Sexually Transmitted Diseases
Herpesvirus Infections – HSV1 & HSV2
History
- replicate in the skin, mucous membranes, oropharynx, and genital tract
- the lesions are vesicular
- can reactivate repeatedly
Diseases
- adults – fever blisters, genital lesions
- neonates – stomatitis, conjunctivitis, encephalitis
- immunosuppressed – disseminated disease
Pathology
- Intranuclear inclusions (Cowdry A bodies – acidophilic, homogenous with clear halo surrounding)
Ø Replicate in nucleus
- Lab test: Tzanck smear, monoclonal antibodies, rapid antigen detection
- Takes 1-2 days to grow in tissue culture
Treatment
- Acyclovir, foscarnet
Chlamydial Infections – C. trachomatis
History
- remember it is an obligate intracellular pathogen
- the ELEMENTARY BODIES are the infectious particles
- the RETICULATE BODIES are not infectious
Pathology
- causes nongonnococcal urethritis, cervicitis
- exudative inflammation
- LGV (lymphogranuloma venereum) – genital ulcer, necrotizing lymphadenitis
Ø you have tender, fluctuant, ulcerative nodes
- infants – inclusion conjunctivitis, pneumonia
- Trachoma – LEADING CAUSE OF BLINDNESS IN THE WORLD
Diagnosis
- INTRACYTOPLASMIC INCLUSIONS (replicate in the cytoplasm)
Treatment
- Azithromycin, doxycycline
Gonorrhea – Neisseria gonorrheae
History
- encapsulated gram (-) diplococcus
Disease process
- pili binds to epithelial cells
- the bug produces endotoxins which can result in multiorgan failure
Pathology
- urethritis, cervicitis, PID, endometritis
- purulent inflammation
- can progress to chronic inflammation and eventually lead to scarring
- Opthalmia neonatorum – acquired during birth from mother
- If deficient in complement components, may not be able to lyse the bacteria and may be more susceptible to dissemination
Diagnosis
- gram stain, culture
Treatment
- Ceftriaxone, quinolones
Trichomoniasis – Trichomonas vaginalis
Description
- flagellated protozoan parasite
- causes: cervicitis, urethritis
- can be asymptomatic
- Urethritis: mucosal itching, burning, redness, frothy exudate
Pathology
- most prevalent non-viral STD
- only found in urogenital tract; humans only host
- cytoadherence to epithelial cells due to trichomonal surface proteins
Diagnosis
- “strawberry mucosa”- creamy exudate
- Wet prep – visualize the trophozoite
Treatment
- metronidazole
Bacterial vaginosis - Gardnerella vaginalis
- synergistic infection between G. vaginalis and anaerobes.
- “fishy odor”
Diagnosis
- visualization of Clue cells (vaginal epithelial cells containing tiny coccobacilli) by wet prep
Treatment
- metronidazole
Chancroid - Haemophilus ducreyi
History
- gram (-) coccobacilli
- causes abscess on external genitalia (most common cause outside the U.S.)
Pathology
- draining ulcer – “soft chancre” – painful inguinal nodes, swollen, contain pus
- shallow small ulcer (<1 cm)
- mild systemic symptoms
Diagnosis
- scrapings of lesion – gram stain – and culture
- “school of fish” – “railroad tracks”
- slow growing – may take up to 10 days
Treatment
- Erythromycin
Human Papillomaviruses
History
- DNA virus – Papovavirus
- > 60 types (some are a cause of cervical cancer)
Pathology
- cause of self-limiting hyperproliferative lesions of the squamous epithelium
- Warts, anogenital warts (condyloma acuminata)
- Koilocytosis – large squamous epithelial cells with shrunken nuclei and large cytoplasmic vacuoles.
- Transmission: sexually and to neonate
Diagnosis
- DNA probes
Treatment
- topical, Interferon, Surgery
Granuloma inguinale – Calymmatobacterium granulomatis
Description
- small Gram (-) bacillus
- endemic in tropical regions
Pathology
- papule enlarges sore with indurated borders, satellite lesions, no lymphadenitis
- Uncomplicated lesions are painless
- 2o lesions – supportive spread via adjacent skin, autoinoculation, systemic dissemination
- Donovan Bodies – small Gram (-) rods within macrophages – Giemsa stain
Syphilis – Treponema pallidum
History
- spirochete
- systemic infection has multiple presentations
Clinical Features
1) Stage One
Ø 3 weeks after contact with infected person
Ø single, firm, nontender, raised, red lesion (chancre)
Ø spirochetes disseminate hematogenously, chancre heals
2) Stage Two
Ø 2-10 weeks after 1o chancre
Ø diffuse rash on palms, soles, fever, lymphadenopathy
Ø resolves spontaneously
3) Stage Three – tertiary syphilis
Ø latent organisms – endarteritis
Ø occurs years after the primary lesion
Ø acute inflammatory lesions in aorta, heart and CNS
Ø may have quiescent lesions (gummas) in liver, bones, and skin
4) congenital syphilis
Ø late abortion, stillbirth, or death soon after delivery
Ø can be latent form until childhood or adulthood
Ø Perinatal syphilis – diffuse rash, slough epithelium, on palms, soles and the skin around the mouth and anus
Ø Diagnosis
- Hallmarks: obliterative endarteritis and plasma cell-rich mononuclear infiltrates
- VDRL, dark-field, immunofluorescence
Treatment
- penicillin or with doxycycline or tetracycline in those with penicillin allergy
Tags: Acyclovir, ardnerella vaginalis, Calymmatobacterium granulomatis, cervicitis, Chlamydia trachomatis, Chlamydial Infections, Chronic Endometritis, conjunctivitis, Cowdry A bodies, encephalitis, fever blisters, foscarnet, genital lesions, Gonorrhea, Haemophilus ducreyi, Herpesvirus Infections, Human Papillomaviruses, lymphogranuloma venereum, PID, stomatitis, trachomatis, Trichomoniasis, urethritis
