STIs

Question 1

Single PAINLESS ulcer at inoculation site with heaped up borders and a clean base.

Dx?

Causative agent?

Test?

Answer 1

Syphilis

Treponema pallidum

Darkfield microscopy or VDRL/RPR

Question 2

Multiple PAINFUL SUPERFICIAL VESICLES OR ULCERATIONS with erythematous base. Possible fever, inguinal LAD.

Dx?

Causative agent?

Test?

Answer 2

Genital herpes

Herpes simplex virus - dsDNA virus

PCR or Tzanck smear

Question 3

DEEP, PURULENT, painful ulcers with matted/SUPPURATIVE lymphadenitis. “School of fish”.

Dx?

Causative agent?

Test?

Answer 3

Chancroid

Haemophilus ducreyi

Gram stain and culture or PCR

Question 4

PAINLESS, progressive, red serpiginous ulcerative lesions WITHOUT lymphadenopathy.

Dx?

Causative agent?

Test?

Answer 4

Granuloma inguinale (donovanosis)

Klebsiella granulomatis

Gram stain and culture (Difficult) or Biopsy for Donovan bodies

Question 5

Thin, off-white discharge with fishy odor. No inflammation.

Dx?

Causative agent?

Test?

Tx?

Answer 5

Bacterial vaginosis.

Gardernella

KOH whiff

Metro or clinda

Question 6

Thin, yellow green malodorous, frothy discharge. Vaginal inflammation.

Dx?

Causative agent?

Test?

Tx?

Answer 6

Trichomoniasis

Trichomonas vaginalis

See motile trichomonads

Tx with metronidazole and TREAT PARTNER

Question 7

Thick “cottage cheese” discharge. Vaginal inflammation.

Dx?

Causative agent?

Test?

Tx?

Answer 7

Candida vaginitis

Vandida albicans

See pseudohyphae under microscope

Treat with fluconazole.

Question 8

What two causes of vaginitis have pH>4.5?

Which has normal pH (3.8-4.5)?

Answer 8

Gardnerella and Trichomonas

Candida

Question 9

Clue cell

Answer 9

gardnerella

Question 10

Triggers for candida and what is reduced?

Answer 10

antibiotic use, high estrogen (pregnancy), systemic GC use, uncontrolled DM, immunosuppression

Anything with a REDUCTION IN LACTOBACILLI.