mkdir -p /home/daytona/workspace/std-seminar && ls /home/daytona/workspace/std-s…

~/std-seminar/build_pptx.js

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// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 1 — Title
// ════════════════════════════════════════════════════════════════════════════
titleSlide(
  "Sexually Transmitted Diseases",
  "A Comprehensive Seminar Presentation"
);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 2 — Overview / Outline
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Seminar Outline", [
  "## 1. Introduction & Global Burden",
  "## 2. Classification of STDs",
  "## 3. Epidemiology in the United States",
  "## 4. STD Syndromes & Clinical Approach",
  "## 5. Syphilis",
  "## 6. Gonorrhea",
  "## 7. Chlamydial Infections",
  "## 8. Herpes Simplex Virus (HSV)",
  "## 9. Human Papillomavirus (HPV)",
  "## 10. Other STDs",
  "## 11. Diagnosis & Screening",
  "## 12. Treatment Principles",
  "## 13. Prevention Strategies",
  "## 14. Summary & Key Take-aways"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 3 — Introduction
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Introduction: What Are STDs?", [
  "Infections transmitted primarily through sexual contact",
  "Also called Sexually Transmitted Infections (STIs)",
  "Caused by bacteria, viruses, protozoa, and ectoparasites",
  "More than 30 pathogens transmissible via sexual activity",
  "Represent a major global public health burden",
  "Many are silent (asymptomatic) — amplifying spread",
  "CDC has tracked reported STI rates in the US since 1941",
  "Disproportionate impact on adolescents, young adults, MSM, and marginalized groups"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 4 — Section divider
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("01", "Global Burden & Epidemiology");

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 5 — Epidemiology US
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Epidemiology: United States (Key Statistics)", [
  "## Gonorrhea",
  "  Peak: 468/100,000 (mid-1970s); fell to 98/100,000 (2012)",
  "  2018: 179.1/100,000 — >80% increase since 2009 all-time low",
  "## Chlamydia",
  "  Reporting began 1984; peaked at 457.6/100,000 in 2011",
  "  Increase driven by broader testing with more sensitive assays",
  "## Syphilis",
  "  2022: 207,255 total cases — highest since 1950",
  "  +17.3% increase from 2021",
  "  45% of primary/secondary cases in MSM",
  "## Congenital Syphilis",
  "  2022: 3,755 cases; rate 102.5/100,000 live births (highest since 1991)",
  "  282 congenital syphilis-related stillbirths/infant deaths"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 6 — Risk Factors
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Risk Factors for STDs", [
  "Adolescent boys and young men aged 15–24 years",
  "Men who have sex with men (MSM)",
  "Multiple sex partners or unprotected intercourse",
  "Sex with commercial sex workers",
  "Illicit drug use",
  "History of previous STI",
  "Transgender individuals",
  "Low condom use or inconsistent use",
  "HIV-positive status (immunosuppression amplifies transmission)",
  "Lack of access to screening and treatment services"
], { twoCol: false });

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 7 — Classification
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("02", "Classification of STD Syndromes");

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 8 — STD Syndromes Table
// ════════════════════════════════════════════════════════════════════════════
tableSlide("Common STD Syndromes & Causative Pathogens", 
  ["Syndrome", "Common Pathogens"],
  [
    ["Urethritis (male)", "N. gonorrhoeae, C. trachomatis, M. genitalium, U. urealyticum, HSV"],
    ["Epididymitis", "C. trachomatis, N. gonorrhoeae"],
    ["Cervicitis / Mucopurulent", "N. gonorrhoeae, C. trachomatis"],
    ["Pelvic Inflammatory Disease", "N. gonorrhoeae, C. trachomatis, anaerobes"],
    ["Genital Ulcer Disease", "HSV-1/2, T. pallidum (syphilis), H. ducreyi"],
    ["Genital Warts / Condyloma", "HPV (types 6, 11, 16, 18)"],
    ["Vaginitis / Vaginosis", "T. vaginalis, Candida, BV organisms"],
    ["Proctitis / Proctocolitis", "N. gonorrhoeae, C. trachomatis (LGV), HSV, syphilis"],
    ["Hepatitis", "HBV, HCV, HAV (feco-oral)"],
    ["Systemic (HIV)", "HIV-1, HIV-2"]
  ]
);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 9 — Syphilis section
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("03", "Syphilis — Treponema pallidum");

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 10 — Syphilis Overview
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Syphilis: Definition & Etiology", [
  "Chronic systemic infection caused by Treponema pallidum subsp. pallidum",
  "Thin spiral organism with trilaminar cytoplasmic membrane",
  "Endoflagella in periplasmic space responsible for motility",
  "Highly dependent on host-derived amino acids, carbohydrates, and lipids",
  "Characterized by episodes of active disease interrupted by latency",
  "Incubation period: average 2–6 weeks",
  "Three Treponema pallidum subspecies:",
  "  pallidum (venereal syphilis)",
  "  pertenue (yaws)",
  "  endemicum (bejel)"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 11 — Stages of Syphilis
// ════════════════════════════════════════════════════════════════════════════
tableSlide("Stages of Syphilis", 
  ["Stage", "Timing", "Key Features"],
  [
    ["Primary", "2–6 wks post-exposure", "Painless chancre at inoculation site; regional lymphadenopathy"],
    ["Secondary", "6–8 wks after primary", "Maculopapular rash (including palms/soles), condylomata lata, mucous patches"],
    ["Latent (Early)", "<1 year duration", "No symptoms; serologic evidence of infection only"],
    ["Latent (Late)", ">1 year duration", "No symptoms; low infectivity"],
    ["Tertiary", "Years to decades", "Gummas, cardiovascular syphilis, neurosyphilis"],
    ["Neurosyphilis", "Any stage", "Meningitis, meningovascular disease, general paresis, tabes dorsalis"],
    ["Congenital", "Vertical transmission", "Stillbirth, hydrops fetalis, snuffles, bone changes"]
  ]
);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 12 — Syphilis Diagnosis & Treatment
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Syphilis: Diagnosis & Treatment", [
  "## Serologic Tests",
  "  Non-treponemal: RPR, VDRL (activity marker; titer reflects disease activity)",
  "  Treponemal: FTA-ABS, TP-PA, EIA (confirm infection, remain positive lifelong)",
  "  RPR titer ≥1:32 associated with neurosyphilis risk",
  "## CSF Exam",
  "  Indicated if neurologic/ocular symptoms, RPR ≥1:32, or HIV co-infection",
  "## Treatment",
  "  Primary/Secondary/Early Latent: Benzathine penicillin G 2.4 MU IM x1",
  "  Late Latent/Unknown duration: Benzathine penicillin G 2.4 MU IM x3 (weekly)",
  "  Neurosyphilis: Aqueous crystalline penicillin G 18–24 MU/day IV x 10–14 days",
  "  Congenital syphilis: Aqueous penicillin G or procaine penicillin"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 13 — Neurosyphilis
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Neurosyphilis: Clinical Manifestations", [
  "## Meningeal Syphilis (<1 year after infection)",
  "  Headache, nausea, vomiting, neck stiffness, cranial nerve palsies",
  "  May coincide with secondary stage",
  "## Meningovascular Syphilis (up to 10 years)",
  "  Stroke-like syndrome in a young adult",
  "  Subacute encephalitic prodrome precedes vascular event",
  "## General Paresis (~20 years)",
  "  Mnemonic: PARESIS — Personality, Affect, Reflexes, Eye, Sensorium, Intellect, Speech",
  "  Argyll Robertson pupil (reacts to accommodation, not light)",
  "## Tabes Dorsalis (25–30 years)",
  "  Demyelination of posterior columns, dorsal roots",
  "  Ataxia, foot drop, paresthesia, bladder disturbances, areflexia",
  "  Loss of positional, deep-pain, and temperature sensations"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 14 — Gonorrhea section
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("04", "Gonorrhea — Neisseria gonorrhoeae");

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 15 — Gonorrhea
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Gonorrhea: Clinical Features & Treatment", [
  "## Pathogen",
  "  Neisseria gonorrhoeae — gram-negative diplococcus",
  "## Clinical Presentations",
  "  Men: urethral discharge, dysuria (urethritis); epididymitis if untreated",
  "  Women: often asymptomatic; cervicitis, PID, salpingitis, infertility",
  "  Both sexes: pharyngitis, proctitis, disseminated gonococcal infection (DGI)",
  "## Antimicrobial Resistance",
  "  Increasing fluoroquinolone resistance — fluoroquinolones no longer recommended",
  "  Decreasing susceptibility to ceftriaxone in small proportion of strains",
  "  Oral cephalosporins not recommended",
  "## Treatment (CDC 2021+)",
  "  Ceftriaxone 500 mg IM single dose (standard weight)",
  "  Persons ≥150 kg: Ceftriaxone 1 g IM",
  "  Treat co-infection with doxycycline if chlamydia not excluded"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 16 — Chlamydia section
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("05", "Chlamydial Infections");

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 17 — Chlamydia
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Chlamydial Infections: Overview", [
  "## Pathogen",
  "  Chlamydia trachomatis — obligate intracellular gram-negative bacterium",
  "## Serovars & Associated Diseases",
  "  Serovars D–K: urogenital infections (urethritis, cervicitis, PID)",
  "  Serovars L1–L3: Lymphogranuloma Venereum (LGV) — invasive, systemic",
  "## Clinical Features",
  "  Most infections are ASYMPTOMATIC — silent reservoir in community",
  "  Men: NGU (non-gonococcal urethritis), epididymitis",
  "  Women: cervicitis, endometritis, salpingitis, Fitz-Hugh–Curtis syndrome",
  "## LGV Resurgence",
  "  Outbreaks among MSM in North America and Europe since 1996",
  "## Treatment",
  "  Doxycycline 100 mg BID x 7 days (preferred for urogenital infection)",
  "  Azithromycin 1 g oral single dose (alternative; less effective for M. genitalium)",
  "  LGV: Doxycycline 100 mg BID x 21 days"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 18 — Urethritis Management
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Management of Urethritis in Men", [
  "## Causative Organisms",
  "  C. trachomatis, N. gonorrhoeae, M. genitalium, U. urealyticum, T. vaginalis, HSV",
  "## Evaluation Steps",
  "  1. Confirm urethral discharge or pyuria",
  "  2. Exclude local/systemic complications",
  "  3. Gram's stain: confirms urethritis; identify gram-negative diplococci",
  "  4. Test for N. gonorrhoeae, C. trachomatis, M. genitalium",
  "## Initial Treatment",
  "  If gonococci seen/suspected: Ceftriaxone 500 mg IM + Doxycycline",
  "  If Gram's stain negative (NGU): Azithromycin or Doxycycline",
  "## Persistent/Recurrent Urethritis",
  "  Most due to M. genitalium",
  "  Azithromycin then Moxifloxacin if needed",
  "  T. vaginalis: Metronidazole",
  "  Partners within 60 days should be tested and treated"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 19 — HSV section
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("06", "Herpes Simplex Virus (HSV)");

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 20 — HSV
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Genital Herpes: HSV-1 & HSV-2", [
  "## Epidemiology",
  "  HSV-2 antibody prevalence began to fall in late 1990s in US",
  "  Decline attributed to delayed sexual debut, increased condom use, fewer partners",
  "## Clinical Features",
  "  Primary infection: painful vesicles/ulcers, systemic symptoms (fever, malaise)",
  "  Recurrent infection: milder; prodrome of burning/tingling",
  "  Many patients remain asymptomatic (major source of transmission)",
  "  Complications: aseptic meningitis, sacral radiculopathy, neonatal herpes",
  "## Diagnosis",
  "  PCR of lesion — most sensitive; viral culture; HSV-2 IgG serology",
  "## Treatment",
  "  Acyclovir 400 mg TID x 7–10 days (primary episode)",
  "  Valacyclovir 1 g BID x 7–10 days (primary episode)",
  "  Suppressive therapy reduces recurrences and transmission risk"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 21 — HPV section
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("07", "Human Papillomavirus (HPV)");

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 22 — HPV
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Human Papillomavirus (HPV): Key Points", [
  "Most common sexually transmitted pathogen in the United States",
  "60% of initially HPV-negative sexually active women infected within 5 years (pre-vaccine era study)",
  "## High-Risk vs Low-Risk Types",
  "  Low-risk (6, 11): genital warts (condylomata acuminata)",
  "  High-risk (16, 18): cervical, oropharyngeal, anal, penile cancers",
  "## Vaccination",
  "  9-valent HPV vaccine (9vHPV) covers types 6, 11, 16, 18, 31, 33, 45, 52, 58",
  "  ACIP: recommended for ages 9–26 years; shared decision-making up to age 45",
  "  Global HPV vaccine expansion has reduced incidence of vaccine-type infections",
  "  Reduction in invasive cervical cancer already demonstrated",
  "## Coverage Gaps",
  "  Immunization gaps remain globally; continued vigilance needed"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 23 — Other STDs section
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("08", "Other Significant STDs");

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 24 — Other STDs
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Other Important Sexually Transmitted Pathogens", [
  "## Mycoplasma genitalium",
  "  Emerging cause of NGU, cervicitis, PID; rapidly developing antibiotic resistance",
  "  Doxycycline → Azithromycin → Moxifloxacin (escalating regimen)",
  "## Trichomonas vaginalis",
  "  Most prevalent non-viral STI worldwide",
  "  Women: frothy yellow-green discharge; men often asymptomatic",
  "  Treatment: Metronidazole 2 g oral single dose",
  "## Haemophilus ducreyi (Chancroid)",
  "  Painful genital ulcer with inguinal lymphadenopathy (bubo)",
  "  Treatment: Azithromycin 1 g oral single dose OR Ceftriaxone 250 mg IM",
  "## Hepatitis B Virus (HBV)",
  "  Annual incidence declined dramatically since mid-1980s (vaccine impact)",
  "  Vaccination recommended for all unvaccinated adults in STI clinics",
  "## Mpox (formerly Monkeypox)",
  "  Declared outbreak 2022; sexual transmission documented among MSM"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 25 — Diagnosis & Screening
// ════════════════════════════════════════════════════════════════════════════
sectionSlide("09", "Diagnosis & Screening");

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 26 — Screening Recommendations
// ════════════════════════════════════════════════════════════════════════════
contentSlide("STD Screening: CDC / USPSTF Guidelines", [
  "## Universal Screening (all adults 15–65 yr)",
  "  HIV — USPSTF recommends regardless of risk",
  "## Increased Risk Screening",
  "  Syphilis, Hepatitis B — screen men at increased risk",
  "  Chlamydia / Gonorrhea — all sexually active women <25 yr annually",
  "## MSM-Specific (CDC)",
  "  HIV, syphilis, gonorrhea, chlamydia — at least annually (more frequent if higher risk)",
  "## STD History Checklist (Harrison's Box)",
  "  Recent partners, condom use, symptoms, prior STIs, drug use, vaccination status",
  "## Behavioral Counseling (USPSTF B recommendation)",
  "  All sexually active adolescents and high-risk adults",
  "  Encourage condom use, reduction in number of partners, consideration of abstinence",
  "## Expedited Partner Therapy (EPT)",
  "  Provide treatment to partners without clinical evaluation where legally permitted"
], { twoCol: false });

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 27 — Prevention
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Prevention of STDs", [
  "## Primary Prevention",
  "  Consistent and correct condom use — MOST important method",
  "  Abstinence; reduction in number of sexual partners",
  "  Targeted sex education for adolescents and high-risk groups",
  "## Immunization",
  "  Hepatitis B: universal vaccination recommended",
  "  HPV: 9vHPV vaccine for ages 9–26 (extended to 45 via shared decision-making)",
  "  Meningococcal: indicated for HIV-infected men and outbreak settings",
  "## HIV-Specific Prevention",
  "  PrEP (Pre-exposure prophylaxis): highly effective in preventing HIV acquisition",
  "  PEP (Post-exposure prophylaxis): within 72 hours of high-risk exposure",
  "  Note: widespread PrEP uptake has reduced motivation for condom use",
  "## Structural Approaches",
  "  Screening clinics; partner notification; syndromic management"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 28 — Summary
// ════════════════════════════════════════════════════════════════════════════
contentSlide("Summary & Key Take-aways", [
  "STDs represent a major preventable public health burden worldwide",
  "Bacterial infections (syphilis, gonorrhea, chlamydia) are curable if caught early",
  "Viral STDs (HSV, HPV, HIV, HBV) are manageable but not fully curable",
  "Asymptomatic infection is common — routine screening is essential",
  "Antibiotic resistance is a growing threat (especially N. gonorrhoeae, M. genitalium)",
  "HPV and HBV are vaccine-preventable — vaccination opportunities must not be missed",
  "Condom use remains the most effective single behavioral prevention method",
  "PrEP has transformed HIV prevention but requires attention to condom complacency",
  "Treat partners simultaneously to prevent ping-pong reinfection",
  "Syphilis rates are at a 70-year high in the USA — heightened vigilance required"
]);

// ════════════════════════════════════════════════════════════════════════════
//  SLIDE 29 — Closing / Thank You
// ════════════════════════════════════════════════════════════════════════════
(function() {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 2.5, w: 10, h: 0.08, fill: { color: ACCENT } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.35, h: 5.625, fill: { color: ACCENT } });
  s.addText("Thank You", {
    x: 0.7, y: 1.4, w: 8.6, h: 1.0,
    fontSize: 44, bold: true, color: WHITE,
    fontFace: "Calibri Light", align: "left", margin: 0
  });
  s.addText("Questions & Discussion", {
    x: 0.7, y: 2.7, w: 8.6, h: 0.6,
    fontSize: 22, color: GOLD, fontFace: "Calibri", align: "left", margin: 0
  });
  s.addText("Source: Harrison's Principles of Internal Medicine, 22nd Edition (2025, McGraw-Hill Medical)", {
    x: 0.7, y: 5.0, w: 9.0, h: 0.35,
    fontSize: 11, color: MED_GRAY, fontFace: "Calibri", align: "left", margin: 0
  });
})();

// ════════════════════════════════════════════════════════════════════════════
//  WRITE FILE
// ════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/std-seminar/STD_Seminar_Harrison.pptx" })
  .then(() => console.log("DONE: /home/daytona/workspace/std-seminar/STD_Seminar_Harrison.pptx"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

cd /home/daytona/workspace/std-seminar && node build_pptx.js

ls -lh /home/daytona/workspace/std-seminar/