Sexually transmitted disorders.

1. Nothing worthwhile comes easily. Work,
Continuous and hard work, is the only
way to accomplish results that last.
-- Steve Jobs.

2. CLINICAL PATHOLOGY
The foundation of clinical medicine.
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
MGS2: Male Genital: STI / STD
CPC : Term4 Week4 - MGS 1/6
System : Male Genital System.
Topic : 1: Overview 2: STD 3: Orchitis 4: Tumours 5: Penis 6: GLS

3. 3
Sexually Transmitted Diseases:
Organism Clinical
Virus Herpes, HPV, HIV & HBV Hepatitis, AIDS, Cancer.
Chlamydia, Mycoplasma
Ureaplasma
Urethritis, epididymo-orchitis
Bacteria Neisseria Gonorrhoeae
Treponema Pallidum
Gonorrhea
Syphilis
Haemophilus ducreyi
Calymmatobacterium
Chancroid
Granuloma inguinale
Shigella, Campylobacter Enterocolitis.
Protozoa Trichomonas vaginalis
Entamoeba
Urethritis, balanitis,
Amoebiasis.
giardia Giardiasis
Note top 5

4. 4
Syphilis:
 Treponema pallidum, global, endemic, increasing.
 Body fluids  skin / mucosa, or placenta to new born.
 Widespread dissemination through lymphatics.
 Proliferative endarteritis Chronic inflam. plasma cells*
 Primary (3wk): Chancre: ulcerated papule, Resolve*
sponteously. Highly infectious*.
 Secondary (months): Recurrent Lymphadenopathy,
Palmar rash, Condyloma lata (Painless, moist, plaques).
Highly infectious. etc. Resolve*.
 Tertiary (years): Gumma- Necrotising granuloma CVS*,
CNS. Tabes dorsalis, General paresis, Aneurysms* 80%.
 Congenital: Abortion  Rash, liver & lung fibrosis, 8th
nerve deafness, interstitial keratitis, hutchinson teeth.
BV, Plasma cells

5. 5
Syphilis: Diagnosis
Non Treponemal Ab
(to cardiolipin), only early phase, non
specific, false positive.
 VDRL (Venereal Disease Research
Lab)
 RPR (Rapid plasma reagin)
Treponemal Ab: Positive in all stages.
False positive*.
 FTA-ABS (fluorescent Trepo. Ab)
 TP-PA (TP particle agglutination)
 MHA-TP (Microhemagglutinin Assay)
Direct detection:
Darkfield microscopy, PCR, Culture?
Summary

6. Nothing worthwhile comes easily. Work,
Continuous and hard work, is the only
way to accomplish results that last.
-- Steve Jobs.

7. 7
Gonorrhea
Pus Common, Second to Chlamydia, increasing,
resistant. Suppurative, only humans. Person
to person & to fetus on birth (passage).
 Dysuria, mucopurulent discharge  PID.
 Neisseria gonorrhoeae, gram neg. diplococci.
 Stick to epithelia, 1-14 day incubation.
 Fever, pain, inflam., dysuria, discharge – white pus
 Urethra, cx, rectum, pharynx, or eyes
 Intracellular, gram neg diplococci.
 Complications: stricture, PID, spread:
 Occular, neonatal conjuctivitis.

8. 8
Nongonococcal Urethritis (NGU):
Chlamydia trachomatis: (pathology similar to gonococci – less pus)
 Gram –ve, elementary body  reticulate body in cell
 ~ 50 % are asymptomatic, Major cause of infertility in men & women.
 40% PID, 20% infertility, 9% Ectopic pregnancy.
 In men urethritis, epididymo-orchitis, prostatitis.
 In patients with HLAB27  reactive arthritis (Reiter’s syndrome)
 Children - seasonal purulent conjunctivitis. Repeated, untreated 
scarring of cornea & eyelids  visual impairment / blindness.
Diagnosis:
 Nucleic acid amplification Test (NAAT). Sensitive
 In combination with tests for Neisseria gonorrhoreae. (also HIV).
 Most common STI. Chlamydia*, trichomonas vaginalis,
Ureaplasma, Mycoplasma genitalium. etc.

9. 9
Reiter’s Syndrome:
 Common Inflammatory polyarthritis in young
men.
 Chlamydia trachomatis (rarely salmonella &
shigella)
 HLA-B27 – risk factor in 70%
 Fever, malaise, myalgia,
 Reactive asymmetric arthritis
 Conjunctivitis.
 Knee, ankle & feet common.
 Chronic, recurrent.
 Disability in ~ 20% cases.
Sausage toe
Inflammed ankle

10. 10
GU – Non GU
 Intracellular diplococci.  > 5 PMN/Hpf.

11. Nothing worthwhile comes easily. Work,
Continuous and hard work, is the only
way to accomplish results that last.
-- Steve Jobs.

12. 12
Lymphogranuloma venereum:
 LGV: Chlamydia trachomatis, serotypes L1-L3
 Chronic ulcerative, lymphedema, Procto-colitis.
 Genital Painless papule 2-5 days.
 1-4 wk suppurative necrotic Inguinal
lymphadenitis.
 Suppurative granuloma (neutrophil abscess) &
Chlamydial inclusions in microscopy.
Complications:
 Rectal strictures. Pelvic inflammatory disease,
frozen pelvis – extensive fibrosis.

13. 13
Chancroid: (soft Chancre)
 Third venereal disease (Syphilis, Gonorrhoea).
 Haemophilus ducreyi
 Gram –ve, coccobacillus.
 Tropical. HIV common, Prostitution risk factor*
 Erythematous papule  painful ulcer, yellow pus.
 Inguinal lymphadenopathy  buboes  pus
draining ulcers.

14. Nothing worthwhile comes easily. Work,
Continuous and hard work, is the only
way to accomplish results that last.
-- Steve Jobs.

15. 15
Granuloma Inguinale:
 Chronic fibrosing STD by Calymmatobacterium
granulomatis. (now Klebsiella granulomatis)
 The initial papules on genitalia  ulcers  urethral,
vulvar, or anal strictures.
 granulation tissue and intense epithelial
hyperplasia that can mimic squamous cell
carcinoma.
 intracellular coccobacilli within vacuolated
macrophages (Donovan bodies).
 Note: Leishmania donovani (protozoa)
– Donovan bodies* is different.

16. 16
Genital herpes:
 STD –Herpes Simplex Virus HSV1 & HSV2*.
 95% of HIV +ve are also positive for HSV.
 Direct contact only – not fomites.
 4 day incubation, Itchy, painful, closely grouped
vesicles surrounded by erythema.
  Vesicles burst to form painful ulcers.
 Multinucleate giant cells with viral inclusion.
 Painful inguinal lymphadenopathy.
 Self limited mild in normal.
 Severe infection in immunocompromised.
 Neonatal herpes encephalitis – severe & fatal.
HPV – with female genital system

17. Nothing worthwhile comes easily. Work,
Continuous and hard work, is the only
way to accomplish results that last.
-- Steve Jobs.

18. Hard work makes dreams come true!
-- Napoleon Hill.