MOT SO BENH LAY TRUYEN QUA NG TNH DUC VA THAI

NHNG THAY OI TRONG THAI KYTrong thai ky, ty le benh va o nang gia tang v co tnh trang giam mien dch do:CD4, lympho T giam ap ng oi vi tac nhan gay benhThay oi GPH trong thai ky

GIANG MAI VA THAI

DCH TE HOCGM I,II neu khong ieu tr anh hng 100% en thai nhi; 50% cac thai ky sanh non hay chet chu sinh.GM muon neu khong ieu tr 40% sanh non, chet chu sinh. 10% GM bam sinhGM sau 2 nam mac benh hiem con lay qua ng tnh duc, trong khi o van con kha nang lay cho con trong nhieu nam sau.

CHAN OANLam sang thng khong ro:GM I nhng sang thng nguyen phat tai vung sinh duc thng co kch thc nho, loet cng khong au, b go, ay co mo hat, ton tai 2-6 tuan, het t nhien, hach ben to, khong au.GM II: 4-10 tuan sau khi lanh chancre xuat hien nhng mang o da

CHAN OANPhan ng huyet thanh hoc:Khong ac hieu:VDRLRPRac hieu:TPIFTA-absTPHA

Phan ng huyet thanh giang mai khong ac hieuCap (6thang)Co thaiLupus o do thuocNhiem trung capTang n nhan nhiem trungSot ret SiThuy auViem phoi khong ien hnhVaccin au muaNghien ma tuyBenh mach mau collagenGia yeuBenh phongUng th di can hoac x ganViem giap HashimotoHoi chng SjogrenSarcoidoseLymphomaa u tuyNghien ma tuy

Phan ng dng tnh gia cua TPHA

TPHACo thaiNghien ma tuyHerpes sinh ducLupus oX cng bViem b cBenh mo lien ket phoi hpX gan do ru

IEU TRMot san phu co VDRL va TPHA (+) khong phai luc nao cung ieu tr:a c ieu tr ung phac o, hien hieu gia khang the VDRL giam > 4 lan, sau khi ngng ieu tr t nhat 3 thang khong ieu tr.Phat hien lan au, cha ieu tr ieu tra ieu tr khong ung, hieu gia khang the khong giam

GIANG MAI SMGom GM I,II va GM tiem tang trc 1 nam, < 1nam c tnh:T khoang cach thi gian vi lan xet nghiem (-) trc oTnh t lan giao hp nghi ngTnh t luc ket hon neu la con so hay lan giao hp au tien

GIANG MAI MUONGom GM III va GM tiem tang sau 1 namNeu khong biet c moc thi gian th tnh nh > 1 nam

IEU TR GIANG MAI PHU N MANG THAI

Phan loaiieu trGiang mai smBenzathine PNC G, 2.4 tr. v TB lieu duy nhat oi khi can 1 lieu th 2 vao tuan sau.Giang mai muonBenzathine PNC G, 2.4 tr. v TB/tuan x 3tuan Giang mai than kinhCrystalline PNC G, 24 tr. v TB/4 gi x 10-14 ngay HayProcaine PNC, 2.4 tr. v TB/ngay va uong probenecid 500 mg/6gi x 1014 ngay

IEU TRPhai ieu tr ong thi ban tnhPhai xet nghiem them xet nghiem HIVNeu thi gian mac benh > 2 nam can phai lam them xet nghiem DNTTheo doi thai nhi va tre neu me c ieu tr trong 3 thang cuoi cua thai ky, nham phat hien sm GM bam sinh

LAU VA THAI Nhiem trung kh quan: 15 30%Nhiem trung lan toa: thng gap phu n co thai hn la khong co thaiPID cap hiem xay ra. Viem tai voi cap khong xay ra khi thai > 12 tuanNhiem lau khi thai con nho say thai nhiem trungNhiem lau/ chuyen da OVS, nhiem trung oi, sanh non

CHAN OANCay tm N. gonorrhoeaeCh nh cay: Sot trong chuyen daCo tien can b lauOVSSay thai nhiem trungBenh pham lay t co trong CTC

IEU TR LAU KHONG BIEN CHNG PHU N MANG THAI

Ceftriaxone 250 mg TB lieu duy nhatCefixime 400 mg uong lieu duy nhatSpectinomycin 2 g TBNeu nhiem chlamydia kem theo th dung them erythromycin

CLAMYDIA TRACHOMATIS VA THAINhiem clamydia trachomatis co the tang do vung lo tuyen CTC trong thai ky hay do thay oi ap ng mien dch vi vi trungYeu to nguy c: tuoi tre, khong ket hon, nhieu ban tnh, co benh lay truyen qua ng tnh duc

NHIEM CHLAMYDIA

Me: Viem nieu ao cap Viem tuyen Bartholin cap Viem co t cung Viem tai voi Viem quanh gan Viem ket mac Viem khp Tre s sinh: Viem ket mac Viem phoi

CHAN OANTam soat chon loc:< 20 tuoi, 20-24 tuoi thnh thoang s dung bien phap nga thai hang rao hay co 1 hay nhieu ban tnh mi trong vong 3 thang gan ay24 tuoi vi ca 2 yeu to trenThi iem: ngay lan kham thai au, lap lai vao TCN II neu van con yeu to nguy c

CHAN OANPhng phap tam soat:Cay te baoKits phat hien khang nguyenHuyet thanh hoc

IEU TR NHIEM CHLAMYDIA PHU N MANG THAI

LieuLa chon 1Erythromycin 500 mg uong/6gi x 7 ngay La chon 2- Erythromycin 250 mg uong/6gi x 14 ngay- Erythromycin ethylsuccinate 800 mg uong/6gi x 7 ngay- Erythromycin ethylsuccinate 400 mg uong/6gi x 14 ngay- Amoxicillin 500 mg uong/8gi x 7 ngay

So ngi nhiem HIV tren toan the gii tnh en cuoi nam 2003 Tong: 34 46 trieu Western Europe520 000 680 000North Africa & Middle East470 000 730 000Sub-Saharan Africa25.0 28.2 millionEastern Europe & Central Asia1.2 1.8 millionSouth & South-East Asia4.6 8.2 millionAustralia & New Zealand12 000 18 000 North America790 000 1.2 millionCaribbean350 000 590 000Latin America1.3 1.9 millionEast Asia & Pacific700 000 1.3 million

HIV VA THAI

ANH HNG CUA THAI KY LEN SC KHOE ME VA IEU TR HIVTang s nhan ban cua HIV, dien tien cua benh cha ro. Khong co li ch ro rang trong viec cham dt thai kyZidovudine (ZDV) la thuoc khang virus duy nhat co the s dung trong thai kyThai ky co the lam lan lon chan oan cac tnh trang lien quan en HIV v trieu chng tac dung phu cua thuoc cung gan giong trieu chng nghen

NGUY C LAY NHIEM CHU SINHTy le: 9,1 50% (san phu khong dung ZDV)ZDV lam giam nguy c lay nhiem chu sinh

Thi iem lay nhiem HIV t me sang con- Lay nhiem me-con: 13 40% , trung bnh 25%- Thi iem lay nhiem lien quan en bien phap can thiep e giam t le lay nhiem. - Nghien cu Zaire: - trong t cung: 6%- trong luc sanh: 18% - Sau sanh: 4%- Hien nay: 2/3 3/4 lay nhiem vao luc sanh

Cac yeu to lien quan en lay nhiem HIV t me sang con

1. Cac yeu to lien quan en ngi me 2. Cac yeu to lien quan en HIV 3. Cac yeu to lien quan en tre s sinh 4. Anh hng cua sa me

Cac yeu to lien quan en ngi me 1. Giai oan nhiem HIV: AIDS co tr/c, nhiem HIV cap. 2. STIs 3. Thieu sinh to A ? 4. S dung ma tuy5. Hut thuoc la 6. QHTD khong bao ve vi nhieu ban tnh 7. Sanh non. 8. Nhau bong non. 9. Sanh dung cu va cac bien phap theo doi thai xam lan, cat tang sinh mon.

Cac yeu to lien quan en ngi me10. V oi sm: T le lay nhiem gia tang theo thi gian v oi11. Cach sanh: MLT trc chuyen da va v oi: giam lay nhiem 55-80%. MLT chng trnh + AZT: t le nhiem # 2%12. S dung ARV : - HAART : 1,1% - 1 hoac 2 loai ? - vao giai oan trc, trong hoac sau sanh ? - bu me hay khong?

Lien quan gia thi gian v oi va t le nhiem HIV cua tre s sinh Landesman SH et al: NEJM 1996;334:1617-23

Cac yeu to lien quan en HIV 1. Nong o HIV RNA : - nguy c cao neu HIV RNA cao 2 nhom ARV (+) va ARV (-). - Rat thap neu HHIVRNA (-) 2. Nong o HIV trong mau va trong dch tiet sinh duc3. CD4 thap, t le lay nhiem cao. 4. ap ng MD cua me: anti-gp 120, anti-gp41, anti-p24, . Lam giam nguy c lay nhiem.

Cac yeu to lien quan en tre s sinh

1. Tre sinh non, kem theo he thong MD kem phat trien. 2. Vai tro cua co-receptors CCR5 tang e khang t nhien vi HIV. 3. ap ng MD te bao vi HIV hien dien trong 1/3 tre khong nhiem t me b nhiem HIV.

Anh hng cua sa me- T le lay nhiem tang cao nhat vao giai oan au sau sanh va t le thuan vi thi gian bu me- Yeu to lien quan: Vet nt, l vu meTre b l hoac nam miengBu bnh: giam 44% t le lay nhiem va cai thien t le song cua tre

Khuyen cao s dung ZDV/ san phu con nham giam lay nhiem HIV theo chieu doc

Trc sanhZDV 100mg x 5lan/ngay uongHay 200mg x 3lan/ngay uongCang sm cang tot sau tuan le th 13 cua thai kyTrong chuyen daLieu khi au: ZDV 2mg/kg tiem TMDuy tr: 1mg/kg cho en luc sanhTre2mg/kg/6gi uong. Tong lieu: 8mg/kg/ngay x 6 tuan, bat au t 8-12 gi sau sanh.

IEU TRLay truyen qua sa me a c ghi nhanTat ca cac thai phu phai c th HIV khong ke en cac yeu to nguy c lay nhiem benh

*Congenital syphilis. A. A 29-week infant gravely ill with congenital lues. Note the enlarged abdomen caused by marked hepatosplenomegaly plus ascites. B. The large syphilitic placenta of the same infant. The placenta weighed 1200 g, almost the birthweight of the infant. (Photographs courtesy of Dr. G. Wendel.)

*Reported cases of congenital syphilis in infants less than 1 year of age and rates of primary and secondary (P&S) syphilis among womenUnited States, 19701994. (From the Centers for Disease Control and Prevention, 1995c.)*Genital condylomata lata of secondary syphilis. (From Wendel and Cunningham, 1991.)*Giang mai*Giang mai giai doan 1*map in the back of epi update

*Schematic model of the natural history of HIV-1 infection. (Reproduced, with permission, from Clark SJ, Saag MS, Decker WD, Campbell-Hill S, Roberson JL, Veldkamp PJ, Kappes JC, Hahn BH, Shaw GM. High titers of cytopathic virus in plasma of patients with symptomatic primary HIV-1 infection. N Engl J Med. 324:954, 1991. Copyright 1991 Massachusetts Medical Society. All rights reserved.)