STD tables

External genitalia
Disease Genital warts Herpes Chancroid Granuloma inguinale

Causative organism Condylomata acuminata (HPV) Haemophilus ducreyi Parasite

Mode of transmission HSV1: oral secretions (oral sex, auto Abrasion of skin and mucous
inoculation) membranes; sexual contact
HSV2: sexual intercourse or Auto-inoculation = multiple
childbirth chancres
Sxs: male Warts on prepuce range from small & Primary and recurrent ulcerating Macules → papules → ulcers Papules → ulcers
sessile to large & papillary lesions (oral cavity, lips, and external Necrotic, jagged edges, painful Swelling, itching, very painful
genitalia) (genital ulcers) + Lymph node involvement
Vesicles or small pustules; rupture + Lymph node involvement
after 5-7 days = painful wet ulcer
Tingle, itch, pain on genitals and
perineum
Dysuria, dyspareunia, urine
retention, urethral discharge

Sxs: female Vulvar pruritis Same as above Same as above Same as above

Sxs: systemic Fever, headache, malaise, muscle

ache, lymphadenopathy
Sxs: foetus or baby Transmitted to baby during delivery; Rash, encephalitis, pneumonitis,
causes papillomas in respiratory hepatic necrosis; risk of high
tract morbidity = do c-section
Diagnosis Abnormal pap smear (colposcopy) Based on symptoms and lesions Examination
Swab Swab & culture
Treatment Symptomatic wart removal: No cure Erythromycin
 Cryotherapy Acyclovir Azithromycin
 Surgical excision Good hygiene Etc
 Laser surgery Herbs (St Johns wort, Echianacea, L-
lysine
Complications Can cause squamous Ca of genital Common cause of genital ulcers
tract Increases risk of HIV
Can be spread by asymptomatic
people
Other Strains 6&11 cause warts; strain 16 Self-limited; recurs (stress, low Less in developed countries; more in
causes Ca sleep, overexertion, infections, PMS tropical and underdeveloped
Fastest growing STD countries
Vaginal infections
Disease Candidiasis STD tables
Trichomoniasis Bacterial vaginosis
Organism Candida albicans + other species Trichomonas vaginalis Not due to candida, trichomonas etc
Mode of Usually not an STD Sex = catalyst; not primary mode of transmission
transmission
Aetiology Antibiotics Increasing prevalence Most common infectious vaginitis
Increased hormones: Men and women can be carriers
 Pregnancy Imbalance of normal vaginal flora
 OCP = increased vaginal glycogen  Increase in anaerobic bacteria
Decreased immunity:  Decrease in Lactobacillus
 DM and increased vaginal glycogen Same risk factors as STDs; risk increases with more sexual
 HIV partners; can still occur in virgins; treating partners doesn’t
change rate of recurrence
IUD increases risk
Sxs: female Vulvo-vaginal irritation Red, swollen, itchy genitalia Itchy irritation
Pruritis Strawberry spots on cervix Usually no redness or swelling
Swelling
Redness
Dysuria, dyspareunia
pH < 4.5
In skin folds: breast, abdominal, inguinal
Discharge: female Thick, odourless, cheesy discharge Malodourous, excessive, frothy, yellow/green Thin, gray-white
Fishy odour/malodourous; smell increases as pH becomes
more alkaline (after intercourse or with menses)
Sxs: male Pruritis, swelling, redness, dysuria, dyspareunia In prostate and urethra = no symptoms
pH < 4.5
In skin folds: breast, abdominal, inguinal
Complications Female: Increases risk for:
PID → infertility  PID
Premature birth  Premature labour, preterm birth, premature rupture
Male: of membranes
Chronic prostatitis  Peri-natal infections (endometritis)
Non-gonococcal urethritis  Increased rate of infections with gynaecological
Infertility; decreased sperm motility procedures (hysterectomies)
Diagnosis Microscopy of organism Test vaginal discharge (wet mount = on slide; check bacteria,
More difficult in men WBCs, and “clue cells” = vaginal epithelial cells with
coccobacilli on surface
Need ¾ criteria:
1. Gray discharge
2. Fishy odour when 10% KOH added (release of
volatile amines from fluid)
3. pH > 4.5 (3.8-4.5)
4. Clue cells
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Treatment Antifungal Metronidazole (protozoan) = avoid alcohol Oral/vaginally:

Sodium bicarbonate in bath Treat all partners  Metronidazole
Light clothing  Clindamycin
Cornstarch
Other
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Urogenital-systemic infections
Disease Chlamydia Gonorrhoea Syphilis
Organism Chlamidiae trachomatis (small intra-cellular Neisseria gonorrhoea = pyogenic diplococcus Treponema pallidum = spirochete
parasite)
Different types:
L1-L3: lymphogranuloma venereum
Pneumonia
D-K: genital infections
A-C: eye infections (chronic
keratoconjunctivitis, trachoma = acute
inflammation, eyelid scarring, clouding of
cornea = blindness)
Mode of transmission & aetiology Industrialised countries = STD STD; after 2-5 days = sxs in urethra, vagina, Direct contact with lesions
Under-developed countries = flies, fomites, cervix = ascending infection (female = Across placenta
non-sexual fallopian tubes = PID; male = prostate and Common with HIV = delayed serological
epididymis) response (increased rate of transmission and
Autoinoculation of conjunctiva progression)
Pharyngitis / proctitis (rectum)
May disseminate via blood to joints, heart
valves, meninges = rare
Sxs: female Up to 95% are asymptomatic May be asymptomatic 3 stages:
Mucopurulent discharge Genito-urinary discharge
Hypertrophic cervical changes Dyspareunia Primary syphilis:
Urinary frequency Pelvic pain/tenderness  Chancre at exposure site (vagina/cervix) =
Dysuria Unusual vaginal bleeding single, hard papule/button → ulcer (NO
Post-coital bleeding Fever pain, heals in 3-12 weeks, very
PID with endometritis and salpingitis = contagious)
irregular uterine bleeding/ spotting,  Enlarged lymph nodes
abdominal/pelvic discomfort
Secondary syphilis:
 2 weeks-3months later = systemic
dissemination & proliferation
 Red, maculopapular rash on trunk &
extremities (especially palms)
 Alopecia
 Condylomata lata (elevated, red-
brown, may ulcerate = foul
discharge, many spirochetes)
 Mucous patches in mouth and
genitals
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 General enlarged lymph nodes

(especially neck and inguinal
regions)
Infectious for first 2 years;
Can be latent for years to decades

Tertiary syphilis:
 No longer infectious but very
destructive
 CVS: destroys media of aorta =
thoracic aortic aneurysms and
insufficiency
 CNS: dementia, blindness, changes
in speech, delusions of grandeur,
spinal cord = ataxia, tabes dorsalis
(impotence, constipation, hypotonic
bladder, pain in legs, loss of balance,
loss of pupil reflex to light
 Gummas: rubbery, necrotic lesions
(liver, testes, bone, skin)
Complications: female Infertility PID=
Ectopic pregnancy Infertility
Chronic pelvic pain Ectopic pregnancy
Sxs: male Up to 95% are asymptomatic May be asymptomatic 3 stages:
Red, tender urethral meatus = the drop Primary syphilis:
Creamy discharge Urethral pain  Chancre at exposure site (penis/scrotum)
Dysuria Dysuria Rest same as female
Urethral itching Creamy yellow discharge (may have blood)
Reiters syndrome (urethritis, conjunctivitis,
arthritis, mucocutaneous lesions)
Complications: male Reiters syndrome
Pregnancy Preterm labour, premature rupture of Premature rupture and birth Trans-placental infection = congenital syphilis
membranes High infant morbidity and mortality (prematurity, still birth)
Post-partum endometritis
Baby Transmitted during birth Conjunctivitis = blindness Active infections = chronic rhinitis, lesions
Conjunctivitis = blindness similar to secondary syphilis
Nasopharyngeal infection = pneumonia Congenital defects = blind, deaf, physical
Low birth weight signs
Transmitted to infant during birth Transmitted to infant in utero
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Diagnosis Must test and treat affected person and all Culture Swab for spirochetes (primary and secondary)
partners NAAT Non-treponemal antibodies: monitor
NAAT = nucleic acid amplification test (urine Screen for chlamydia and syphilis (rule out) treatment; indicate severity; BUT also show up
sample or vaginal swab) with pregnancy, SLE, drug addiction
PCR (polymerase chain reaction), LCR (ligase Treponemal antibodies: specific; stays
chain reaction), TMA (transcription-mediated positive for life
amplification)
Treatment Doxycycline Treat patient and all partners + ABSTAIN Penicillin (can be used in pregnancy)
Erythromycin Antibiotics: Tetracycline/doxycycline
Amoxicillin Doxycycline Partners must also be treated
NOT penicillin Azithromycin
(many penicillin-resistant strains)