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Sexually Transmitted Diseases (STD’s)

Chlamydia

Clinical Presentation

Usually asymptomatic or minimally symptomatic in both men and women.

Males – Urethritis, epididymitis, prostatitis

Females – Urethritis, cervicitis, endometritis, PID – infertility and ectopic pregnancy.

Diagnosis

Tissue culture

Direct fluorescent antibody (DFA) staining, ELISA, DNA probe (expensive, therefore tx is preferred if suspected).

Gonorrhea

Clinical Presentation

Symptomatic or asymptomatic – patients who are not treated become asymptomatic (immune system may have caught on but dz doesn’t go away)

Males – Urethritis, dysuria, frequency

Females – symptoms nonspecific – bleeding, dysuria, frequency (b/c infected for along time and immune system may have caught on but dz doesn’t go away). If untreated patients may develop Pelvic Inflammatory Disease – PID – that may lead to tubal scarring, infertility, and ectopic pregnancy.

Diagnosis

Gram stain – intracellular gram-negative diplococcus

Culture

Rapid diagnostic tests

Syphilis

Clinical Presentation

Primary – Single painless papule (chancre) – 21 days

Highly contagious at this stage, persists 1-8 wks wo tx then disappears.

Secondary – 2-6 wks after primary stage if untreated or inadequately treated.

Hematogenous and/or lymphatic spread, mucocutaneous eruptions which disappear in 4-6 wks (systemic spread, rash, lymphonopathy…)

Latent – Positive serology, but no symptoms, 25-30% progress to tertiary stage, “early” acquired within the preceding year, all others “late”. Early latent ≤ 1 yr, Late > 1 yr.

Diagnosis

Direct darkfield examination and direct fluorescent antibody tests of lesion exudates or tissue definitive methods of diagnosis for early syphilis.

Nonspecific nontreponemal tests (VDRL, RPR, ART); Early 70-100%, Late 60-98%; used to monitor treatment – titers correlate with disease activity à 4 fold-change signs: e.g. if 1:16 → 1:4 means tx is not effective, dz’s worsen.

If 1:8 → 1:32 means tx is effective. Tests must be done at same lab.

If +, then perform specific treponemal test to make sure. False + found in pts who have strong immune response, vaccine, pregnancy, liver dz, connective tissue isorders such as Rheumatoid arthritis or lupus…

Specific treponemal tests (FTA-abs, TPPA); remain positive, used for confirmation.