Urethral discharges
Gonococcal urethritis
Non-gonococcal urethritis
Genital ulcers
Syphilis
Herpes simplex
Chancroid
Lymphogranuloma venereum
Granuloma inguinale
Warts
Gonococcal urethritis
Etiology
Neisseria gonorrhoeae
(gram negative diplococci)
Cilnical manifestations
dysurea
urethral discharge
Laboratory tests
gram negative
diplococci intracellular
Treatment
1. quinolones (oral)
-norfloxacin 800 mg single dose
-ofloxacin 400 mg single dose
-ciprofloxacin 250-500 mg single dose
2. spectinomycin 2 gm intramuscular
3. cephalosporins
-ceftriaxone 250 mg intramuscular
-cefotaxime 500 mg intramuscular
+ probenecid 1 gm. oral
Complications
-posterior urethritis
-epididymitis
-paraurethral duct abscess
-periurethral duct abscess
-disseminated gonococcal
infection(DGI)
-gonococcal conjunctivitis
Non-gonococcal urethritis
Etiology
•Chlamydia trachomatis
•Ureaplasma urealyticum
•Trichomonas vaginalis
Clinical manifestations
• dysurea
• urethral discharge
• leukorrhea in female
Laboratory tests
1. gram stain
2. culture in cyclohexamide
treated McCoy cell culture
3. direct fluorescent antibody
detection or enzyme
immunoassay
Treatment
1. tetracycline 500 mg. qid 1-3 wks
2. doxycycline or minocycline 100mg.
bid 1-3 wks
3. erythromycin 500 mg. qid. 1-3 wks or
roxithromycin 150 mg. bid. 1-2wks or
thiamphenical 500 mg. qid. 1wks or
ofloxacin 200 mg. bid. 1 wks or
ciprofloxacin 500 mg. bid. 1 wks
Syphilis
Etiology
Treponema pallidum
:active motile spiral spirochete
(4-14 spirals , 5-20 um)
Clinical manifestations
1. Primary syphilis
2. Secondary syphilis
3. Latent syphilis
4. Tertiary syphilis
1. Primary syphilis
• IP 18-21 day
• hard chancre (Hunterian chancre)
• non-tender not suppurate
lymphadenopathy
• chancre redux
• syphilitic balanitis of Follmann
Laboratory tests
1. direct fluorescent antibody tissue test for
T.pallidum (DFAT-TP)
2. dark field examination
3. nontreponemal tests
Rapid plasma reagin (RPR)
Venereal disease research laboratory(VDRL)
4. polymerase chain reaction (PCR)
5. microhemagglutination assay for
T.pallidum(MHA-TP)
6. fluorescent treponemal antibody absorption
(FTA-ABS) for treponemal test
2.Secondary syphilis (syphilids)
• maculopapular rash
• condyloma lata
• alopecia (moth-eaten)
• pharyngitis,tonsillitis
• relapsing secondary syphilis
• systemic involvement
Laboratory tests
1. VDRL strongly+ve
2. dark-field illumination
3.Latent syphilis
• early latent : no symtom (<2 yrs)
• late latent(>2 yrs)
4.Tertiary syphilis(3-5 yrs)
• nodular (reddish brown or copper-
color) with crust and scales(Kidney
shape),scars , ulceration , atrophy ,
macroglossia , perforation of hard
palate
• gumma (deep punched ulcer)
Laboratory tests
1. VDRL or RPR + ve 75%
2. FTA-ABS or MHA-TP + ve 100%
3. Dark field illumination
4. PCR
Late complication
• osseous syphilis
• neurosyphilis
• cardiovascular syphilis
• congenital syphilis
Treatment
Primary , Secondary , Early latent syphilis
1. benzathine penicillin 2.4 million IM
2. tetracycline (250mg) 2x4 pc x 2 wks
3. doxycycline (100mg) 1x2x2 wks
4. ceftriaxone 1 gm IM or IV x8-10 d.
5. azithromycin 2 gm single dose oral
Treatment
Late or Early latent syphilis > 1 yr
1. benzathine penicillin 2.4 milliom Imx
3 wks
2. tetracycline (250 mg) 2 x 4 x1 month
3. doxycycline (100 mg)1 x 2 x 1 month
Neurosyphilis
1. Pen G 3-4 mu IV every 4 hrs x2 wks.
2. Procaine Pen G 2.4 mu IM / day
+probenecid (500 mg) oral qid x 2wks
+Benzathine Pen G 2.4 mu IM/wk x 3wks
Congenital syphilis
Pen G 2-3 mu/kg/d IV
or 0.5mu every 4-6 hrs x2 wks
Pregnant
depends on stage
Jarisch – Herxheimer reaction
: 6-8 hrs after initial injection of Penicillin
: fever , sore throat , malaise , myalgia
headache , tachycardia
: erythematous swelling of initial syphilitic
lesions
: premature labor , fetal distress
: symtomatic treatment
Herpes simplex
fever blister , cold sore
Etiology
Herpes simplex virus (DNA virus)
type I , II
Clinical
1. Mild primary infections
2. Severe primary infection
3. Recurrent herpes simplex
I Mild primary infections
• gingivostomatitis
• genital herpes
• keratoconjunctivitis
2 Severe primary infection
• kaposi’s varicelliform eruption
(eczema herpeticum)
• meningoencephalitis
• disseminated herpes simplex
3.Recurrent herpes simplex
less severe , no symtom
Laboratory test
1. Tzanck test:multinucleated giant cell
2. Immunofluorescence:Ag detection
3. Elisa