STDs

Question 1

Etiology and complications of urethral discharge

Answer 1

Gonococcal by Neisseria or non gonococcal: chlamydia trachomatis, ureaplasma urealyticum, trichomonis vaginalis

Complications for GU: urethral stricture (20years later) epididymitis and infert. For nonGU epididymitis and strictures.

Question 2

Urethral discharge present and examination

Answer 2

GU: 1-7 days, thick purulent yellow or brown , gram neg intracellular diplococci on micro.
NGU: 1-5 weeks, watery or scanty discharge, chlamydial monoclonal antibody test serum.

Question 3

Urethral discharge mx

Answer 3

Counseling and mx of partner, HIV test
Antibiotics: GU 500mg stat ciproflox, doxycycline 100mg bd 7days.
NGU: alternatives to doxy, erythromycin 500mg 4x for 7 days or azithromycin 1g oral stat.

Question 4

Genital ulcers ddx

NB‼ persistence of ulcers for >3/4 weeks needs a biopsy to exclude penile ca.

Answer 4

STD: syphilis(VDRL & RPR vs TPHA and FTA), chancroid(selective culture for haemophilis ducreyi), LGV (serology) granuloma inguinale( crush preparation Donovan bodies) herpes simplex( immunofluorescence). 
Pre malignant: cis, leukoplakia 
Malignant: scc of penis
Trauma during intercourse 
Dermatological problems.

Question 5

Urethral discharge ddx

Answer 5

Urethritis: STD

Secondary to urethral catheter, instrumentation, calculus, tumor, irritation systemic illness(reactive arthritis)