Transmitted Diseases
Common Diseases
Dr.T.V.Rao MD

Dr.T.V.Rao MD


What are Sexually Transmitted Diseases
• STD’s are infections that are spread from person to person through intimate sexual contact. • STD’s are dangerous because they are easily spread and it is hard to tell just by looking who has an STD. • 1 in 4 teenagers has an STD.(Western Statistics)
Dr.T.V.Rao MD 2

• STDs are diseases and infections which are capable of being spread from person to person through:
– sexual intercourse – oral-genital contact or in non-sexual ways. – IV drug – Congenitally transmitted
Dr.T.V.Rao MD 3

Common STI’s
• Chlamydia • Gonorrhea • Genital Herpes (HSV-2) • Genital Warts (HPV) • Hepatitis B

• • • •

HIV and AIDS Pubic Lice Syphilis Trichomoniasis

Dr.T.V.Rao MD


STD’s of Concern
• Actually, all of them • “Sores” (ulcers)
– Syphilis – Genital herpes (HSV-2, HSV-1)

– Others uncommon in the U.S.
• Lymphogranuloma venereum • Chancroid • Granuloma inguinale
Dr.T.V.Rao MD 5

Do Patients Want to Know? About STD’s
• 92.4% wanted to know if they were infected • 90.8% wanted to know if their partners were infected • 65% expected the test as part of STD screening
Dr.T.V.Rao MD


STDs of Concern (continued)
• “Drips” (discharges) – Gonorrhea – Chlamydia – Nongonococcal urethritis / mucopurulent cervicitis – Trichomonas vaginitis / urethritis – Candidiasis (vulvovaginal, less problems in men)

• Other major concerns
– Genital HPV (especially type 16, 18) and Cervical Cancer
Dr.T.V.Rao MD 7

Genital Ulcer Diseases – Does It Hurt?
• Painful
– Chancroid – Genital herpes simplex


• Painless
– Syphilis – Lymphogranuloma venereum – Granuloma inguinale
Dr.T.V.Rao MD 8

Treponema pallidum – The Agent of Syphilis
• Spirochete • Obligate human parasite

• Transmission – Sexual – Trans-placental – Percutaneous following contact with infectious lesions – Blood Transfusion • No reported cases of transmission since 1964
Dr.T.V.Rao 5 MD 9

Syphilis – The “Great Imitator”
• Infectious Dose: ~57 organisms1

• Incubation Period – 21 days (median) • 3 clinical stages of syphilis

– Primary:
• Painless sore (chancre) at inoculation site – Secondary: • Rash, Fever, Lymphadenopathy, Malaise – Tertiary/Latent: • CNS invasion, organ damage • “The physician that knows syphilis knows medicine.” – Sir William Osler
Dr.T.V.Rao MD



Primary Syphilis - Clinical Manifestations
• Incubation: 10-90 days (average 3 weeks) • Chancre
– Early: macule/papule  erodes – Late: clean based, painless, indurated ulcer with smooth firm borders – Unnoticed in 15-30% of patients – Resolves in 1-5 weeks – HIGHLY INFECTIOUS
Dr.T.V.Rao MD 11

Primary Syphilis

Dr.T.V.Rao MD


Primary Syphilis - Chancre

Dr.T.V.Rao MD


Primary Syphilis - Chancre

Dr.T.V.Rao MD


Primary Syphilis Chancre

Source: Florida STD/HIV Prevention Training Center

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Primary Syphilis Chancre
• Represents haematogenous dissemination of spirochetes • Usually 2-8 weeks after chancre appears • Findings:
– rash - whole body (includes palms/soles) – mucous patches – Condylomata lata - HIGHLY INFECTIOUS – constitutional symptoms

• Sn/Sx resolve in 2-10 weeks
Dr.T.V.Rao MD 16

S o r e s


Secondary Syphilis Rash

Source: Florida STD/HIV Prevention Training Center

Dr.T.V.Rao MD


Secondary Syphilis: Generalized Body Rash


Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

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Secondary Syphilis Rash

Source: Florida STD/HIV Prevention Training Center

Dr.T.V.Rao MD


Secondary Syphilis Rash

Source: Cincinnati STD/HIV Prevention Training Center

Dr.T.V.Rao MD


Secondary Syphilis

Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas

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Secondary Syphilis Condylomata Lata


Source: Florida STD/HIV Prevention Training Center

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Congenital Syphilis
• Congenital syphilis usually occurs following vertical transmission of T. pallidum from the infected mother to the fetus in utero, but neonates may also be infected during passage through the infected birth canal at delivery.
Dr.T.V.Rao MD 23

1. History and clinical examination. 2. Dark-field microscopy: special technique use to demonstrate the spirochete as shiny motile spiral structures with a dark background. • The specimen includes oozing from the lesion or sometimes L.N. aspirate. It is usually positive in the primary and secondary stages and it is most useful in the primary stage when the serological tests are still negative.
Dr.T.V.Rao MD 24

Laboratory Testing
• Direct examination of clinical specimen by dark-field microscopy or fluorescent antibody testing of sample. • Non-specific or non-treponemal serological test to detect reagin, utilized as screening test only. • Specific Treponemal antibody tests are used as a confirmatory test for a positive reagin test.
Dr.T.V.Rao MD 25

Diagnosis of Syphilis
• Evaluation based on three factors: – Clinical findings.
– Demonstration of spirochetes in clinical specimen. – Present of antibodies in blood or cerebrospinal fluid.

• More than one test should be performed. • No serological test can distinguish between other Treponemal infections.
Dr.T.V.Rao MD 26

Provisional Diagnosis of Syphilis
• A presumptive diagnosis is possible with sequential serologic tests (e.g. VDRL, RPR), using the same testing method each time. A fourfold change in titer (e.g. from 1:8 to 1:32) is usually considered to be clinically significant. Confirmatory tests should be performed
Dr.T.V.Rao MD 27

Other Diagnostic Tests
• Serological tests of syphilis. • Biopsy rarely needed. It shows endarteritis obliterans with inflammatory reaction containing a plenty of plasma cells. Granuloma may found in tertiary syphilis.
Dr.T.V.Rao MD 28

Laboratory Diagnosis of Syphilis
The Uncommon Methods
• Rabbit Infectivity Test (RIT)
– High Sensitivity and Specificity – Long turn-around-time – Limited to research settings

• Dark Field Microscopy
– Useful only during primary infection – Technician expertise required

• Immunostaining
– Direct fluorescent antibody or silver stain

• Polymerase Chain Reaction (PCR)
– Not commercial available

Dr.T.V.Rao 7 MD


Non-specific or lipoidal tests • A. VDRL (venereal disease research laboratories) - It is useful for the screening, diagnosis and follow up. - The results can be qualitative or qualitative


False positive results

• 1. Acute type: usually low titre and don’t persist for more than 6 months • 2. Chronic type: usually last for more than 6 months • B. Rapid plasma reagin test. • C. Wasserman test not used more
Dr.T.V.Rao MD 30

Laboratory Diagnosis of Syphilis

• Serology

The Common Methods

–Mainstay for syphilis testing –Two classes of serologic tests
• Non-treponemal • Treponemal
Dr.T.V.Rao 8 MD 31

• A. Reiter protein complement fixation test. • B. Fluorescent Treponemal antibody/absorption test, FTA/ABS. the most specific and most sensitive . • C. Treponema pallidum

Specific serological tests of Syphilis

haemagglutination test- TPHA- D.
Treponema pallidum immobilization testTPI
Dr.T.V.Rao MD 32

Serologic Tests for Syphilis:
Non-Treponemal Assays
• Principle:
– T. pallidum infection leads to the production of reagin • Reagin – Antibodies to substances released from cells damaged by T. pallidum – Reagin reacts with cardiolipin • Cardiolipin – a phospholipid component of certain eukaryotic and prokaryotic membranes

• Examples of non-treponemal tests:
– Rapid Plasma Reagin (RPR) – Venereal Disease Research Laboratory (VDRL)
Dr.T.V.Rao 9 MD 33

Serologic Tests for Syphilis:
Non-Treponemal Assays
• RPR and VDRL are agglutination assays
Charcoal Cardiolipin

Dr.T.V.Rao 10 MD


Serologic Tests for Syphilis:
Non-Treponemal Assays
• RPR and VDRL are agglutination assays

Charcoal Cardiolipin Reagin Serum or CSF

Dr.T.V.Rao 11 MD



• Each preparation of antigen suspension should first be examined by testing with known positive or negative serum controls. • The antigen particles appear as short rod forms at magnification of about 100x. Aggregation of these particles into large or small clumps is interpreted as degrees of positivity • Reactive on left, non-reactive on right
Dr.T.V.Rao MD 36

Rapid Plasma Reagin Test - RPR
• General screening test, can be adapted to automation. • CANNOT be performed on CSF. • Antigen
– VDRL cardiolipin antigen is modified with choline chloride to make it more stable – attached to charcoal particles to allow macroscopic reading – antigen comes prepared and is very stable.

• Serum or plasma may be used for testing, serum is not heated.
Dr.T.V.Rao MD 37

• Test Procedure:
– Serum or plasma added to circle on card and spread. – One drop of antigen from a needle capable of delivering 60 drops/mL is added. – Rotate at 100 rpms/minute for 8 minutes. – Results are read macroscopically.

• Daily quality control:
– – – – 20 gauge needle checked for delivery of 60 drops/mL Rotator checked for 100 rpms/minute Room temperature must be 23-29 C. Three levels of control must be run and give appropriate results.

• RPR appears to be more sensitive than the VDRL.
Dr.T.V.Rao MD 38

Treponema pallidum haemagglutination (TPHA)
• Adapted to micro techniques (MHA-TP) • Tanned sheep RBCs are coated with T. pallidum antigen from Nichol’s strain. • Agglutination of the RBCs is a positive result.
Dr.T.V.Rao MD 39

Non-Treponemal Tests:

• Rapid turnaround time – Minutes • Inexpensive • No specialized instrumentation required • Usually revert to negative following therapy – Can be used to monitor response to therapy
Dr.T.V.Rao 12 MD 40

Non-Treponemal Tests:
• Results are subjective – Intra- and Inter-laboratory variability • Non-specific – False positive results can result from other infectious or non-infectious conditions • EBV, Lupus, etc. • Limited sensitivity in early/primary syphilis and in late/latent syphilis • Low throughput – Problematic for high volume laboratories
Dr.T.V.Rao 13 MD 41

Non-Treponemal Tests:
Limitations, continued
• Possibility for prozone effect – High levels of antibody may inhibit the agglutination reaction – To identify prozone, labs must serially dilute samples






Dr.T.V.Rao 14 MD


Serologic Tests for Syphilis: Treponemal Assays

• Principle: –Infection leads to production of specific antibodies directed against T. pallidum • Treponemal tests detect IgG or total IgM/IgG antibodies directed against T. pallidum
Dr.T.V.Rao 15 MD 43

Serologic Tests for Syphilis:
Treponemal Assays
• • • • • Microhemagglutination assay (MHA) Fluorescent treponemal antibody (FTA-ABS) Treponema pallidum particle agglutination (TP-PA) Enzyme Immunoassay (EIA) Multiplex Flow Immunoassay (MFI)
FTA-ABS TP-PA Conventional EIA Yellow wells = positive

Dr.T.V.Rao 16 MD


Treponemal Assays:
• High Specificity • Possibly higher sensitivity during early and late syphilis stages compared to non-treponemal tests • Newer Methods – Objective result interpretation – Automation option – High throughput – High reproducibility/precision
Dr.T.V.Rao 20 MD 45

Fluorescent Treponemal Antibody Absorption Test (FTA-ABS) • Diluted, heat inactivated serum added to Reiter’s strain of T. pallidum to remove cross reactivity due to other Treponemes. • Slides are coated with Nichol’s strain of T. pallidum and add absorbed patient serum.
Dr.T.V.Rao MD 46

Fluorescent Treponemal Antibody Absorption Test (FTA-ABS)
• Slides are washed, and incubated with antibody bound to a fluorescent tag. • After washing the slides are examined for fluorescence. • Requires experienced personnel to read. • Highly sensitive and specific, but time consuming to perform.
Dr.T.V.Rao MD 47

Treponemal Assays:
• Remain positive despite treatment – Cannot be used to monitor response to therapy • Conventional Methods – Subjective interpretation requiring technician expertise to read • Newer Methods – Expensive instrumentation – Higher cost/test
Dr.T.V.Rao 21 MD 48

Traditional Algorithm
Non-treponemal test (e.g., RPR) Reactive Treponemal test (e.g., FTA) Non-reactive Negative for syphilis

Reactive Syphilis


Negative for syphilis

Advantages: – – – – Results show good correlation with disease status Rapid, inexpensive screening method Excellent option for laboratory with small throughput Recommended by the CDC

Dr.T.V.Rao 24 MD


Traditional Algorithm
Non-treponemal test (e.g., RPR) Reactive Treponemal test (e.g., FTA) Non-reactive Negative for syphilis

Reactive Syphilis


Negative for syphilis

Disadvantages: – Manual (RPR) and subjective interpretation – Screening method is non-specific and may lead to false-positive results – Not suitable for high throughput laboratories – Potentially lower sensitivity for detecting early syphilis and late/latent disease
Dr.T.V.Rao 25 MD 50

Reverse Algorithm
Treponemal test (eg, EIA) Reactive Non-Treponemal test (eg, RPR) Non-reactive Negative for syphilis

Reactive Syphilis

Non-reactive Second Treponemal Test (e.g., TP-PA) Reactive Non-reactive

Evaluation Required*

Negative for syphilis

Dr.T.V.Rao 27 MD


Every Pregnant women Needs Screening

Dr.T.V.Rao MD


Genital Herpes Simplex

Dr.T.V.Rao MD


Genital Herpes Simplex - Clinical Manifestations
• Direct contact – may be with asymptomatic shedding • Primary infection commonly asymptomatic; symptomatic cases sometimes severe, prolonged, systemic manifestations • Vesicles  painful ulcerations  crusting • Recurrence a potential • Diagnosis:
– Culture – Serology (Western blot) – PCR
Dr.T.V.Rao MD


Epidemiology of Genital Herpes
• One of the 3 most common STDs, increased 30% from late 70s to early 90s • 25% of US population by age 35 • HSV-2: 80-90%, HSV-1: 10-20% (majority of infections in some regions) • Most cases subclinical • Transmission primarily from subclinical infection • Complications: neonatal transmission, 55 enhanced HIV transmission, psychosocial issues
Dr.T.V.Rao MD


Underdiagnoses of Genital Herpes
• 779 women attending STD clinic • 372 genital herpes diagnosis:
– 363 HSV-2 antibody positive – 9 HSV-1 culture positive lesions

• Of the 372 diagnosed with genital herpes
– – – – 82 (22%) symptomatic 14 (4%) viral shedding without symptoms 60 (14%) history of symptoms 216 (58%) HSV-2 antibody without viral shedding or history of symptoms
Dr.T.V.Rao MD


Genital Herpes Simplex

Source: Diepgen TL, Yihune G et al. Dermatology Online Atlas

Dr.T.V.Rao MD


Genital Herpes Simplex

Source: CDC/NCHSTP/Division of STD, STD Clinical Slides

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–Gonorrhea –Nongonococcal urethritis –Chlamydia –Mucopurulent cervicitis –Trichomonas vaginitis and urethritis –Candidiasis
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Gonorrhea Clinical Manifestations
• Urethritis - male
– – – – – – – – Incubation: 1-14 d (usually 2-5 d) Sx: Dysuria and urethral discharge (5% asymptomatic) Dx: Gram stain urethral smear (+) > 98% culture Complications

• Urogenital infection - female
Endocervical canal primary site 70-90% also colonize urethra Incubation: unclear; sx usually in l0 d Sx: majority asymptomatic; may have vaginal discharge, dysuria, urination, labial pain/swelling, abd. pain – Dx: Gram stain smear (+) 50-70% culture – Complications
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Source: Florida STD/HIV Prevention Training Center

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Gonorrhea Gram Stain

Source: Cincinnati STD/HIV Prevention Training Center

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Diagnosis not Easy
• Three levels of diagnosis are defined on the basis of clinical findings or the results of laboratory diagnostic tests. A definitive diagnosis of gonorrhoea must be obtained for medico legal purposes.
Dr.T.V.Rao MD 63

Diagnosis of Gonorrhoea
• Suggestive diagnosis is defined by the presence of: • A mucopurulent endocervical or urethral exudate on physical examination and sexual exposure to a person infected with N. gonorrhoea.
Dr.T.V.Rao MD 64

Presumptive diagnosis of gonorrhoea is made on the basis of one of the following three criteria:
• Typical gram-negative intracellular diplococci on microscopic examination of a smear of urethral exudate from men or endocervical secretions from women*; • Growth of a gram-negative, oxidase-positive diplococcus, from the urethra (men) or endocervix (women), on a selective culture medium, and demonstration of typical colonial morphology, positive oxidase reaction, and typical gram- negative morphology;
Dr.T.V.Rao MD 65

Presumptive Diagnosis of Gonorrhoea
• The observation of gram-negative, intracellular diplococci on microscopic examination of endocervical secretions from women must be supported by a positive result from a test from either 2 or 3 to make a laboratory diagnosis of “presumptive N. gonorrhoea.”
Dr.T.V.Rao MD


Definitive diagnosis of gonorrhoea requires:
• Isolation of N. gonorrhoea from sites of exposure (e.g., urethra, endocervix, throat, rectum) by culture (usually a selective medium) and demonstrating typical colonial morphology, positive oxidase reaction, and typical gramnegative morphology

Dr.T.V.Rao MD


Definitive diagnosis of gonorrhoea requires:
• Confirmation of isolates by biochemical, enzymatic, serologic, or nucleic acid testing e.g., carbohydrate utilization, rapid enzyme substrate tests, serologic methods such as coagglutination or fluorescent antibody tests supplemented with additional tests that will ensure accurate identification of isolates, or a DNA probe culture confirmation technique.
Dr.T.V.Rao MD 68

Newer Methods in Diagnosis of

• Detection of N. gonorrhoea by a nonculture laboratory test (Antigen detection test (e.g., Gonozyme [Abbott]), direct specimen nucleic acid probe test (e.g., Pace II [GenProbe]), nucleic acid amplification test (e.g., LCR [Abbott]).
Dr.T.V.Rao MD


Definitive diagnosis of gonorrhoea requires:
• Isolation of N. gonorrhoea from sites of exposure (e.g., urethra, endocervix, throat, rectum) by culture (usually a selective medium) and demonstrating typical colonial morphology, positive oxidase reaction, and typical gram-negative morphology and

Dr.T.V.Rao MD


Definitive diagnosis of gonorrhoea requires:
• Confirmation of isolates by biochemical, enzymatic, serologic, or nucleic acid testing e.g., carbohydrate utilization, rapid enzyme substrate tests, serologic methods such as coagglutination or fluorescent antibody tests supplemented with additional tests that will ensure accurate identification of isolates, or a DNA probe culture confirmation technique.
Dr.T.V.Rao MD 71


Nongonococcal Urethritis
• Etiology:
– 20-40% C. trachomatis – 20-30% genital mycoplasmas (Ureaplasma urealyticum, Mycoplasma genitalium) – Occasional Trichomonas vaginalis, HSV – Unknown in ~50% cases

• Sx: Mild dysuria, mucoid discharge • Dx: Urethral smear  5 PMNs (usually 15)/OI field Urine microscopic  10 PMNs/HPF Leukocyte esterase (+) 72
Dr.T.V.Rao MD


Dr.T.V.Rao MD


• Chlamydia is an infection of the penis, vagina, throat, or tube that carries urine. • Chlamydia is caused by bacteria (a kind of germ). • You get it by having sex with someone who has Chlamydia. • Chlamydia can be spread by the vagina, penis, mouth, or anus.
Dr.T.V.Rao MD 74

• Too many people are continuing to have unsafe sex, put themselves at risk of STIs and the serious consequences associated with infection, including infertility. • "On-going investment in programmes to increase sexual health awareness, condom use and testing, particularly for groups at most risk, is vital.
Dr.T.V.Rao MD 75

Chlamydia trachomatis
• More than three million new cases annually • Responsible for causing cervicitis, urethritis, Proctitis, lymphogranuloma venereum, and pelvic inflammatory disease • Direct and indirect cost of chlamydial infections run into billions of dollars • Potential to transmit to newborn during delivery
– Conjunctivitis, pneumonia
Dr.T.V.Rao MD


Normal Cervix

Dr.T.V.Rao MD Source: Claire E. Stevens, Seattle STD/HIV Prevention Training Center


Chlamydia Cervicitis

Dr.T.V.Rao MD Source: St. Louis STD/HIV Prevention Training Center


Mucopurulent Cervicitis

Dr.T.V.Rao MD Source: Seattle STD/HIV Prevention Training Center



Laboratory Tests for Chlamydia
• Tissue culture has been the standard
– Specificity approaching 100% – Sensitivity ranges from 60% to 90%

• Non-amplified tests
– Enzyme Immunoassay (EIA), e.g. Chlamydiazyme
• sensitivity and specificity of 85% and 97% respectively • useful for high volume screening • false positives

– Nucleic Acid Hybridization (NA Probe), e.g. Gen-Probe Pace2
• sensitivities ranging from 75% to 100%; specificities greater than 95% • detects chlamydial ribosomal RNA • able to detect gonorrhea and chlamydia from one swab • need for large amounts of sample DNA
Dr.T.V.Rao MD


Laboratory Tests for Chlamydia

• DNA amplification assays
– polymerase chain reaction (PCR) – ligase chain reaction (LCR)

• Sensitivities with PCR and LCR 95% and 85-98% respectively; specificity approaches 100% • LCR ability to detect chlamydia in first void urine
Dr.T.V.Rao MD


Chlamydia Direct Fluorescent Antibody (DFA)

Source: Centers for Disease Control and Prevention

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Pelvic Inflammatory Disease (PID)
• l0%-20% women with GC develop PID • In Europe and North America, higher proportion of C. trachomatis than N. gonorrhoeae in women with symptoms of PID • CDC minimal criteria
– uterine adnexal tenderness, cervical motion tenderness

• Other symptoms include
– endocervical discharge, fever, lower abd. pain

• Complications:
– Infertility: 15%-24% with 1 episode PID secondary to GC or chlamydia – 7X risk of ectopic pregnancy with 1 episode PID – chronic pelvic pain in 18%
Dr.T.V.Rao MD


• The combination of a painful genital ulcer and tender Suppurative inguinal adenopathy suggests the diagnosis of Chancroid A probable diagnosis of Chancroid, for both clinical and surveillance purposes, can be made if all of the following criteria are met: 1) the patient has one or more painful genital ulcers; 2) the patient has no evidence of T. pallidum infection by dark field examination of ulcer exudate or by a serologic test for syphilis performed at least 7 days after onset of ulcers;
Dr.T.V.Rao MD 84

• 3) the clinical presentation, appearance of genital ulcers and, if present, regional lymphadenopathy are typical for Chancroid; and 4) a test for HSV performed on the ulcer exudate is negative.
Dr.T.V.Rao MD 85

• A definitive diagnosis of Chancroid requires the identification of H. ducreyi on special culture media that is not widely available from commercial sources; even when these media are used, sensitivity is <80% (145).
Dr.T.V.Rao MD 86

Granuloma Inguinale (Donovanosis)
• Granuloma inguinale is a genital ulcerative disease caused by the intracellular gramnegative bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). The disease occurs rarely in the United States, although it is endemic in some tropical and developing areas, including India; Papua, New Guinea; the Caribbean; central Australia; and southern Africa (192,193).
Dr.T.V.Rao MD 87

Granuloma Inguinale (Donovanosis)
• Clinically, the disease is commonly characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudoboboes) might also occur. The lesions are highly vascular (i.e., beefy red appearance) and bleed easily on contact.
Dr.T.V.Rao MD 88

Granuloma Inguinale (Donovanosis)
• The causative organism is difficult to culture, and diagnosis requires visualization of darkstaining Donovan bodies on tissue crush preparation or biopsy. No FDA-cleared molecular tests for the detection of K. granulomatis DNA exist, but such an assay might be useful when undertaken by laboratories that have conducted a CLIA verification study.
Dr.T.V.Rao MD 89

Lymph granuloma Venereum
• Lymph granuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3 . The most common clinical manifestation of LGV among heterosexuals is tender inguinal and/or femoral lymphadenopathy that is typically unilateral.
Dr.T.V.Rao MD 90

Lymph granuloma Venereum
• Diagnosis is based on clinical suspicion, epidemiologic information, and the exclusion of other Aetiologies for proctocolitis, inguinal lymphadenopathy, or genital or rectal ulcers. C. trachomatis testing also should be conducted, if available.
Dr.T.V.Rao MD 91

Lymph granuloma Venereum
• Genital and lymph node specimens (i.e., lesion swab or bubo aspirate) can be tested for C. trachomatis by culture, direct immunofluorescence, or nucleic acid detection. NAATs for C. trachomatis are not FDA-cleared for testing rectal specimens, although some laboratories have performed the CLIA validation studies that are needed to provide results for clinical management. Additional molecular procedures (e.g., PCR-based genotyping) can be used to differentiate LGV from non-LGV C. trachomatis, but these are not widely available.
Dr.T.V.Rao MD 92

Lymph granuloma Venereum
• chlamydia serology (complement fixation titers >1:64) can support the diagnosis of LGV in the appropriate clinical context. Comparative data between types of serologic tests are lacking, and the diagnostic utility of serologic methods other than complement fixation and some micro immunofluorescence procedures has not been established.
Dr.T.V.Rao MD 93

• • • •

An estimated 5 million new cases occur each year in women and men. Occurs in vagina of women so may be sexually transmitted to men using infected washcloths and towels. It is transmitted to the baby during delivery. It also can occur in the urethra (carries urine to penis) in men, doesn’t have symptoms usually. SYMPTOMS: Appear within 5 to 28 days of exposure Women usually have a vaginal discharge that FEMALE SYMPTOMS: Itching and burning at the outside of the opening of the vagina and vulva. Painful and frequent urination Heavy, unpleasant smelling greenish, yellow discharge MALE SYMPTOMS: Usually nothing, or discomfort in urethra, inflamed head of the penis.
Dr.T.V.Rao MD 94


Bacterial Vaginitis
• Controversy: STD - yes or no • Need for treatment
– 1980: only if patient complains – 2002: increased risk of:
• • • • • • • • Preterm birth / premature rupture of membranes Amniotic fluid infection Chorioamnionitis / Postpartum endometritis Pelvic inflammatory disease Postsurgical infection Cervical intraepithelial neoplasia Mucopurulent cervicitis Acquisition of HIV Dr.T.V.Rao infection MD


Life at Risk with Sexually Transmitted Infections Best Choice Play safe

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• Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World

• Email

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