1. Reproductive block 2013

3. Objectives Name various etiological agents causing sexually transmitted diseases (STD) Describe the clinical presentations of STD (ie Gonococcal vs non-gonococcal) Describe the proper specimen collection for diagnosis of STD Discuss the microbiological and non microbiological methods for diagnosis of STD Outline the management, complication and prevention of STD

4. Case 1 A 23-year-old alcoholic and drugs (cocaine) addict single male arrived from his trip to South East Asia six months ago. He gave history of multiple sexual partners. Two months ago he developed ulcer on his penis which disappeared compeletly. A full physical notes a rash on both his palms and his soles

6. What are the possible causes for his presentation? Treponema Pallidum Herpes Simplex Virus 2 Haemophilus Ducreyi

7. Genital ulcer

8. How could you differentiate between them based on s/s of the patient? UlcerEtiologyUlcerLymphadeno pathy (Babo) Systemic Chancroid Chancer Ulcerated Vesicles

9. How could you differentiate between them based on s/s of the patient? UlcerEtiologyUlcerLymphadeno pathy (Babo) Systemic ChancroidHaemophilus Ducreyi Wet, painfulInguinal tender Present Chancer Treponema Pallidum Dry, painless and raised margin Inguinal part of generalize disease Depends on stage Ulcerated Vesicles Herpes Simplex Virus 2 Multiple shallow painful Occasionally present In primary

10. What investigations would you like to order for him? Explain how those investigations would help you? UlcerMicroscopyCulture DFASerology Haemophilus Ducreyi Treponema Pallidum Herpes Simplex Virus 2

11. What investigations would you like to order for him? Explain how those investigations would help you? UlcerMicroscopyCulture DFASerology Haemophilus Ducreyi Gram stain; gm-ve small bacillia Selective mediaNA Treponema Pallidum Dark Field M; Motile Spirochetes Not grownNARPR TPHA FTA.ABS Herpes Simplex Virus 2 NAProduce cytopathic effect in cell culture + IgM IgG

12. The lesion was sampled and examined by dark-field microscopy;

13. Cytopathic effect of HSV in cell culture Gram stain; gm-ve small bacilli Haemophilus Ducreyi

14. Case 2 A 35-year-old Pilipino married male presented to the emergency room complaining of dysuria for the last 24-hour and noted some "pus-like" drainage in his underwear and the tip of his penis.

15. "pus-like" drainage

16. Base on the finding, what is the most likely diagnosis? Briefly outline the management of this patient?

17. What are the possible causes for his presentation? OrganismsUrethritis Gonococcal Urethritis Non-gonococcal urethritis

18. What are the possible causes for his presentation? OrganismsUrethritis Gonococcal Urethritis Neisseria gonorrhoeae Purulent discharge Non-gonococcal urethritis Chlamydia trachomatis Mucopurulent Others Trichomonas vaginatis Mycoplasma

19. What investigations do you like to order for him? Explain how those investigations would help you? OrganismsSmear/CultureImmunological tests Molecular testing GCU Neisseria gonorrhoeae NGCU Chlamydia trachomatis Others Trichomonas vaginalis Mycoplasma

20. What investigations do you like to order for him? Explain how those investigations would help you? OrganismsSmear/CultureImmunological tests Molecular testing GCU Neisseria gonorrhoeae Gram-ve diplococci & pus cell s Selective media +ve (Gold Standard) NGCU Chlamydia trachomatis Pus cell/McCoy Cell culture DFA+ve(Gold Standard) Others Trichomonas vaginalis Mycoplasma  Wet mount; pus &TV/ Culture  Pus cell / Special media culture EIA +ve

21. Gram Stain of Urethral Swab

23. Base on the finding, what is the most likely diagnosis? Briefly outline the management of this patient?

24. A 24-year-old female noted vaginal itching and irritation with a discharge. Previously, she developed a yeast infection that was treated with over-the-counter medications and resolved. Thinking that this was recurrence, she again self- treated. This time, however, the symptoms did not resolve. Case 3

25. What are the possible causes for her presentation? Bacterial vaginosis Candida vaginitis Trichomonas vaginalis Allergic vaginitis Chlamydia trachomatis Neisseria gonorrhoeae

26. PH Whiff test Gram stain / Wet prep Culture Immunologic/ molecular test Bacterial vaginosis Candida vaginitis Trichomonas vaginatis What investigations would you like to order for her? Explain how those investigations would help you?

27. PH Whiff test Gram stain / Wet prep Culture Immunologic/ molecular test Bacterial vaginosis >4.5+++Clue cells Not helpful DNA Probe (gardnerella vaginalis) Candida vaginitis <4.5- Yeast and pseudohyphae CandidaDNA Probe Trichomona s vaginalis >4.5+-TrichomonasMotile Trophozoite s EIA DNA Probe What investigations you like to order for her? Explain how those investigations would help you?

28. Wet prep/ Gram stain A wet mount of the swab demonstrates "swimming" Motile Trophozoites.

29. 29 Wet Prep: Trichomoniasis Saline: 40X objective *Trichomonas shown for size reference only: must be motile for identification PMN Trichomonas* Squamous epithelial cells PMN Trichomonas* Yeast buds Source: Seattle STD/HIV Prevention Training Center at the University of Washington

30. 30 Trichomonas vaginalis Source: CDC, National Center for Infectious Diseases, Division of Parasitic Diseases Trichomoniasis CurriculumPathogenesis

31. Base on the finding, what is the most likely diagnosis? Briefly outline the management this case?

32. What organisms would you screen for in any patient presented with any STD?