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STD Anatomy of GU Tract External genitalia o Labia o Penis Internal genitalia o Testis Epididymis Seminal vesicle Urethra o Ovaries Fallopian tube Uterus Vagina General STI Clinical Manifestations Asymptomatic o Gonorrhea o Chlamydia o Trichomoniasis (goes unnoticed in males) o Primary Lesions of Sy...

STD Anatomy of GU Tract External genitalia o Labia o Penis Internal genitalia o Testis Epididymis Seminal vesicle Urethra o Ovaries Fallopian tube Uterus Vagina General STI Clinical Manifestations Asymptomatic o Gonorrhea o Chlamydia o Trichomoniasis (goes unnoticed in males) o Primary Lesions of Syphilis Dysuria (discomfort urination) Urethritis (Gonococcal & Non-gonococcal) Vaginal discharge Gential warts (HPV) Genital Ulcers (HSV) Urethritis & Cervicitis What is it? Gonococcal Most common Non-Gonococcal Urethritis Males Females Chlamydia trachomatis Inflammation of urethra Inflammation of N. gonorrhoea Mycoplasma Asymptomatic hominis & genitalium Profuse mucopurulent Ureaplasma yellow/green urealyticum Cervix Trichomonas vaginalis Yeast HSV Discharge Primary site endocervical canal BV and Urethritis Organisms Organism Neisseria gonorrhea Chlamydia trachomatis General Feature Gonorrhea Gram (-) intracellular Diplococci Clinical Feature Males Discharge Dysuria Females Pruritus Discharge Dysuria Lymphogranuloma Venereum Urethritis w/ Gram (-) intracellular moderate whitish discharge & dysuria Ureaplasma urealyticum Non-specific urethritis Males Urethritis Proctitis Reiter’s Syndrome Females Cervicitis Vaginitis Mycoplasma genitalium Recurrent urethritis Trichomonas vaginalis Bacterial vaginosis Mycoplasma hominis Genital Ulcer Pathology w/ or w/o Inguinal Lymphadenopathy Disease Syphilis Hard sore Herpes Etiology Primary Lesion Diagnosis Treponema pallidum Papule Dark Field Microscopy HSV-2 Less commonly by HSV-1 LGV Papules Macules Vesicles Multinucleated Giant Cells Ground glass appearance Lymphogranuloma Chlamydia trachomatis Venereum Herpetiform Chlamydia infusion bodies Ulcer/Papule McCoy Cell Line Chancroid Haemophilus ducrey Pustule Microscopy Donovanosis Klebsiella granulomatis Nodule or Papule Wright Giemsa Stain Donovan bodies Spontaneous Healing 3-8 weeks 14-21 days 2-5 days Self-limiting May persist for years No healing` Vaginitis or Vaginal Discharge Normal Discharge Clear or White Viscous Odorless Vaginitis Dominant Organism Symptoms Vaginal discharge Vulvar itching Irritation Odor Lactobacillus Produces H2O2 Organisms Trichomonas vaginalis Gardenella vaginalis Candida Herpes Cause Characteristics Spread Most common cause of genital ulcers Clusters of 1-2 mm papules & nodules → vesicles → rupture → painful ulcers HSV-2 > HSV-1 Direct sexual contact Multinucleated w/ lesions Ground glass Intranuclear inclusion bodies Genital Warts Cause Characteristics HPV Flat Papule Pedunculated Symptoms Asymptomatic Pruritus Painful Location Men Under foreskin Shaft Anogenital Epithelium Rectal Lesions → Proctitis Risk Anogenital sex stuff Organisms/Cause N. gonorrhea Chlamydia trachomatis Bartholinitis N. gonorrhea Chlamydia trachomatis Anaerobics from genital flora Lab Diagnosis of STI: Vaginal swab Rectal swab Ulcer execudate collection Symptoms Itching Pain Bleeding Tenesmus Mucopurulent discharge HSV similar symptoms Features Women Introitus Anogenital Epithelium Direct Microscopy → for presumptive diagnosis STD Organism Gonorrhea Vaginitis Microscope N. gonorrhea Gram negative → Pink → diplococci Candida Gram positive → violet → oval yeast Trichomonas vaginalis Wet mount Chlamydia Chlamydia trachomatis Syphilis Treponema pallidum Donovanosis Klebsiella granulomatis HSV Iodine stain → Inclusion bodies Dark ground microscopy Donovan Body Wright & Giemsa H&E Stain Pap stain Intranuclear Inclusion Bodies Wright & Giemsa H&E Stain Pap stain DNA virus Culture inoculated in a suitable medium for isolation of suspected organism STD Vaginitis Chancroid Urethritis Organism Media Candida Blood Agar H. ducreyi N. gonorrhea Blood Agar Chocolate Agar Thayer Martin Agar New York City Agar Mycoplasma Biphasic genital mycoplasma culture system Donovanosis LGV HPV Klebsiella Embryonated eggs Cell line Chlamydia McCoy Hela Monkey kidney cells Cannot be grown HIV & AIDS Attacks immune system HIV meds do not prevent transmission Mono-like syndrome associated w acute HIV is the INITIAL manifestation HIV vs Aids HIV o Virus that causes HIV infection o Kills CD4 cells Aids o Final stage of HIV infection o HIV increase = CD4 decrease o Meds can stop AIDS from coming § w/o meds → 10 year progression § ART therapy Virus RNA retrovirus (infects CD4 & macrophages) HIV becomes AIDs when CD4 < 200 cells/uL AIDs Conditions Opportunistic infections o Retinitis o Penumonia o Intestinal Cryptosporidiosis o Encephalopathy o TB Cervical Cancer Signs & Symptoms 1st few weeks o Asymptomatic o Flu like → fever, headache, rash, sore throat HIV progression weakens immune system o Swollen lymph nodes Weight loss Fever diarrhea cough No treatment will lead to severe illnesses o TB meningitis severe bacterial infections lymphomas o Worsening of infections like Hep B HIV pt Management 1st priority: Relieve pain & tx infections Invasive o Medical consult o Antibiotic prophylaxis o Thrombocytopenia → platelet replacement and AVOID NSAID Oral health effects (meds, HIV) o Xerostomia, Periodontal disease, Candidiasis o HHV → 1, 2, 3, 4, 5, 8 o HHV-8 → Kaposi’s Sarcoma → purple macule on palate, tongue, gums o EBV → oral hairy leukoplakia o Non-Hodgkin lymphoma o Toxoplasmosis Syphilis Bacterium → Treponema pallidum Effects most organs o Florid manifestations on one hand o Asymptomatic latency on the other hand Open ulcerative sore → chancre ACQUIRED Syphilis Stage Primary Secondary Latent Time Period 21 days after initial infection Painless ulcer in: Mouth Genitals Rectum Skin 4-8 weeks after primary infection Body rash Headache Fever Fatigue Lymphadenopathy Early 1st year after resolution of primary or secondary lesions Late Unknown duration Tertiary Symptoms 1-10 years after initial infection Syphilis Complications Neurosyphilis Ocular syphilis Cardiovascular syphilis Congenital syphilis Joint / Bone syphilis Signs & Symptoms disappear Altered mental status Syphilis Diagnosis Blood Antibodies o Remain in body for years o Test past & current infection Cerebral Spinal Fluid o For nervous system problems o From spinal tap Tests o Visual Microscopic § DFA- Dark field antigen § Immunofluorescence § Silver staining o Non-Treponemal Serological Antigen § VDRL § RPR § TRUST o Treponemal Serological Antigen § FTA-ABS § TP-PA Treatment Periodic blood test to see penicillin response No sex until blood tests show no infection Notify sex partner Mostly transmitted by sex with affected patient Transmitted to baby from mom Contact with lesions of infected person Blood transfusion Types o Acquired o Congenital o Syphilis related disease (Yawns, Pinta, Bejel)