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PATHOGENESIS

1. TRICHOMONIASIS Natural flora (bacteria) keep the pH of the vagina at 4-5.5 and ordinarily this discourages infections T. vaginalis can survive at a low pH Once established it causes a shift towards alkalinity (pH 5-6) which further encourages its growth

2. SYPHILIS Syphilis in human is ordianarily transmitted by sexual contact. Infected males, T. Pallidum are present in lesions on the penis or discharged from deeper genitourinary sites along with the seminal fluid. Infected females, the lesions are commonly located in the perianal region or the labia, vaginal wall or cervix. In some cases the primary infection is extragenital usually in or about the mouth.

1. Primary stage (early) T. Pallidum enter the skin through small breaks capable of passing through intact mucous membranes which is carried by the blood stream to every organ of the body. Chancre develops at the site of entrance within 10- 60 days. Chancre usually begins as a papule, breakdown to form a superficial ulcer. Chancre in males occurs at the sulcus of penis or inside the urethra.

In females the chancre occurs at the labia majora or minora, fourchette, clitoris, cervix, uterus or urethral orifice. Persists for 1- 5 week, positive result is between the 1st and 3rd week after the appearance of chancre.

2. Secondary stage Usually occurs from 6-8 weeks after the appearance of the primary chancre. About 1/3 of the cases it occurs before the chancre disappears. Symptoms are generalized rash( involving the mucus membrane) Lesions may develop in the eyes ,joints or CNS Lesions subsides spontaneously after 2-6 weeks. Serologic test are invariably positive. In some cases the primary and secondary stages go unnoticed.

3.The late latent stage Occurs after the 2nd year of infection. Disease is contagious(communicable disease) at this stage. There are no clinical signs and symptoms positive serologic test. May lost for many years or even for the rest of patients life. For more than 4 years it is rarely communicable except between mother and fetus.

4. Tertiary stage Lesions are usually seen from 3-10 years after the primary stage. The lesions (gummata) usually located on the skin, mucous membranes, subcutaneous and sub mucous tissues, joints, muscles and ligaments Serious manifestations when lesions are present in the nervous system (causing general paralysis) cardiovascular system(aortic aneurysm) eyes (permanent blindness) In about of untreated cases this stage is asymptomatic.

Congenital syphilis Acquired fetal life from the maternal circulation through the placental passage of T.Palladum. More likely to occur when the mother is suffering from early syphilis. Adequate treatment of the mother before the 18th weak of pregnancy prevents infections of the fetus because penicillin will cross the placenta in adequate amount.

Cont..

Lesions of the 1st 2 year of life are infectious and resemble those of secondary syphilis in the acquired form of the disease. Late lesions appearing from the 3rd year onward are mostly of gummatous type and are non-infectious. The stigmata are the scars or deformities resulting from early or late lesions that have healed.

3. HUMAN PAPILLOMA VIRUSE (HPV)


Papillomaviruses are mainly transmitted by skin or genital contact. HPV infect squamous epithelial cells, but their life cycle is not well understood since these viruses cannot be cultured in vitro. In upper layers of stratified epithelium, HPV leads to a characteristic perinuclear vacuolization in epithelial cells (koilocytosis).

4. Varicella-Zoster Virus (VZV)


Acute infection with VZV causes chickenpox( Varicella ); reactivation of latent VZV causes shingles ( zoster). In contrast to HSV, VZV is transmitted in epidemic fashion by aerosols, disseminates hematogenously, and causes widespread vesicular skin lesions. VZV infects neurons in dorsal root ganglia and may recur many years after the primary infection, causing shingles. In contrast to numerous recurrences of HSV, VZV usually recurs only once, most frequently in immunosuppressed or elderly persons.

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