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

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

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 Summary 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?

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

7. 7 Gonorrhea  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. Pus

8. 8 Nongonococcal Urethritis (NGU):  Most common STI. Chlamydia*, trichomonas vaginalis, Ureaplasma, Mycoplasma genitalium. etc. 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).

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.