caused by the Gram negative diplococci Neisseria gonorrhea; causes endocervitis, urethritis, and PID
may progress to Disseminated Gonoccal Infection DGI – has symptoms of arthritis, dermatitis, pericarditis, meningitis
Friends Travel Together – many people with gonorrhea have concurrent Chlamydial infections; treat both
Diagnosis
: Gram stain of exudate will demonstrate Gram negative intracellular diplococci.
Chlamydia
most common STD by recent CDC poll; Chlamydia trachomatis estimated to have prevalence of 5-12%
An obligate intracellular parasite with two life stages:
(1) elementary body, the infectious particle
(2) reticulate body, intracellular or inclusion body
Associated with cervicitis but not vaginitis because it cannot grow in vaginal squamous epithelium
cervicitis is chronic, with mucopurulent endocervical discharge, hypertrophy and friability of columnar epithelial cells
Acute Urethral Syndrome
(dysuria and pyuria) is caused by Chlamydia 70% of the time
often asymptomatic with Chlamydia, the most serious complication is Salpingitis
Þ PID and infertility
Treat gonorrhea too, remember friends travel together
Syphilis
caused by Treponema pallidum, a spirochete infection with the patron saint "Denis"
incidence has decreased this century and perhaps will be irradicated in the US in the next ten years.
Three stages, the 2nd and 3rd separated by a latency period of months to years
(1) Chancre, a local lesion at the site of entry. (painless ulcer with raised well defined margin and lots of spiochetes)
(2) 3-6 wks after 1st stage, Classically a rash on the palms and soles, lymphadenopathy, constitutional symptoms (fever malaise, myalgias, headache)
(3) Gummas and CNS manifestations.
Diagnosis
– by Darkfield microscopy, or serology. Treatment is Penicillin.
Herpes
most frequent cause of genital ulcers in the US, name comes from the greek herpein, "to creep"
Etiology
: both Herpes Simplex Virus I and II can cause genital lesion but HSV II is more trophic to the genitals
Histology
: infection is associated with a PMN and lymphocytic response (gives rise to multiple painful ulcers)
Clinical Presentation
: primary infection classically has multiple painful lesions, myalgias, fever; secondary infection is just genital lesions.
latency established by ascending sensory nerves and remaining the nerve root ganglion
many people do not know that they have it (did not have or do not remember primary outbreak symptoms)
Genital Ulcer Disease
Chancroid
– Heamophilus ducreyi, a gram neg. anaerobic bacillus. STD more common in the tropics, painful ulcer
Granuloma Inguinale
– Calymmatobacterium granulomatis gram neg. bacterium. Beefy painless ulcer, rare in US
Lymphogranuloma Venereum
– C. trachomatis types L1, L2, and L3. Small ulcer, very swollen inguinal lymph nodes
Human Papillomavirus HPV
– causes genital warts; HPV is trophic for squamous epithelium
expression of viral function is limited to terminally differentiated cells; viral replication occurs once during the cell cycle and virus is proportioned to both daughter cells.
Cervical Cancer
is now thought to be due to HPV in susceptible individuals where the viral genome integrates
HPV 16 and 18 are more likely to give rise to invasive cancer, HPV 6 and 11 are thought not to.
Diagnosis
: by cytology (changes can be seen on PAP) Treatment - is by incision or ablation (e.g. crypsurgery, electrocautery)
Molluscum Contagiosum
A benign viral skin lesion caused by a DNA-containing Pox virus. Self-limited, resolves with time, associated with STDs
Pelvic Inflammatory Disease PID
Definition – an infection of the upper genital tract
Risk Factors
– sexually active individuals, N. gonorrhea or C. trachamoatis infection, previous PID, recent IUD insertion, multiple partners, nulliparous individuals, people who do not use contraception (condoms and foams ß risk)
Etiology
– most commonly N. gonorrhea(symptomatic disease) or C. trachamoatis (asymptomatic)
anaerobic and aerobic bacteria from the lower genital tract can also be involved (esp. following gonorrhea or chlamydia)
infection travels up the genital tract: Cervical infection
Þ Endometritis Þ Salpingitis Þ Peritonitis
Sequelae
– Infertility due to scarring from salpingitis, chronic pelvic pain, Ý risk of ectopic pregnancy, tuboovarian abscess, and ultimately total hysterectomy or death from peritonitis – sepsis
chlamydia tends to yield fibrosis of the ovarian tubes because it is taken in and phagocytized by the cells lining the tube
Diagnosis
– must have (1) lower abdominal pain, (2) cervical motion tenderness, (3) adnexal tenderness, plus 1 of the following: temp > 38o, Ý WBC, tender mass on bimanual exam, Ý ESR (or C-reactive protein), + for GC or Chlamydia
Criteria for hospitalization
– uncertain diagnosis, suspected pelvic abscess, pregnancy, adolescence, HIV +, inability to use oral antibiotics (nausea and vomiting), failed outpatient treatment