STI Pictures Flashcards
Pearly Penile Papules
– fibro-epithelial lumps, in rows, soft in texture – do not cryo-therapy
Vestibular papillae
Fordyce spots – small sebaceous cysts - normal
Tyson’s glands – small sebaceous glands
Lymphocoele
Fixed drug eruption – often antibiotics (esp tetracyclines)
Lichen Planus
- Dysparunia, maybe with a little bleeding after intercourse
- Moderate discharge, may be scanty
- No odour but some irritation
- Regular partner.
- O/E vaginal skin thin, red, maybe superficial haemorrhagic areas, cervix is ok
Diagnosis Atrophic Vaginitis
Significant Features post-menopausal, dysparunia, thin reddened vaginal skin
Aetiology It is due to a loss of oestrogens. The vagina loses the rugae, elasticity, and natural defences.
Treatment Easy. Give exogenous oestrogens. You can give them topically with creams or pessaries, or systemically with pills or transdermal patches.
- 2-3 days of dysuria
- 1 day heavy urethral discharge
- New female partner 2 weeks
- Not using condoms
Gonococcal Urethritis
Urethritis
- Gonococcal?-Chlamydia?
- Other (NSU)? -HSV, Trich.Vaginalis, Mycoplasma genitalium, Adenovirus, Ureaplasma Urealyticum, trauma,
- Reiters’ syn.
- yellowish discharge
- lower abdominal pain
- dysuria and dysparunia
- O/E purulent cervical and vaginal discharge, and pelvic tenderness.
- Casual male partner / 10d / no condom
Gonorrhoea cervicitis
Diagnosis Vaginal thrush Candida albicans
Management
Antifungal cream or pessary – Eg Clotrimazole
or
Fluconazole
- Married – no other contacts
- 2 weeks of profuse greyish-green discharge with offensive odour
- Pain with intercourse
- Bubbles in discharge and odour
- Erythematous cervix with punctate appearance
Trichamonas vaginitis
Investigations
wet prep to see the Trichomonads. They are flagellated protozoae
Management
Usually use oral Metronidazole or Tinidazole, except you can’t use these in pregnancy (use Clotrimazole in pregnancy)
It is a genuine STD, so you must treat both partners
- 1 week of profuse smelly discharge
- No pain or itch
- O/E greyish watery discharge, no associated inflammation, odour present
- Has had it before
- Has regular male partner, no other contacts.
Bacterial vaginosis •Gardnerella vaginalis, •Mycoplasma hominis and •Mobiluncus
Investigations
- Cervical swab – MCS
- Wet prep – micro – “clue” cells
- Vaginal pH >4.5
- Other STI screen if appropriate
Management
•Metronidazole 400mg bd for 7 days.
or
•Clindamycin cream 2% PV nocte x7d.
Or
•Metronidazole gel 0.75% PV nocte x5d
- Recurring penile irritation
- Small itchy sores on penis last 12 hours
- Present on and off for years with the sores lasting 5-7 days and usually in roughly the same area.
- Has regular partner, no other contacts
Herpes Simplex - vesicular stage
- Painful? (YES –> HSV NO –> Syphilis)
- Recent medications (fixed drug reaction?)
- Recent topical applications?
- Trauma?
- Sexual contacts – overseas? (syphilis, chancroid, LGV, donavanosis)
- Same sex partners ? (syphilis)
Herpes Simplex – meatal ulcer
- Very painful external genitalia 2-3d
- Severe dysuria and dysparunia
- Ulceration visible
- New sexual partner last week
Herpes Simplex in the vulva
Herpes Simplex - outer vulva
Herpes simplex - oedema
- Gay male
- Recently noticed lesion on penis
- It is painless
- He practices “safe sex”
Syphilis – primary - chancre
Syphilis – secondary, but again a genital ulcer
Syphilis – secondary – generalised pleomorphic rash
Syphilis – secondary – always beware of rashes on palms or soles
Syphilis – secondary – soles of feet. In this case also HIV+
Tropical travel
•LGV (Lymphogranuloma Venereum)
Chlamydia trachomatis serovars L1-L3
Azithromycin 1gm if suspicious
Or
Doxycycline 100mg bd x21d. If confirmed
Tropical travel
Chancroid
Haemophilus Ducreyi
Azithromycin 1gm
Or
Ciprofloxacin 500mg bd x 3d
Or
Ceftriaxone 500mg IM stat.
Tropical travel
Donovanosis
Klebsiella Granulomatis
Azithromycin 1gm each week for 4 weeks
And
Review – may need Bx
Tropical Travel
Donovanosis
Klebsiella Granulomatis
Azithromycin 1gm each week for 4 weeks
And
Review – may need Bx
Genital warts on shaft of penis
- Very common –75-80% of sexually active adults –BUT less than ¼ will have visible warts
- 90% due to HPV types 6 & 11
- Long dormant phase is possible – days to years
- Treatment rids the wart but not the virus
- Peri-anal warts are not necessarily a marker of anal intercourse. •Partners – females –> regular Pap smears
- Think – local or systemic immune suppression.
- Treatment options ?
- Education
Genital warts in meatus
Management
- Ablation – cryotherapy or diathermy •Immune modulation – Imiqimod cream
- Chemical – Podophyllin paint
- Other – laser, surgical, TriChlorAcetic acid
- Pregnant? –> cryotherapy
Perianal warts does not necessarily indicate anal sexual intercourse
Prevention
•Gardasil vaccine – 3 doses –Females 10-45yo –Males 9-15yo –Good protection against HPV types 6 & 11 •Condoms – some protection only
