Disease Causative bacteria Epidemiology Clinical Features Complications Diagnosis Treatment Preventio

n
Gonorrhea Neisseria Gonnorhoea  Commonest- men  Men- Purulent yellow/green discharge  Can  Urethral/Cervical swab
Intracellular gram negative  Commonest in 20-24 and dysuria disseminate to gold standard- culture
Diplococci age gp in men and 16-  Women-ASYMPTOMATIC (over 50%) skin- RASH (looks for resistance)
19 age gp in women  Pelvic  Nucleic acid amplification
 Homosexuals account Inflammatory test (NAAT)- PCR done on
for 1/3 of diagnosis disease- urine/body fluid (cannot
 Decreasing in last few infection of monitor resistance)
years uterus-can
lead to
infertility
 Epidydimo-
orchitis
Chlamydia Chlamydia  Most common STI  Women- ASYMPTOMATIC (75%) if not  PID NAAT- eg PCR- done on urine Azithromycin Screening
Trachomatis- obligate  1:6 in the average cervicitis  Tubal Factor or swab or freee for
intracellular pathogen (cannot young persons clinic  Men- ASYMPTOMATIC (50%) if not Infertility doxycycline under 25s
culture)- caused by D to K  10% of under 25s urethritis- discharge/dysuria  Ectopic
serovars Pregnancy
 Endometriosi
s
 Chronic
pelvic pain
 Epididymitis,
Reiters
syndrome
 Adult
conjunctivitis
 Opthamia
neonatorum
Lymphogranulom Chlamydia Trachomatis-  Prevalence highest Primary Stage- symptoms in 50% Inguinal Nucleic acid amplification test Doxycycline
a venereum serovars L1,2,3 in developing world  3-12 day incubation syndrome and if positive PCR to isolate Or
(LGV) Passes through epithelial cells  Rare in Western  Painless genital ulcer (anal or on complications: genotype and assess Azithromycin
to infect regional lymph nodes Europe for decade penis)that may go on to proctitis balanitis  Hepatitis organism or
– invasive except netherland or cervicitis meningo- erythromycin
outbreak- gay men Secondary Stage encephalitis
 Classically seen in  10-30 days incubation but up to 6/12 and
tropics  Anogenitorectal syndrome- proctocollitis pneumonitis
 High prevalence in and then hyperplasia of lymph nodes
HIV infected males  Inguinal syndrome- enlarged inguinal
lymph nodes (abscess known as buboe)
Third stage- strictures, abscesses,
lymphorroids, fistula, genital elephantiasis,
frozen pelvis
Syphilis Syphilis- Treponema pallidum  Increasing in UK Primary syphilis- (9-90 days) CANNOT be CULTURED Procraine
 especially amoung  Macule ® papule ® indurated painless  Antibody test- method of Penicillin or
gay men ulcer(chancre) choice: doxycycine
 Regional adenopathy 
Secondary Syphilis (4-8 wks after chancre) (EIA): Total Ab.
 Skin lesions 
– symmetrical 
– non-itchy haemagglutination
– maculo-papular test (TPHA).
– back, trunk, arms, legs, 
palms, soles, face agglutination test
Tertiary Syphilis (2-40 years later) (TPPA).
 Gummas (granulomas) 
 skin (70%) treponemal
 bone (10%), antigens (Inno-
 mucosa (10%) Lia).
 Cardiovascular- aortitis (FTA-ABS :
 Neurosyphilis Immunofluoresce
– meningovascular (4%) nce test).
– general paresis of the  Cardiolipin antibody Test
insane (5%) –VDRL or RPR – indicated
– tabes dorsalis (4%) active primary disease
– gumma (1%) and decreases with
– Argyll-Robertson Pupil treatment
 Dark ground microscopy
and multiplex realtime
PCR too
Trichomaniasis- protozoan parasite  Frothy fishy smelling DISCHARGE in  Wet prep microscopy Metronidazol
Trichomonas Vaginalis women  Culture (rarely done) e
 Asymptomatic or urethritis in men  PCR

Bacterial  Abnormal vaginal flora  Discharge- fishy smelling  Diagnosed on microscopy-

Vaginosis due to ph greater than ‘clue cells’, raised pH, whiff
5.5 test
 Sexually associated, not
transmitted
 May be associated with
hygiene practices-
excessive cleaning

Candidiasis/Thru Candida albicans usually  White Curd Discharge  Microscopy- strings of Clotrimazole
sh  Vulva and vagina red sore and fissured in mycelium or oval spores pessary
some  Culture on Sabouraud’s
medium
Genital Warts  Caused by Human  Incubation 3 weeks to > 8 months  Examination Cryotherapy
Papillomaviruses (>100  Diagnosis by naked eye examination - or
 types described) papular, planar, pedunculated, carpet, podophylloto
 dsDNA keratinised, pigmented xin (not if
viruses, no pregnant) or
envelope, 2nd line
icosahedral outer imiquimod
structure
 Caused by HPV 6/11 (these
do not cause cervical
cancer)
Molluscum Pox virus, dsDNA  Hands and faces in children, spread skin to 
Contagiosum skin contact
 In adults, causes genital lesions and
spread via sexual contact
 Giant lesions in immunocompromised
 Facial molluscum in adult=HIV until
proved otherwise

Chancroid Haemophilus ducreyi  Tropical ulcer disease  Genital Ulcers  Culture or PCR
 Mainly Africa

Donovanosis/Gra Klebsiella granulomatis  Africa, India, PNG,   Giemsa stain of biopsy or

nuloma inguinale Australian aboriginal tissue crush
communities  Donovan bodies

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Sexually Transmitted Infections