis of human STIs
- Includes bench to bedside content that will appeal to both basic and clinical researchers
By offering the latest knowledge about recent advances in sexually transmitted infections in an interdisciplinary fashion, Diagnostics to Pathogenomics of Sexually Transmitted Infections is the perfect book for virologists, microbiologists, infectious disease experts, vaccinologists, biomedical researchers, clinicians, pharmacologists, and public health specialists.
Table of Contents
About the Editor xv
Contributors xvii
Preface xxi
1 Mucosal Immunity in Sexually Transmitted Infections 1
Jiri Mestecky and Michael W. Russell
1.1 Introduction 1
1.2 Innate Immunity in the Genital Tract 2
1.2.1 Humoral Defense Factors in Female Secretions 2
1.2.2 Innate Defense Factors in the Male Tract 4
1.3 Immunoglobulins in Secretions of the Genital Tract 4
1.3.1 Female Genital Tract Secretions 4
1.3.2 Origin of Igs in Human Genital Tract Secretions 7
1.3.3 Functions of Genital Tract Antibodies 8
1.4 Cells of the Mucosal Immune System of the Genital Tract 10
1.4.1 Epithelial Cells 10
1.4.2 Immunoglobulin‐Producing Cells 10
1.4.3 T Cells and Other Cell Types 11
1.5 Induction of Immune Responses in the Genital Tract 12
1.5.1 Induction of Humoral Immune Responses in Human Male Genital Tract Secretions 14
1.5.2 Immune Responses in the Genital Tract after Infections 15
1.5.2.1 Gonorrhea 15
1.5.2.2 Chlamydia 15
1.5.2.3 Human Immunodeficiency Virus (HIV) 16
1.5.2.4 Human Papilloma Virus 16
1.6 Concluding
Remarks 17
References 17
2 The Role of Circumcision in Preventing Sexually Transmitted Infections 27
Kourosh Afshar, Behnam Kazemi, and Andrew E. MacNeily
2.1 Introduction 27
2.2 Biological Mechanisms 27
2.3 Methods of Circumcision 28
2.4 Complications 28
2.5 Role of MC in Transmission of HIV 29
2.5.1 Male‐to‐Female Transmission 29
2.5.2 Female‐to‐Male Transmission 29
2.5.3 Male‐to‐Male Transmission 30
2.6 Human Papilloma Virus (HPV) 30
2.7 Nonulcerative STIs 31
2.7.1 Gonorrhea 31
2.7.2 Trichomonas Vaginalis (Tv) 32
2.7.3 Chlamydia Trachomatis (Ct) 32
2.8 Ulcerative STIs/Genital Ulcer Disease (GUD) 32
2.8.1 Syphilis 33
2.8.2 Chancroid 34
2.9 Use of Male Circumcision as a Public Health Measure 34
2.10 Female Genital Mutilation (FGM) 35
References 36
3 Effect of Probiotics on Reproductive Health 41
Piotr Kochan, Magdalena Strus, and Piotr B. Heczko
3.1 Introduction 41
3.2 Definition of Probiotics 43
3.3 Vaginal Microflora (Microbiota) 46
3.4 Applications of Probiotics in Vaginal and Reproductive Health 49
3.4.1 Vaginitis (Aerobic Vaginitis (AV), Bacterial Vaginosis (BV), and Vulvovaginal Candidiasis (VVC)) 50
3.4.2 UTI 52
3.4.3 Pregnancy 52
3.4.4 Other Obstetrics and Gynecology (OB/GYN) Uses of Probiotics 53
3.5 Conclusions 53
References 54
4 Human Immunodeficiency Virus (HIV) Infection 61
Santosh Kumar Singh and Sunit K. Singh
4.1 Introduction 61
4.2 HIV Structure/Genome 62
4.3 Routes of Transmission 64
4.3.1 Sexual Transmission 64
4.3.1.1 STDs and Sexual Transmission of HIV 64
4.3.1.2 Vulnerability of Female Genital Tract for HIV Transmission 66
4.3.2 Transmission by Contaminated Blood/Blood Product Transfusion 68
4.3.3 Transmission by Sharing Syringe and Needles 68
4.3.4 Transmission from Mother to Fetus or Newborn Babies 68
4.3.5 Occupational Risk in Healthcare Workers 68
4.4 Host Factors Influencing HIV Infectivity in Sexual Transmission 69
4.4.1 Systemic Host Factors 69
4.4.2 Local Host Factors 69
4.5 Viral Factors Influencing HIV Infectivity in Sexual Transmission 70
4.6 Mechanism of Pathogenesis 71
4.7 Diagnosis of HIV Infections 72
4.8 Therapeutics 73
4.8.1 Antiretroviral Therapies (ARTs) 73
4.8.2 Combinational ARTs 74
4.9 Conclusion 74
References 75
5 Genital Herpes 83
Andreas Sauerbrei
5.1 Introduction 83
5.2 Pathogen 83
5.3 Epidemiology 84
5.4 Pathogenesis and Immunity 84
5.5 Clinical Features 86
5.6 Diagnosis 87
5.7 Treatment 90
5.8 Prevention and Control 93
5.9 Conclusion 94
References 95
6 Molluscum Contagiosum 101
Tugba Kevser Uzuncakmak and Ayse Serap Karadag
6.1 Introduction 101
6.2 Epidemiology 101
6.3 Molecular Pathogenesis 102
6.4 Diagnosis 103
6.5 Clinical Features 106
6.6 Mode of Spread of Infections 107
6.7 Treatment 107
6.7.1 Treatment Options 108
6.7.1.1 Watchful Waiting 108
6.7.1.2 Procedure‐Based Treatments 109
6.7.1.3 Chemical Agents 110
6.7.1.4 Immune Modulators 111
6.7.1.5 Antiviral Agents 112
6.7.1.6 Immunocompromised Patients 112
6.8 Conclusion 113
References 113
7 Genital Warts 119
Filip Rob
7.1 Introduction 119
7.2 Human Papillomavirus 119
7.2.1 Taxonomy 119
7.2.2 Life Cycle 120
7.2.3 Interaction with Immune System 120
7.2.4 Transmission 120
7.2.5 Clearance 120
7.3 Epidemiology 121
7.4 Risk and Protective Factors 121
7.4.1 Risk Factors 121
7.4.2 Protective Factors 122
7.5 Clinical Features 122
7.5.1 Physical Signs 122
7.5.2 Symptoms 123
7.6 Diagnostics 124
7.6.1 Clinical Investigation 124
7.6.2 3-5% Acetic Acid 124
7.6.3 Histopathology 124
7.6.4 HPV DNA Detection 125
7.6.5 HPV Antibodies 125
7.7 Differential Diagnosis 125
7.8 Treatment 126
7.8.1 Cryotherapy 126
7.8.2 Laser Therapy (CO2 laser, Er:YAG laser) 127
7.8.3 Electrocautery 127
7.8.4 Surgical Excision 127
7.8.5 Trichloracetic Acid (80-90% solution) 127
7.8.6 Podophyllotoxin (0.05% solution or 0.15% gel) 127
7.8.7 Imiquimod (3.75% or 5% cream) 127
7.8.8 Sinecatechins (10% or 15% ointment) 129
7.9 Specific Groups 129
7.9.1 Immunocompromised Patients 129
7.9.2 Pregnant Women 129
7.9.3 Children 129
7.10 HPV Vaccination 130
References 131
8 Chlamydia Trachomatis Urogenital Infections: Epidemiology, Clinical Presentations, and Pathogenesis 135
Charles W. Armitage, Alison J. Carey, Danica K. Hickey, and Kenneth W. Beagley
8.1 Introduction 135
8.2 Epidemiology 135
8.3 Chlamydial Biology 136
8.3.1 The Attachment and Entry of Chlamydial EBs 136
8.3.2 The Chlamydial Inclusion 137
8.3.3 Chlamydial Replication and Persistence 137
8.4 Clinical Features 138
8.4.1 Urogenital Tract Infections 139
8.4.2 Female Urogenital Tract 139
8.4.3 Infection and Pregnancy 141
8.4.4 Male Urogenital Tract 142
8.4.5 Anorectal Tract Infections 143
8.4.6 Gastrointestinal Chlamydial Infections and Persistence 144
8.4.7 Lymphogranuloma Venereum 144
8.5 Pathogenesis of Chlamydial Infections 145
8.5.1 Pathogenesis of Female Genital Tract Chlamydial Infections 145
8.5.2 Lower FRT Pathogenesis 146
8.5.3 Upper FRT Pathogenesis 146
8.5.4 Pathogenesis of Male Urogenital Tract 148
8.5.5 Chlamydial Urethritis and Prostatitis 148
8.5.6 Chlamydial Infections of the Upper MRT 148
8.5.7 Chlamydial Epididymitis 149
8.5.8 Chlamydial Orchitis 149
8.6 Diagnosis and Treatment 150
8.7 Prevention and Control 151
8.8 Conclusion 152
References 153
9 Donovanosis 167
Sarita Martins De Carvalho Bezerra, Marcio Martins Lobo Jardim, and Juliana Uchiyama
9.1 Introduction 167
9.2 Epidemiology 168
9.3 Pathology 168
9.4 Incubation Period 169
9.5 Clinical Pictures 170
9.6 Sites of Involvement 174
9.7 Complications and Sequelae 175
9.8 Diagnosis 175
9.9 Differential Diagnosis 176
9.10 Treatment 176
9.11 Prevention and Control 177
9.12 Disease Control and Prevention 178
References 178
10 Gonorrhea 181
María Teresa Pérez‐Gracia and Beatriz Suay‐García
10.1 Introduction 181
10.2 Pathogen 182
10.2.1 Morphology 182
10.2.2 Virulence Factors 183
10.2.2.1 Type IV Pili (Tfp) 183
10.2.2.2 Por Proteins 183
10.2.2.3 Opacity Proteins (Opa) 184
10.2.2.4 Rmp Proteins 184
10.2.2.5 Lipooligosaccharide (LOS) 184
10.2.2.6 IgA Protease 185
10.2.3 Physiology 185
10.2.4 Genome 185
10.3 Pathogenesis and Immunity 185
10.4 Epidemiology 186
10.5 Clinical Features 188
10.5.1 Gonococcal Infection in Men 188
10.5.2 Gonococcal Infection in Women 188
10.5.3 Extragenital Locations 188
10.6 Diagnosis 189
10.6.1 Samples 189
10.6.2 Staining 191
10.6.3 Culture 191
10.6.4 Identification 193
10.6.5 Neisseria gonorrhoeae Genotyping 193
10.6.6 Nucleic Acid Amplification Tests (NAATs) 197
10.7 Treatment 198
10.8 Prevention and Control 200
10.9 Conclusion 202
References 202
11 Sexually Transmitted Treponematoses 211
Lenka Mikalová and David Šmajs
11.1 Introduction 211
11.2 Genetics of TPA and TEN Strains 212
11.3 Virulence Factors of Syphilis and Bejel 214
11.4 Diagnostics of Syphilis and Bejel 215
11.5 Treatment of Syphilis and Bejel 217
11.6 Molecular Typing of Syphilis and Bejel Treponemes 220
11.7 Vaccine Development for Syphilis and Bejel 222
References 223
12 Genital Mycoplasmas 233
Suncanica Ljubin‐Sternak
12.1 Introduction 233
12.2 Biology 234
12.3 Pathogenesis 235
12.3.1 Adhesion Proteins 236
12.3.2 Antigenic Variation 236
12.3.3 Production of Enzymes 236
12.3.4 Facultative Intracellular Localization 237
12.3.5 Capacity to Induce Host Immune Response 237
12.4 Epidemiology 237
12.5 Clinical Presentation 238
12.5.1 Urogenital Infections in Women 238
12.5.1.1 Bacterial Vaginosis 238
12.5.1.2 Cervicitis 239
12.5.1.3 Pelvic Inflammatory Disease (PID) and Its Sequalae 239
12.5.1.4 Infections in Pregnancy 240
12.5.2 Urogenital Infections in Men 241
12.5.2.1 Nongonococcal Urethritis (NGU) 241
12.5.2.2 Epididymitis and Prostatitis 241
12.5.2.3 Infertility 241
12.5.3 Rare Manifestations and Clinical Features in Immunocompromised Persons 242
12.5.3.1 Urinary Calculi 242
12.5.3.2 Systemic Infection and Arthritis 242
12.5.3.3 Infection in Immunocompromised Patients 242
12.6 Laboratory Diagnosis 243
12.6.1 Specimen Collection 243
12.6.2 Culture Methods 243
12.6.3 Molecular Methods 245
12.6.4 Serology 246
12.7 Treatment 247
12.8 Prevention and Control 248
References 249
13 Bacterial Vaginosis 257
Aliona Rosca and Nuno Cerca
13.1 Introduction 257
13.2 Implication of G. vaginalis in Bacterial Vaginosis 258
13.3 Epidemiology and Risk Factors 260
13.4 Pathogenesis and Immunity 261
13.5 Clinical Features 263
13.6 Diagnosis 263
13.7 Treatment 266
13.8 Conclusions 268
References 268
14 Chancroid 277
Margaret E. Bauer and Diane M. Janowicz
14.1 Introduction 277
14.2 Epidemiology of Chancroid and H. ducreyi 277
14.3 Clinical Features 278
14.4 The Pathogen 279
14.5 Pathogenesis and Immunity 280
14.5.1 Overview of Pathogenesis 280
14.5.2 Virulence Mechanisms 280
14.5.3 Regulation of Virulence 282
14.5.4 Immune Response 283
14.6 Diagnosis, Treatment, and Prevention 284
14.7 Chronic Limb Ulcers Caused by H. ducreyi 285
14.8 Conclusions 286
References 287
15 Vulvovaginal Candidosis 293
Gilbert G.G. Donders, Katerina S. Ruban, Gert Bellen, and Sivtrigaile Grinceviciene
15.1 Introduction 293
15.2 Etiology 293
15.2.1 Pathogens 293
15.2.2 Morphology 294
15.3 Epidemiology 294
15.3.1 Prevalence 294
15.3.1.1 Asymptomatic Colonization 294
15.3.1.2 Symptomatic Infection 295
15.3.2 Risk Factors 298
15.3.3 Sexual Transmission 298
15.3.4 Young and Elderly Women 298
15.4 Pathogenesis and Immunity 300
15.4.1 Hormones 300
15.4.2 Pregnancy 300
15.4.3 Impaired Glucose Tolerance 301
15.4.4 Genetic Predisposition 301
15.4.4.1 STAT1 Gain of Function Mutations 302
15.4.4.2 CARD9 302
15.4.4.3 AIRE Mutation 302
15.4.4.4 NALP3/CIAS1 304
15.4.4.5 Interleukin-4 304
15.4.4.6 Dectin-1 304
15.4.4.7 Mannose‐Binding Lectin (MBL) 304
15.4.5 Other Factors Affecting Pathogenesis 305
15.5 Symptoms and Signs 305
15.5.1 Acute/Episodic Infection 305
15.5.2 Recurrent Vulvovaginal Candidosis 306
15.6 Diagnosis and Differential Diagnosis 306
15.6.1 Clinical Signs 306
15.6.2 Clinical Examination 306
15.6.3 Wet Mount Microscopy 307
15.6.4 Vaginal pH 309
15.6.5 Vaginal Mycological Culture 310
15.6.6 Molecular Biology 310
15.6.7 Histology 310
15.6.8 Differential Diagnosis 310
15.7 Treatment 311
15.7.1 General Principles of Treatment 311
15.7.2 Treatment of Uncomplicated Acute Infection 311
15.7.3 Treatment of Complicated Acute Infection 312
15.7.3.1 Severe Symptoms, C. albicans Vulvovaginitis 314
15.7.3.2 Non‐Albicans Candida Infection 314
15.7.3.3 Poorly Controlled Diabetes, Immune Suppression 315
15.7.3.4 Pregnancy and Breastfeeding 315
15.7.4 Recurrent Vulvovaginal Candidiasis (RVVC) 316
15.7.4.1 Azole‐Resistant C. albicans 317
15.7.4.2 Elimination of Risk Factors of Recurrence in RVVC Patients 317
15.7.4.3 Underlying Reasons for Failing Maintenance Therapy 318
References 319
16 Tinea Cruris 329
Anuradha Bishnoi and Rahul Mahajan
16.1 Introduction 329
16.2 Etiology and Epidemiology 330
16.3 Tinea Cruris as a Sexually Transmitted Infection (STI) 331
16.4 Transmission 331
16.5 Pathogenesis 332
16.5.1 Environmental Factors 332
16.5.2 Agent Factors 332
16.5.3 Host Factors 332
16.5.4 Host Immune Response 333
16.5.5 Clinical Features 333
16.5.6 Variants 335
16.5.6.1 Tinea incognito 335
16.5.6.2 Vesico‐Bullous Tinea Cruris 335
16.5.6.3 White Paint Dots and Pseudomembranous Tinea 335
16.6 Differential Diagnoses 336
16.6.1 Candidiasis 336
16.6.2 Erythrasma 336
16.6.3 Hyperpigmented Pityriasis Versicolor 336
16.7 Laboratory Diagnosis 336
16.7.1 Direct Examination 336
16.7.2 Culture 337
16.7.3 Nucleic Acid Amplification Tests 337
16.8 Treatment of Tinea Cruris and Genitalis 337
16.8.1 Topicals 337
16.8.2 Systemic 337
16.8.3 Recalcitrant/Resistant Tinea: Pathomechanisms and Treatment 338
16.8.4 General Measures to Prevent Tinea Cruris 338
16.9 Conclusion 338
Acknowledgments 339
References 339
17 Trichomonas Vaginalis 341
Barbara Van Der Pol
17.1 Introduction 341
17.2 Epidemiology of T. vaginalis 342
17.3 HIV and Trichomonas 344
17.4 Biology and Pathogenesis of T. vaginalis 345
17.5 Clinical Features of T. vaginalis Infection 346
17.6 Diagnosis of T. vaginalis 348
17.6.1 Laboratory Diagnosis 349
17.7 Treatment of T. vaginalis 350
17.8 Conclusion 351
References 351
18 Scabies 357
Giuseppe Micali, Giorgia Giuffrida, and Francesco Lacarrubba
18.1 Introduction 357
18.2 Epidemiology 357
18.3 Etiopathogenesis 358
18.4 Clinical Features 359
18.5 Diagnosis 363
18.5.1 Microscopy 363
18.5.2 Dermatoscopy/Videodermatoscopy 363
18.5.3 Histopathology 365
18.5.4 Other Diagnostic Procedures 366
18.6 Treatment 366
18.6.1 Topical Agents 366
18.6.2 Oral Agents 367
18.6.3 Treatment for Crusted Scabies 367
18.7 Prevention and Control 368
18.8 Conclusion 368
References 368
Index 373
