OBJECTIVE 1:DIFFERENTIAL DIAGNOSIS OF PAINFUL LESIONS ON GENITAL
Definition: Any sore that appears on the penis, scrotum or urethra
INFECTIOUS
Herpes simplex
Syphilis
Condyloma
accumonata
Candida
INFLAMMATORY
Fixed drug
eruption
Balanitides
Proriasis
Contact dermatitis
Lichen planus
NEOPLASTIC
Squamous cell
carcinoma
Bowens disease
TRAUMATIC
Accident/ burns
Suction/vacuum
erection divice
Zipper entrapment
Sexual induced
Amateur
circumcision
OBJECTIVE 2 : GENITAL ULCER [PAINFUL, INFECTIOUS, NO]
ETIOLOGY
Herpes simplex
Chancroid
ETIOLOGY
Primary syphilis
(Chancre)
Lymphogranuloma
venereum
PAINFUL GENITAL ULCERS
CLINICAL PICTURES
DIAGNOSIS
Multiple, vesicular lesions that Definitive : Herpes simplex virus
on PCR, scrapping/vesical fluid
rupture painful shallow
aspirate
ulcer
Associated with constitutional
symp, lymphadenopathy on
1st time infection
Definitive : Hemophilus Ducreyi
Multiple, non-indurated,
on culture [school of fish pattern]
painful with serpiginous
border, friable base +
necrotic, purulent exudate
Tender, unilateral inguinal
lymphadenopathy
PAINLESS GENITAL ULCER
CLINICAL PICTURES
1.
Single, painless, well
demarcated ulcer, indurated
border
2.
Mild tender inguinal
lymphadenopathy
1.
Small, shallow, painless
papule/ulcer
2.
no induration
Unilateral, tender inguinal/
femoral lymphadenopathy
KyraKhali
d
DIAGNOSIS
Treponema pallidum on
darkfield microscopy/direct
fluorescent or LN aspirate
+ve serologic non treponemal
testing
Definitive : Chlamydia
trachomatis on culture
LN aspirate +ve
immunofluorescence = Bodies
inclusion/+ve C.trachomatis
Granuloma inguinale
Persistent, painless, beefy red
papules/ulcer
No lymphadenopathy
Definitive :
1. Intracytolasmic Donovan
bodie on Wright stain
2. +ve Giemsa stain
OBJECTIVE 3: INGUINAL LN ENLARGEMENT IN STD
Site : Situated in the crease between the leg and pelvis (laterally)
Drainage: Penis, scrotum, perineum, gluteal region, lower abdominal wall, lower
anal canal
Causes : Herpes simplex, chancroid, herpes simplex, lymphogranuloma venereum,
gonococcal infection
OBJECTIVE 4 : DIFFERENTIAL DIAGNOSIS OF URETHRAL DISCHARGE
Definition: Secretion passed through the urethral meatus at times other than
voiding. It could be clear, purulent or bloody.
Differential diagnosis
PHYSIOLOGIC
AL
1. Prostatorrhea : An escape of prostatovesico fluid from external urinary
vesicle.
Character: Clear, sticky, whitish discharge [no pus]
Timing: During micturition or defecation
Causes : In unmarried males and those without regular sexual activity,
prostate may be congested and full of secretion.
2. Urethrorrhoea : An escape of normal urethral secretion from Cowper
and Littre gland
Character: Clear viscid mucus [no pus]
Timing : During sexual excitement and before absolute normal
ejaculation
Causes : To lubricate the urethra and neutralize the acidic urine
GONORRHEA
NON-GONOCOCCAL
PATHOLOGIC
AL
Def: Acute infectious STD affects the epithelium
of lower urogenital system
Etio: Neisseria gonorrhea
MOT: Sexual contact [Homo,hetero,orogenital]
Asexual [Contaminated towel,hand]
IP : 2-5 days
CP: 1. Gonococcal ant Urethral discharge,
KyraKhali
d
1. Infectious
Sexually transm. urethritis -Chlamydia,
mycoplasma genitalium
Non sexual urethritis Bacterial + UTI,
schistommomiasis
2. Infected organ: Cystitis, Balanitis,
Prostatitis
edema of urethral orifice
2 . Extends to post urethral Dysuria,
frequency, hematuria, urgency, const sym
3. Neoplastic : Urethra polyp, carcinoma
4. Anatomical dis : Foreign body in urethra,
urethral stricture
5. Irritants from local antiseptic
OBJECTIVE 6 : INCUBATION PERIOD OF STD
ETIOLOGY
Gonorrhea Urethritis
Syphilis
Chancroid
Granuloma Inguinale
Lymphogranuloma Venerium
Genital Herpes
Aids
INCUBATION PERIOD
2-5 days
9-90 days
7 days [3 days to 3 weeks]
9 -90 days
1-6 weeks
2-7 days
3-10 years
KyraKhali
d
OBJECTIVE 5 : INVESTIGATION OF STD
Causative organism
Treponema pallidum
Specimen collected
Serous discharge from 1ry
ulcer
LN aspiration
Blood/CSF [for serological
test]
Causative organism
Hemophilus ducreyi
Specimen collected
From base/margin of ulcer
Aspirate from unruptured
bubo
Causative organism
Klebsiella granulomatis
SYPHILIS
1. Dark field microscopy
Bright, corkscrew-shaped
2. PCR
3. Tissue biopsy
4. Serological test
Reagin test [non-specific antibodies test]: Wasserman
reaction, Rapid Plasma Reagin Test
Trepomal test [specific] : Flourescent Treponemal
Antibody [FTA]
5. Others: CSF [>5% lymphocyte,> 40% protein]
CHANCROID
1. Direct smear stained with Grams stain
School of fish pattern
2. Direct immunofluorescent : Check antigen
3. Culture on specific media [aka beef infusion agar,
rabbits blood]
colonies of organisms
4. ELISA/PCR
GRANULOMA INGUINALE
1. Tissue Smear with Wrights/Giemsa/Grams stain
Closed safety-pin apprearance
2. PCR
Specimen collected
Tissue biopsy from the margin
of the lesion
LYMPHOGRANULOMA VENERUM
Causative organism
Chlamydia trachomatis
Specimen collected
Urethral exudate
Causative organism
Herpes simplex type 1, 2
Specimen collected
Scrapping of the lesion floor
1. Direct demonstration of C.Trachomatis by smear
or tisuue by monoclonal antibodies
2. PCR
3. Culture [by inoculation of pathogenic materials]
4. Serological test
Microimmunofluorescence [specific & sensitive]
GENITAL HERPES
1. Tzanck smear
Presence of multinucleated giant cell
2. Direct immunofluorescent antibody assay
3. Electron microscopy
HSV particles load in the specimen >106 particle/ml
4. Cell culture
Viral growth evidence by it cytopathic effect on
culture
5. ELISA/PCR
AIDS
KyraKhali
d
Causative organism
HIV 1 & 2
Specimen collected
1. Immune status [WBC:T-cell ratio <1]
2. Smear, culture, biopsy
3. Test for HIV virus
HIV culture[most accurate]
HIV antibodies by ELISA
HIV antigen by ELISA/PCR
Overall investigations
1. Dark microscopic exam 2. Serological test 3. Viral study 4. Biopsy
KyraKhali
d
OBJECTIVE 7: STD THAT CAN CROSS THE PLACENTA AND AFFECT THE FETUS
1. Bacterial STIs
Infection
Risks (M=Mom; B=Baby)
Method of Transfer
Gonorrhea
M Can result in ectopic pregnancies and
leads to PID, which can cause infertility
B Premature birth, stillbirth, eye infections
Can transfer in the birth
canal during delivery
Chlamydia
M Can result in ectopic pregnancies and
leads to PID, which can cause infertility
B Pneumonia, eye infections, blindness
Can transfer in the birth
canal during delivery
Trichomoniasis
M Can cause fallopian tube damage
B Premature birth, low birth weight
Can transfer in the birth
canal during delivery
Bacterial
Vaginosis
B Premature birth, low birth weight
Can transfer in the birth
canal during delivery
Syphilis
M Miscarriage
B Stillbirth, congenital syphilis which can
result in mental & physical problems
Can cross the placenta
during pregnancy and can
transfer in the birth canal
during delivery
2. Viral STIs
Infection
Risks (M=Mom; B=Baby)
Method of Transfer
Human
Papilloma
Virus (HPV)
M Can lead to genital cancer
B Warts can develop in the babys throat
which will require surgery
Can transfer in the birth
canal during delivery, but
very rare
Herpes
M Severe outbreak in the first trimester can
result in miscarriage
B Fetus is at higher risk. Herpes can be
contracted during pregnancy, and lead to
neonatal herpes.
Can transfer in the birth
canal during delivery and
rarely can cross the
placenta during pregnancy
Human
Immunodeficiency
Virus (HIV)
M & B HIV can develop into AIDS, which is
fatal
Can cross the placenta
during pregnancy and birth
canal during delivery. Also
through breastfeeding
OBJECTIVE 8 : VAGINAL DISCHARGE
KyraKhali
d
OBJECTIVE 9: RISK FACTOR STD
KyraKhali
d
