STD

Question 1

STD with sores

Answer 1

“Sores” (ulcers)
• Syphilis
• Genital herpes (HSV-2, HSV-1)
• Others uncommon in the U.S.
• Lymphogranuloma venereum
• Chancroid
• Granuloma inguinale

Question 2

STD with drips/ HPV for cervical cancer

Answer 2

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

Question 3

treat gonococcal infections

Answer 3

ceftriaxon and azithromycin generally

Question 4

bacterial vaginosis

increased risk of

Answer 4

• 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 infection

Question 5

genital ulcer diseases

painful vs pain less

Answer 5

Painful
• Chancroid
• Genital herpes simplex
• Painless
• Syphilis
• Lymphogranuloma venereum
• Granuloma inguinale

Question 6

Primary syphilis
incubation
chancre

Answer 6

• 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

Question 7

secondary syphilis 
represents 
usually -----after chancre
findings
resolves in

Answer 7

Represents hematogenous 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
• Resolves in 2-10 weeks

Question 8

genital herpes simplex
transmision
primary infection is 
vesicles
dx

Answer 8

Direct contact – may be with asymptomatic shedding
• Primary infection commonly asymptomatic; symptomatic
cases sometimes severe, prolonged, systemic
manifestations
• Vesicles Þ painful ulcerations Þ crusting
• Recurrence a potential
• Diagnosis:
• Culture
• Serology (Western blot)
• PCR

Question 9

epidemiology of genital herpes

common or uncommon
–% by age 35

most cases are
transmission is
complications

Answer 9

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, enhanced HIV
transmission, psychosocial issues

Question 10

gonorrhea

male

Answer 10

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

Question 11

gonorrhea female

Answer 11

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

Question 12

nongonococcal urethritis

etiology
sx
dx

Answer 12

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 ³ 5 PMNs (usually ³15)/OI field
Urine microscopic ³ 10 PMNs/HPF
Leukocyte esterase (+)

Question 13

Chlamydia trachomatis

Answer 13

• 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

Question 14

Laboratory Tests for Chlamydia

tissue culture
non amplified tests
nucleic acid hybridization

Answer 14

• 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 Pace-2
• 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

Question 15

lab test for chlamydia

Answer 15

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

Question 16

Pelvic Inflammatory Disease (PID)

Answer 16

• 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 one episode
chronic pelvic pain in 18%

Question 17

HPV and Cervical Cancer

Answer 17

• Infection is generally indicated by the detection of
HPV DNA
• HPV infection is causally associated with cervical
cancer and probably other anogenital squamous
cell cancers (e.g. anal, penile, vulvar, vaginal)
• Over 99% of cervical cancers have HPV DNA
detected within the tumor
• Routine Pap smear screening ensures early
detection (and treatment) of pre-cancerous lesions

Question 18

Estimates for HPV-Associated Cancers

Answer 18

Cervical cancer:
• In the U.S., an estimated 14,000 cases and
5,000 deaths
• Worldwide, an estimated 450,000 cases and
200,000 deaths