SEXUALLY

TRANSMITTED
DISEASES

Pongsak Mahanupab, MD.

serenitystreetnews.com

Department of Pathology
Faculty of Medicine
Chiang Mai University

Block Reproductive System BMES304, Sept..2016

health.wyo.gov

Specific Educational Objectives

The student should be able to
1. Identify the common cause of each of the STD
2. Describe the common and pathognomonic signs and
symptoms of each common STD
3. Describe the major manifestations of each and
differentiate it from other
4. Describe how you diagnose and prevent these
infections

BACTERIA

Neisseria gonorrhoeae
Chlamydia trachomatis
Mycoplasma homonis
Ureaplasma urealyticum
Treponema pallidum
Hemophilus ducreyi
Calymmatobacterium
granulomatois
Shigella sp.

Urethritis, cervicitis etc.

Same
Salpingitis
Urethritis
Syphilis
Chancroid
Granuloma inguinale

Shigellosis

VIRUS

Herpes simplex
Hepatitis B
Cytomegalovirus
Human papilloma
Molluscum contagiosum
virus
Human
immunodeficiency virus

Genital herpes
Viral hepatitis
Congenital infection
Condyloma acuminata
Molluscum contagiosum

AIDS

PROTOZOA
Trichomonas vaginalis
Entamoeba histolytica
Giardia lamblia

Vaginitis, urethritis
Amoebiasis
(homosexual)
Giardiasis
(homosexual)

FUNGUS
Candida albicans

Candidiasis

ECTOPARASITE
Phthirus pubis

Pubic louse infestation

Sarcoptis scabei

Scabies

http://www.visualinformation.info/std-risk-factors-infographic/

http://www.visualinformation.info/std-risk-factors-infographic/

http://www.visualinformation.info/std-risk-factors-infographic/

http://www.visualinformation.info/std-risk-factors-infographic/

http://www.visualinformation.info/std-risk-factors-infographic/

http://www.visualinformation.info/std-risk-factors-infographic/

OVERVEIW (1)
- STD affects men and women of all backgrounds and
economic levels
- They are most prevalent among teenagers and young
adults. Nearly two-thirds of all STD occur in people
younger than 25 years of age
- The incidence of STD is rising few decades,
- young people have become sexually active earlier
- divorce is more common
- have multiple sex partners

OVERVEIW (2)
- Usually STD cause no symptoms, especially in women
- Health problems caused by STD tend to be more severe
and more frequent for women than for men. This is
because of the increased frequency of asymptomatic
infections
- STD in women also may be associated with cervical
cancer (e.g. Papillomavirus infections)

OVERVEIW (3)
- STD can be passed from a mother to her baby before,
during, or immediately after birth
- When diagnosed and treated early, many STD can be
treated effectively. Some infections have become
resistant to the drugs and require different types of
antibiotics. Some can not be cured and can be terminal
(ex. HIV, chronic HBV). Experts believe that having
STD other than AIDS increases one's risk for becoming
infected with the HIV

DEFENSE MECHANISM

(1)

1. Mucosa
- glycocalyx (glycoprotein and
glycolipids), mucus: mucosal barrier
- in females, hormonal response of
epithelium

DEFENSE MECHANISM

(2)

2. Microbial flora
- adherence of micro-organism
- mucociliary activity, mucus stream
- colonization- attachment, bacterial
division, no inflammation - normal flora

DEFENSE MECHANISM

(3)

- male: very few S.epidermidis, alphastreptococci, corynebacterium in urethra

- female: vaginal secretion-108 -109
bacteria per gram of fluid (facultative:
S.epidermidis, streptococci, E.coli and
anaerobes: peptococci, lactobacilli and
Bacterioes spp.)

DEFENSE MECHANISM

(4)

- Ureaplasma urealyticum, M. Hominis,

- Hormonal influence; normal flora in
females; glycogen

DEFENSE MECHANISM

(5)

3. Nonspecific factors
- mucus: semen and vaginal secretion
- mechanical: urine stream
- mucosal immune system

DEFENSE MECHANISM

(6)

Vulva: - Apocrine glands: modified sweat glands fungicidal acid

- Apposition of labia closes introitus
Vagina: - Apposition of anterior and posterior walls
- Stratified squamous epithelium resistant to infection
- Vaginal acidity
- Flora: the G+ve Doderleins bacilli splits glycogen into
lactic acid
Cervix: - closed by bacteriolytic cervical mucus
Uterus: - Periodic endometrial shedding during menstruation
eliminates any infection

DEFENSE MECHANISM

(7)

With Age
During childhood and after the menopause
- Estrogen deficiency glycogen and Doderlein bacilli
absent vaginal acidity
- Endometrium poorly developed or atrophic and does not
undergo cyclic shedding

With menstruation
- Absent cervical mucus plug
- Lowered vaginal acidity by alkaline menstruation

DEFENSE MECHANISM
During the puerperium:
- Uterus, cervix and vagina widely opened
- Vaginal acidity neutralized by alkaline lochia
- Raw placental site
- Lacerations
- Low general resistance

(8)

SYMPTOMATOLOGY
1. Genital discharge
2. Skin and mucous membrane lesions
3. Inguinal lymphadenopathy
4. Positive serology

health.wyo.gov

OUTLINES
1. Syphilis
2. Gonorrhoea
3. Nongonococcal urethritis
4. Chancroid
5. Genital herpes
6. Condyloma acuminata
7. Molluscum contagiosum

8. Lymphogranuloma
venereum
9. Candidiasis
10. Trchomoniasis
11. Pelvic inflammatory
disease

SYPHILIS
ETIOLOGY
- Treponema pallidum
- Spiral 5-20 microns
- Sensitive to - dryness
- heat
- antiseptic

(1)

Centers for Disease Control and Prevention, part of the United States Department of Health and Human Services

SYPHILIS
CLASSIFICATION
A. EARLY INFECTIOUS STAGE
(Diagnosed within 2 years)

- Primary stage
- Secondary stage
- Recurrent stage
- Early latent stage

(2)

SYPHILIS

(3)

B. LATE NONINFECTIOUS STAGE

(Diagnosed 2 years after infection)

- Late latent stage
- Tertiary stage
- Cardiovascular syphilis
- Neurosyphilis

SYPHILIS

(4)

CONGENITAL SYPHILIS
A. Early (within 2 years after birth)
B. Late (after 2 years)
C. Stigmata

PRIMARY SYPHILIS

(1)

Abrasion
Penetration through mucous membranes
Incubation period 10-90 days (21)
Clinical:
Macule or papule 2-10 mm. and progress
to ulcer (CHANCRE)
Regional lymphadenopathy

PRIMARY SYPHILIS
Chancre

(2)

- One (usually) or kissing

- Round, granulation tissue at base, clean
- Painless
- Small bleeding
- Red indurated edge
- Ulcer healing (3-6 w) with no or little scar
- Highly contagious
- Number of ulcer depends on number of
treponema

Chancre

Chancre

Chancre

Chancre

http://dermchallenge.blogspot.com/2012/12/primary-syphilis-given-that-answer-is.html

Chancre

http://std.sagepub.com/content/19/3/145/F1.expansion

Chancre

Chancre

Chancre

Chancre

Chancre

http://www.cmaj.ca/content/183/17/2015/F1.large.jpg

http://walnet.org/sos/

Oral chancre

Chancre

PRIMARY SYPHILIS

(3)

DIFFERENTIAL DIAGNOSIS
1. Herpes genitalis
2. Chancroid
3. Lymphogranuloma venereum
4. Balanitis
5. Scabies
6. Carcinoma

SECONDARY SYPHILIS

(1)

4 (6)-8 w following primary syphilis

CONSTITUTIONAL SYMPTOMS
Headache, malaise, anorexia,
weight loss, low grade fever,
generalized lymphadenopathy, alopecia

SECONDARY SYPHILIS

(2)

SKIN AND MUCOUS MEMBRANE LESIONS

Symmetrical, flexor side
- macule, papule
- Pustular or nodular
Red brown, round discrete, confluent, pleomorphism
CONDYLOMA LATA - pruritic
High bacteremia
Lasts 2-6 weeks

Secondary
syphilis
Rash

Rash in secondary
syphilis

Rash in secondary syphilis

Rash

Palmar rash

Palmar rash

Papular rash

Plantar rash

Palmar rash

Rash

Primary and
secondary
syphilis

Condyloma lata

Condyloma lata

Condyloma lata

Condyloma lata

SECONDARY SYPHILIS

(3)

Moth-eaten alopecia
(frontotemporal, occiput)
Hepatitis, jaundice, hepatomegaly
Nephrotic syndrome
Arthritis, bursitis, periostitis
Neurological involvement - abnormal CSF
Cardiac involvement - abnormal EKG, heart
block

Alopecia
moth - eaten

Alopecia

EARLY LATENT SYPHILIS

No symptom of primary syphilis

Nontreponemal and treponemal test - positive
Normal CSF
Infection less than 2 years

RELAPSE
5-10 % (4th-9th month after treatment)
Lesion at mucocutaneous area same as
primary lesion
- Positive treponema
Lymphadenopathy
Condyloma lata

LATE SYPHILIS
3-10 years after primary syphilis

TERTIARY SYPHILIS
- Noncontagious and highly destructive

(1)

LATE SYPHILIS

(2)

1. COVERING STRUCTURES
- Skin, mucous membrane
- Subcutaneous and submucosal tissue
2. SUPPORTING STRUCTURES
- Bone, joint, muscle and ligament
3. INTERNAL ORGANS
- Liver, spleen, stomach

LATE SYPHILIS
PATHOLOGY
GUMMA
Single, multiple, variable size
Self remission

http://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/Syphilis-and-trachoma.html

(3)

Gumma

Gumma

LATE SYPHILIS

(4)

- Necrosis - caseous liked material

- surrounding by granulation tissue
- lymphocytes and plasmacytic perivascular
cuffing
- endarteritis
- epithelioid cell
- multinucleated giant cell

CARDIOVASCULAR SYPHILIS (1)

Most common cause of death in untreated
population (10-40 years after initial infection)
Decrease incidence due to proper treatment
Endarteritis obliterans,
periarteritis (perivascular cuffing)

Syphilitic aneurysm

CARDIOVASCULAR SYPHILIS (2)

Ascending aorta (more lymphatic drainage)
Destruction of muscular and elastic medial wall
Tree bark appearance

Inflam. vasa vasorum

ANEURYSM
Obstruction of coronary artery ostia, aortic valvulitis, aortic
regurgitation
Inflammed aortic root

NEUROSYPHILIS
M>F
Four types
1. Asymptomatic neurosyphilis - abnormal CSF
2. Meningo-vascular syphilis
3. Parenchymatous neurosyphilis
4. Gumma

CONGENITAL SYPHILIS
Intrauterine infection - common
PATHOLOGY

Mother- any stage of syphilis

Transmission - every trimester
Treponemal proliferation in liver and
spread to other organs

1. EARLY CONGENITAL SYPHILIS

First 2 years
Secondary syphilis in adults
Resolving after treatment

NEONATAL SYPHILIS

Low birth weight

Enlarged placenta (>1/5 of BW)
Hepatosplenomegaly
Desquamation of palms and soles
Syphilitic face
Hydrops fetalis
Chorioamnionitis
CSF - VDRL - positive

Desquamation of sole

WEEKS TO 2-3 MONTHS

Prolonged jaundice
Pseudoparesis
(epiphyseal separation or pathological Fx.)
Small for date
Anasarca
Alopecia
Paronychia
Mucositis - Rhagades

Alopecia

Mucositis

Mucositis

Rhagades

Paronychia

2. LATE CONGENITAL SYPHILIS

>2 years (late children and early adolescent)
Tertiary syphilis in adult
Hutchinsons teeth, blindness, deafness
HUTCHINSONS TRIAD
Sabre tibia, Clutton joint, Mulberry molars,
saddle nose

Hutchinsons teeth

Sabre shin

Clutton joints
Symmetrical joint swelling seen in
patients with congenital syphilis, most
commonly affects the knees, presenting
with synovitis and joint effusions

http://www.rightdiagnosis.com/phil/html/syphilis/4102.html

Flattened nose

Bossing forehead

health.wyo.gov

GONORRHOEA

(1)

Gonos = seed, rhoea = flow

Old disease
EPIDEMIOLOGY
- Incidence
- Man is the only known host and infection is
almost always via sexual contact
Both sexes, symptomatic and asymptomatic

GONORRHOEA

(2)

Etiology
- Neisseria gonorrhoea - Type I and II gram negative
diplococci

Ability of gonococci to attach to mucosal cells (columnar and

transitional epithelium) via their pili, then penetrate to submucosal
areas to induce a strong PMN influx

GONORRHOEA
Infectivity
M + F with disease,
chance 20 % (single)
60-80% (4 exposures)
F + M with disease,
chance 50-90 %
via conventional intercourse

(3)

GONORRHOEA

(4)

SYMPTOM
MALE
Symptomatic or asymptomatic
Burning urination of variable degree, dysuria
Purulent discharge, inflammation and erythema around
the opening of the urethra
Homosexual men, infection involves the urethra, anal
canal, and pharynx

GONORRHOEA

(5)

SYMPTOM
FEMALE
Urethra and cervix
Asymptomatic (30%)> M
The usual site of infection is the cervix, frequently leads to
contiguous spread along mucous membranes to the urethral and
anal areas
10-20% of cervical infections result in gonococcal pelvic
inflammatory disease (PID)

Mucous discharge

Purulent discharge

Purulent
discharge

http://www.yourblackworld.net/2012/06/black-news/drug-resistant-gonorrhea-spreading-saysworld-health-organization/

Purulent discharge
per urethra

GONORRHOEA
PATHOLOGY
Highly contagious
Mode of transmission
- Venereal
- Nonvenereal

(6)

GONORRHOEA

(7)

N.GONORRHOEA adhere to columnar cell (pili)

3 days
Multiply in subepithelial tissue
Lymphatic and vascular access
Microabscess
Rupture, discharge - N and bacteria

GONORRHOEA
COMPLICATION
MALE
1. Tysonitis
2. Preputial sac
3. Paraurethral duct
4. Median raphe
5. Duct and gland of Littre
6. Periurethral tissue
7. Prostate gland
8. Vas, epididymis, seminal vesicles

(8)

Epididymitis

GONORRHOEA

(9)

COMPLICATION
FEMALE
1. Skene gland
2. Bartholin gland
3. Vulva
4. Pelvic inflammatory disease (PID)-10-20% of cervical
infection
5. Fitz-Hugh-Curtis syndrome (gonococcal perihepatitis)

Fitz Hugh Curtis

syndrome

GONORRHOEA

(10)

COMPLICATION
FEMALE
6. Disseminated gonococcal infection
- Endocervix > anorectal
- Low grade fever
- Migratory polyarthralgias involving the large joints, septic
arthritis, tenosynovitis
- Endocarditis, meningitis, bacteremia
- Dermatitis - erythema, pustule, hemorrhage, necrosis

Disseminated
gonococcal
infection
Dermatitis

Disseminated
gonococcal
infection

Dermatitis

http://www.pediatricsconsultant360.com/content/lesions-point-serious-bacterial-infections

GONORRHOEA

(11)

Oropharyngeal gonorrhoea
Rectal gonorrhoea
Pediatric gonorrhoea
- Genital infection F > M
- Ophthalmia neonatorum
(1% AgNO3 or 0.5%erythromycin or 1% tetracycline)
- Pharynx, respiratory tract and GI tract

Ophthalmia
neonatorum

https://www.flickr.com/photos/communityeyehealth/5444949477/sizes/z/in/photostream/

Gonococcal
conjuncitivitis

Gonococcal
conjunctivitis

health.wyo.gov

NONGONOCOCCAL URETHRITIS
(NGU) (1)
Nonspecific urethritis (NSU)
ETIOLOGY
- Chlamydia trachomatis- most common
- Ureaplasma urealyticum- most common
- Gardnerella vaginalis
- Trichomonas vaginalis
- Herpes Simplex virus
- and other as yet unknown organisms

NONGONOCOCCAL URETHRITIS
(NGU) (2)
Most frequent cause of urethritis in
heterosexual men
45% of the cases of gonorrhea also have
NGU
Men between 15 and 30, with multiple
sexual partners, are most at risk

NONGONOCOCCAL URETHRITIS
(NGU) (3)
SYMPTOM

Incubation period 7-14 days

Dysuria
Mucopurulent discharge
Diagnosis
- by exclusion of GC.

Mucous
discharge

Mucous discharge

Mucous
discharge

NONGONOCOCCAL URETHRITIS
(NGU) (4)
COMPLICATION
MALE : Littre gland, Tyson gland ,
Cowpers gland, paraurethral duct,
prostate, seminal vesicles, epididymis,
urethral stricture
FEMALE : Bartholin gland, salpingitis

health.wyo.gov

CHANCROID
(SOFT CHANCRE) (1)
EPIDEMIOLOGY
Common in developing country and low
socioeconomic class
M>F
Transmission of H. ducreyi is almost exclusively
by sexual contact
Hygiene and cleanliness are important
determinants of contagiousness

CHANCROID
(SOFT CHANCRE) (2)
ETIOLOGY
Hemophilus ducreyi
(facultative anaerobic bacilli - gram negative)

CHANCROID
(SOFT CHANCRE) (3)
SYMPTOM
Incubation period 4-7 days, through skin abrasions
Macule or papule
24-48 hours
pustule
2-3 days
ULCER
Painful, soft edge, circumscribed, shagged border, undermined ,
0.1-2 cm., hemorrhage
MALE : prepuce, frenulum, coronal sulcus, glans penis, shaft
FEMALE : fourchette, labia, vestibule, clitoris
BUBO 30-50 %

Chancroid

Chancroid

Chancroid

Chancroid

Chancroid

Chancroid

Chancroid

CHANCROID
(SOFT CHANCRE) (4)
COMPLICATION
1. Ruptured bubo
2. Balanitis, phimosis, paraphimosis
3. Urethral fistula
4. Rectovaginal fistula

health.wyo.gov

GENITAL HERPES

(1)

EPIDEMIOLOGY
Sexual transmission
Symptomatic infection
ETIOLOGY

DNA virus group, Herpesvirus group - Herpes simplex virus

HSV I AND II, 5-30% of first-episode cases are caused by HSV-1
Clinical recurrences are much less frequent for HSV-1
Risk of infection is approximately 75%

GENITAL HERPES

(2)

SYMPTOM
PRIMARY GENITAL HERPES

No immune
Large and multiple ulcers
Constitutional symptoms
Pain, dysuria, vesicles
24-48 hours
erosion
3 w healed

rupture

GENITAL HERPES

(3)

FEMALE : vagina, cervix, urethra

MALE : Constitutional symptoms less
than female
Aseptic meningitis, pharynx

GENITAL HERPES

(4)

RECURRENT GENITAL HERPES

Less symptom, rapid healing
2/3 recurrent, vesicle
ruptured
3-4 days
7-10 days healed

24 hours
contagious

GENITAL HERPES

(5)

PATHOLOGY
VIRUS

contact mucous membrane or skin

Vesicles (edema and intraepidermal vesicle)

Acantholytic cells, multinucleated cells , Inclusion body in nucleus
VIRUS
- Enter nerve bundle
- Sensory nerve ganglion

HSV

HSV

HSV

HSV

HSV

HSV

HSV

Blister
Viral infected cells
(multinucleated giant cells)

Dermis

health.wyo.gov

CONDYLOMA ACUMINATA(1)
EPIDEMIOLOGY
Sexual transmission
Incubation period 3w-8 m (2-3 m)
Pregnancy - decreased CMI
- Increase incidence
ETIOLOGY
Papilloma virus - family papoviridae 6,11

CONDYLOMA ACUMINATA(2)
SYMPTOM
Classic form - Pink verrucous growth (cauliflower)
MALE : Inner surface of prepuce, frenum, sulcus,
meatus
FEMALE : Vestibule, labia, clitoris, vagina, cervix
BUSCHKE - LOWENSTEIN TUMOR
- rapid growth and destructive

Condyloma
acuminata

Condyloma
acuminata

BUSCHKE - LOWENSTEIN TUMOR

Condyloma
acuminata

Condyloma acuminata

Condyloma acuminata

Condyloma acuminata

CONDYLOMA ACUMINATA(3)
PATHOLOGY
Virus infects epithelial cells (skin and
mucous membranes), transformation,
hyperplasia
HPV replicates in differentiating squamous
cell (Malphighian layer)

Papillomatosis
Fibrovascular core
Dilatation of BV.
Squamous hyperplasia

 Koilocyte
(Viral-infected cell)
Perinuclear halo
Ground-glass nuclei
Irregular nuclear
membrane

CONDYLOMA ACUMINATA

(4)

COMPLICATION
1. Torsion, hemorrhage, ulcer, bacterial superimposed
infection
2. Malignant transformation

health.wyo.gov

MOLLUSCUM CONTAGIOSUM
EPIDEMIOLOGY
Worldwide
Childhood - body, face - contact
Teenager - genital organ - sexual
ETIOLOGY - Poxvirus
Intracytoplasmic inclusion

(1)

MOLLUSCUM CONTAGIOSUM

(2)

SYMPTOM
Incubation period 1w-6 m
Domeshaped papule, smooth surface, small,
central umbilication, 2-5 mm.
Creamy content when squeezing
http://www.healthhype.com/hiv-skin-infections-rash-and-sores-with-pictures.html

Molluscum
contagiosum

Umbilication
Molluscum
contagiosum

Molluscum
contagiosum

Molluscum
contagiosum in
HIV patient

Epidermal
hyperplasia

Umbilication

Molluscum body

Intracytoplasmic inclusion body

health.wyo.gov

LYMPHOGRANULOMA VENEREUM (1)

EPIDEMIOLOGY

Worldwide especially tropical country

ETIOLOGY

Chlamydia trachomatis
Serotype L1, L2, L3

LYMPHOGRANULOMA VENEREUM (2)

SYMPTOM
Incubation period 3-30 days (1-2 w)
1. EARLY PHASE
1.1 PRIMARY LESION - Papule, shallow ulcer, herpetiform lesion,
urethra
- Resolute within 2-3 days
1.2 INGUINAL ADENITIS - M > F,
- 2/3 unilateral, sign of groove
1.3 CONSTITUTIONAL SYMPTOM

Primary lesion

Inguinal bubo

Inguinal bubo

Inguinal bubo

Inguinal bubo

Primary lesion with bubo

http://www.corbisimages.com/stock-photo/rights-managed/IH067008/lymphogranuloma-venereum

LYMPHOGRANULOMA VENEREUM (3)

2. LATE PHASE 1-2 years
2.1 ANORECTAL SYNDROME
- F>M
- Proctitis
- Necrotic ulcer or hypertrophic mucosa
- Fistula in ano
- Rectovesical or rectovaginal fistulas
- Perirectal abscess
- Stricture

http://tmcr.usuhs.edu/tmcr/chapter20/radiological2.htm

Stricture of
rectum

LYMPHOGRANULOMA VENEREUM (4)

2.2 GENITAL ELEPHANTIASIS (ESTIOMENE)
- F>M , lymphadema
PATHOLOGY
Abrasion
Small ulcer
INGUINAL BUBO
(Minute miliary abscess, stellate, N, palisading of epithelioid cells
and Langhans giant cells)

Vulva elephantiasis
http://openi.nlm.nih.gov/detailedresult.php?img=2994881_1752-1947-4-369-1&req=4

health.wyo.gov

CANDIDIASIS

(1)

EPIDEMIOLOGY
Contact, respiration, swallowing, sexual
MALE : Balanitis from sexual
FEMALE : - Sexual or anal infection
- Pregnancy, contraceptive
pills, antibiotics, steroid, DM, weak
F>M

CANDIDIASIS

(2)

http://pathmicro.med.sc.edu/mycology/candida200.jpg

ETIOLOGY
CANDIDA ALBICANS
Pseudohyphae (mycelia) and yeasts

CANDIDIASIS

(3)

SYMPTOM
FEMALE
Pruritus, burning sensation, irritated, dysuria, frequency,
dyspareunia
Mucus or white purulent, no smell
Skin at perineum and labia
MALE
Balanoposthitis 10-27 %
Discharge or pus at prepuce, urethritis

Vaginal
candidiasis

Vaginal
candidiasis

http://www.medicalobserver.com.au/news/five-things-to-know-about-vulvovaginal-candidiasis

Candidiasis

CANDIDIASIS

(4)

PATHOLOGY
Hypha, yeast at the outer layer of
squamous mucosa
Neutrophils, microabscess

health.wyo.gov

TRICHOMONIASIS
EPIDEMIOLOGY
Common in black > white
Venereal and nonvenereal
transmission
ETIOLOGY
Trichomonas vaginalis

(1)

http://www.trichomoniasis.org/Diagnosis

TRICHOMONIASIS

(2)

SYMPTOM
FEMALE : - Asymptomatic 10-50 %
- Symptomatic - leukorrhea, foul smell,
genital irritation, dyspareunia
MALE : - Asymptomatic - most common
- Urethritis - dysuria 25 %
- Purulent discharge 60 %

TRICHOMONIASIS

(3)

PATHOLOGY
Site specific
FEMALE : - Vaginitis (nutrient from squamous cell),
edema, red rugae - vasodilatation, petechia
- Leukorrhea - increase WBC
- STRAWBERRY CERVIX
MALE :- Urethritis

http://www.suggestkeyword.com/c3RyYXdiZXJyeSBjZXJ2aXg/

Strawberry cervix

Strawberry cervix

Vaginal
discharge
Frothy fluid

TRICHOMONIASIS
COMPLICATION
Premature rupture of membranes
Postpartum endometritis

(4)

health.wyo.gov

PELVIC INFLAMMATORY
DISEASE ( PID) (1)
Inflammation of uterine tube, ovary
parametrium and pelvic peritoneum,
resulting from the ascending spread of
microorganisms from the vagina and
endocervix

PELVIC INFLAMMATORY
DISEASE ( PID) (2)
EPIDEMIOLOGY
1. Age 15-24 years (menstruation)
2. Parity 3/4 - nulliparity
3. Sexual activity (multiple sexual partner)
4. Mode of contraception- IUD use (oral contraceptives decrease
the risk)
5. Recurrence (history of previous PID)
6. Abortion, procedure , labor
7. Asymptomatic gonococcal infection in either sexual partner

PELVIC INFLAMMATORY DISEASE

( PID) (3)
ETIOLOGY
Type of agents
- STD (N. gonorrhoeae most common, C. trachomatis )
- Endogenous aerobic or facultative anaerobic
(Bacteroides, E.coli, Mycoplasma hominis, Actinomyces
israelii )
- Tuberculosis

PELVIC INFLAMMATORY DISEASE

( PID) (4)
SIGN AND SYMPTOM

Moderate fever (generally above 99F)

Bilateral lower abdominal pain that is maximal in the region of the fallopian tubes
and generally lasts no longer than 14 days
Increased vaginal discharge
Irregular bleeding
Tenderness on cervical motion
Tender adnexal mass(es)
Purulent endocervical discharge
Nausea and vomiting

PELVIC INFLAMMATORY
DISEASE ( PID) (5)
PATHOLOGY
Inflammation of tubes, purulent discharge
Fibrin coating, adhesion to surrounding
organs
Pelvic peritonitis, pyosalpinx ,
TUBO-OVARIAN ABSCESS

PELVIC INFLAMMATORY DISEASE (

PID) (6)
DIAGNOSIS
ACUTE PID - D.Dx :Acute appendicitis
ectopic pregnancy
septic abortion etc.
CHRONIC PID - D.Dx :Chronic appendicitis or
abscess
endometriosis
torsion of ovary

http://www.pathologyoutlines.com/topic/ovarynontumorabscess.html

http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/Problems/PID.htm

PELVIC INFLAMMATORY
DISEASE ( PID) (7)
COMPLICATION
1. Tubo-ovarian abscess
2. Ectopic pregnancy 6-10 times
3. Infertility
4. Chronic abdominal pain
5. Fitz-Hugh-Curtis syndrome