• N. gonnorrhae!
• haematogenous and causes systemic disease only 1-3% of the time
• intense PMN infiltrate
• urethritis/MPC/DGI (disseminated gonococcal infections which occurs in <1% and affects skin, tendon sheaths and joints)/PID
• way more purulent than chalmydia

• Chlamydia!
• local infection only
• intense LYMPHOCYTIC infiltrate (unlike the PMN infiltrate of gonorrhea)
• NGU (non-gonnococal urethritis), MPC, PID

• Mycoplasma hominish, genitalium and ureaplasma urealyticum
• local only
• extracellular pathogen
• NGU, MPC, PID
• few labs test for these, and you treat them like you would Chlamydia
• require e- microscopy to visualize

• Trichamonas vaginalis!
• epithelial cell attachement
• local infection
• intense PMN inflammation
• profuse frothy discharge

• Candida albicans!
• epithelial cell adherance
• local infection
• mild PMN inflammation with hypersensitivity
• pruritic discharge, NOT STI
• hypersensitivity/allergic type response

• BV! (garnerella vaginalis & anaerobes)
• local infection
• non-inflammatory anaerobic overgrowth
• foul discharge, not STI

• Treponema Pallidum/Sypilis!
• direct mucosal infection
• haematogenous
• perivascular mononuclear infiltration causing vasculitis

• Chancroid! (Haemophilus ducreyi)
• mucosal trauma
• lymph node can spread this
• dense inflammatory exudate

• Genital herpes!
• direct mucosal infection
• lymph nodes, sacral ganglia
• necrotic inflammation

• *Chlamydiae is also the classification of Chlamydia
• This is Chalmydia trachomatis L1, L2 and L3, or LGV (lymphogranulomatous venereum)
• mucosal abrasions
• systemic: lymphnodes and CNS
• granuloma with central necrosis

• Confidentiality/counselling
• Case detection (screening)
• Contact Tracing
• Compliance
• Condom use

Chalmydia: 1-5 WEEKS

Gonorrhea: 1-5 DAYS

• Chlamydia: scant, mucoid, dysuria in uncommon, microscopic examination is done by IF, culture done on tissue culture
• Gonorrhea: profuse, purulent, dysuria common, microscopic examination is done by gram stain
• Both: asymptomatic up to 50% of the time, antigen detection by ELISA, PCR or DNA probe

• STI that has spread to the pelvic organs (endometritis, salpingitis, pelvic peritonitis, tubo-ovarian abscess)
• GC, CT, anerobes, gnb, streptococci, mycoplasmas
• Risk: young, multiple partner, BV, IUD maybe
• Diagnosis: CMT (cervical motion tenderness) or adnexal tenderness + fever, high ESR, + GC/CT

• ceftriaxone 250 mg IM (GC) PLUS
• doxycycline 100 mg BID x 14 days (CT) PLUS
• metronidazole 500 mg TID x 14 days (anaerobes)

• Trich: purulent, profuse, FROTHY, yellow/green, inflammation moderate to severe, pus and motile trichomonads on LM, pH >5, strawberry cervix
• Candida: intense vulvar itch, minimal, clumped, white, moderate inflammation, pus, yeast or mycelia on LM, pH<4.5, no odour
• BV: malodorous, moderate amount, FOUL SMELL, grey/white, no inflammation, no plus, clue cells and profuse bacteria on LM, pH >5, strong "fishy" odour

• cefixime 800 mg PO (per oral) OR
• Azithromycin 2g PO OR
• Ceftriaxone 250mg IM (more expensive, and that's part of PID tx remember)

• Azithromycin 1g PO OR
• Erythromycin 500mg QID x 7 days
• Doxycycline 100mg BID x 7 days

• doxycycline 100 mg BID X 7-14 days

• metronidazole 500 mg BID x 7 days

• syphilis, HSV, chancroid and LGV
• frenulum is the most common area

• incubation as much as a month
• primary lesion is a papule 
• well defined, raised, round
• 5-15mm
• induration is FIRM
• firm, rubbery, non-tender bilateral lymphadenopathy

• incubation up to a week (2-7 days)
• primary lesion is a vesicle
• 1-2mm
• erythmatous, flat, round
• serous purulence
• pain and tenderness common
• firm, tender and bilateral lymphadenopathy

• inculation 1 day to 2 weeks
• primary lesion is papule/pustule
• more than 1 lesion
• 2-100mm
• ragged, undetermined, irregular appearance
• SOFT induration
• purulence is abundant, EXCRUCIATING PAIN
• soft, buboes, tender, unilateral lynphadenopathy

• this is an invasive form of chlamydia
• "groove sign" lymphadenopathy is pathognemonic (above and below inguinal canal)
• genital ulcers, buboes (lymphnode swelling!) and haemorrhagic proctitis
• incubation 3 days -6 weeks
• papule/pustule
• well defined, raised, round
• firm induration
• looks more like syphilis
  

• 1- ulcer. You can get on mouth or tongue, need the sores to spread it
• 2- "great imitator": it does not itch, no vesicles. Generalized rash, vasculitis, non-blanching, scaly, may look like psoriasis
• 3- other organs involved and lots of damage

• Benz Pen G 2.4 units IM OR
• Ceftriacone 2g IN daily x10-14 days OR
• Doxycycline 100mg PO BID 14-28 days

• erythromycin 500 mg TID 7 days

• Acyclovir 400 mg TID x 10 days