Diagnostic tests NAAT, culture (using Thayer-Martin selective media) NAAT hpf, High-powered field; NAAT, nucleic acid amplification test; PID, pelvic inflammatory disease; PMN, polymorphonuclear cells. *Coinfection is common, and clinical presentations have significant overlap.
Table 116-2 Features of Sexually Transmitted Infections Characterized by Genital Ulcers SYPHILIS GENITAL HERPES CHANCROID GRANULOMA INGUINALE (DONOVANOSIS) Agent Treponema pallidum HSV-1, HSV-2 Haemophilus ducreyi Klebsiella granulomatis
Primary lesion Papule Vesicle Papule to pustule Papule
Number >1 Multiple <3 >1, may coalesce
Edges Distinct Reddened, ragged Ragged, undermined Rolled, distinct
Base Red, smooth Red, smooth Necrotic Beefy red, clean
Secretion Serous Serous Pus, blood None
Isolation No in vitro test; rabbit Culture Aspirate of node, swab of None inoculation
Treatment Early: Benzathine penicillin G Acyclovir or famciclovir or Aspirate fluctuant nodes Doxycycline or TMP-SMX (2.4 million U IM) once valacyclovir
Late (>1 yr duration):
Incision and drainage Benzathine penicillin G (2.4
FTA-ABS, Fluorescent treponemal antibody-absorption; HSV, herpes simplex virus; MHA-TP, microhemagglutination assay-Treponema pallidum; PCR, polymerase chain reaction; RPR, rapid plasma reagin; TMP-SMX, trimethoprim-sulfamethoxazole; VDRL, Venereal Disease Research Laboratory.
Table 116-3 Features of Sexually Transmitted Infections Characterized by Vaginal Discharge FEATURE PHYSIOLOGIC LEUKORRHEA (NORMAL) TRICHOMONIASIS BACTERIAL VAGINOSIS (GARDNERELLA VAGINALIS-ASSOCIATED VAGINITIS) Agent Normal flora Trichomonas vaginalis G. vaginalis and anaerobes
Pruritus None Mild to moderate None to mild
Discharge Minimal Moderate to severe Mild to moderate
Characteristics of discharge
Color Clear, milky Yellow-green or grey Grey
Odor with None Possible Characteristic fishy odor pH <4.5 >5.0 >4.5
Saline drop Squamous and few WBCs WBC; Motile flagellates, slightly Squamous cells studded with larger than WBCs bacteria (“clue cells”) and WBCs
Treatment Reassurance Metronidazole or tinidazole Metronidazole, tinidazole, or clindamycin
KOH, Potassium hydroxide; WBCs, white blood cells.
Presenting complaints Genital warts are seen or felt Vulvar itching or discharge Pubic itching; live organisms may be seen; sexual partner has “crabs”
Clinical associations Cervical neoplasia, dysplasia Oral contraceptives, diabetes, — antibiotics
Treatment Patient-applied therapies: Podofilox solution Intravaginal agents: butoconazole Permethrin 1% cream or gel or Imiquimod cream or clotrimazole or miconazole
KOH, Potassium hydroxide.
for preventing medical complications and infertility. All STIs are preventable; primary prevention of STIs should be a goal for all health care providers for adolescents. Diagnosis of an STI necessitates evaluation or treatment for concomitant STIs, notification and treatment of sexual partners, and some are reportable to state health departments.