Prof Ong Kok Hai’s Notes

Sexually transmitted diseases

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Image: treponema pallidum

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Image: lymphogranuloma venerum (with lymphodenopathy of inguinal nodes)

Lesions

  • syphilis
    • treponema pallidum
    • Primary: chancre
    • Secondary: rash
    • Diagnosis
      • clinical
      • laboratory
        • microscopy
        • serology (antibody detection)
          • VRDL
          • RPR
          • TPHA
          • FTA-Abs
    • Routine screening
      • antenatal, insurance, blood donors
    • Treatment
      • penicillin
  • herpes
    • HSV 1: oral lesions
    • HSV 2: genital lesions
    • antigen detection
      • EIA, immunofluorescence)
      • tissue culture
    • IgM
  • Lymphogranuloma venerum (LGV)
    • Chlamydia trachomatis
    • A-C: trachoma
    • D-K: urethritis, cervicitis, proctitis
    • L1-L3: LGV (liver disease, swelling of lymph nodes)
    • skin lesions – ulcerating papule
      • papules will heal
    • lymphadenopathy
      • systemic spread
    • treatment: tetracycline, erythromycin
  • Chandroid
    • Haem. ducreyi
      • gram –ve rod
    • rare
    • genital ulcer
  • donovanosis
    • Calymmatobacterium granulomatis
      • gram –ve bacteria
    • tropical genital ulcer
    • bacteria stains black in Giemsa stain
      • within monocytes
    • treatment: tetracycline
  • genital warts
    • condylomata acuminata
    • papillomavirus
      • 6,11,12,16,18,31
    • may not regress for months
    • infective period: 1-6 months
    • strong association with cervical cancer
      • 16,18
    • removed by laser
  • urethritis
    • microbe:
      • gonorrhea
        • systemic spread
          • septicaemia
          • septic arthritis
          • skin rash/dermatitis
        • treatment: penicillin, sulphonamides, spectinomycin
        • non-gonococcal urethritis (NGU)
          • most common STD
          • purulent discharge
      • chlamydia
        • treatment: tetracycline, erythromycin
      • Trichomoniasis
        • vaginal discharge foul smelling
        • male asymptomatic
        • treatment:
          • metronidazole
    • pus with/without pain on micturition
    • symptoms less obvious in females
  • vaginitis
  • HIV
  • hepatitis
  • PID
  • Mycoplasma
    • M. hominis (atypical pneumonia)
    • U. urealyticum
      • PID
      • urethritis
      • proctitis
    • treatment: tetracycline

Pelvic Inflammatory Disease

  • Aetiology
    • GC
    • NGU
    • normal flora
  • Complication of gonorrhea & NGU
  • asymptomic/mild
  • diagnosis
    • symptoms
    • colposcopy
    • high vaginal swab (HVS)
    • antigen detection
  • treatment
    • combination therapy
      • chlamydia, gonorrhea, normal flora

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