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GAYATHRI KUMBALATARA
MEDICAL OFFICER LAB NATIONAL REFERENCE LAB STD & HIV
genital ulcer
SYPHILIS
Caused by
Treponema pallidum
subspecies pallidum
a spirochaete
can not be cultured in artificial media or on tissue culture not easily stained has characteristic movements can survive in blood at 2-6 0c for 48 to 72 hours
LABORATORY TESTS
Demonstration of pathogen (only when lesions are present) -Dark ground microscopy -Direct fluorescent antibody test (DFA-TP) specimen- tissue fluid from primary chancre, IIry syphilis and early congenital syphilis Serological tests ( STS) -Nonspecific nontreponemal Ab test -Specific treponemal Ab test
N0N SPECIFIC TESTS Ag - cardiolipin Ab - antilipoidal Commonly used tests :These tests are used :VDRL , RPR
as screening tests to monitor disease activity to monitor response to therapy Test principle :- floccular type agglutination qualitative and quantitative assessment Biological false positive :acute chronic viral infections auto immune diseases immunizations pregnancy
SPECIFIC TESTS Ag - T . pallidum Ab - antitreponemal Commonly used tests :- TPHA( T.pallidum haemagglutination) FTA-Abs (Fluorescent treponemal antibody absorption test) FTA-Abs IgM These tests are used
Test principle :-
:-
RECENT ADVANCES :-
GENITAL HERPES Caused by Herpes simplex virus type 2 (HSV 2) (rarely by type 1 )
Clinical manifestation shallow painful ulcers complications Lab tests : Direct detection - smear for giant cells antigen detection by ELISA electron microscopy PCR Culture - tissue culture Detection of antibodies - ELISA,IFA,RPHA
CHANCROID Caused by
Haemophilus ducreyi
GRANULOMA INGUINALE Caused by - Calymmatobacterium granulomatis Clinical manifestations deep ulcer specimen biopsy from base or edge of ulcer Lab tests : -
Histology Crushed smear stain with Giemsa or Leishman stain Donovan bodies short, pink, bipolar, encapsulated rods lying in vacuoles of mononuclear cell
LYMPHOGRANULOMA VENERUM
Caused by Chlamydia trachomatis serovars L1-L3 Clinical manifestations - papule -> ulcer , lymphangitis, lymphadenitis,fistulas,strictures Specimen infected tissue and pus from bubo Lab tests : Culture Antigen detection Serology DNA probes
vaginal discharge
vaginitis -
cervicitis -
urethral discharge
TRICHOMONIASIS Caused by Trichomonas vaginalis Clinical manifestations mild urethritis in men vulvo-vaginitis Specimen vaginal swab Lab tests : Wet smear motile flagellated protozoa Dry smear Leishman stain Culture
CANDIDIASIS
Caused by - Candida albicans
Clinical manifestations- vulvo-vaginitis balanitis Specimen vaginal swab Lab tests : wet mount with 10% KOH Gram stain Culture
BACTERIAL VAGINOSIS
Caused by Gardnerella vaginalis
Lab tests : vaginal pH > 4.5 amine (Whiff) test presence of clue cells absence of Lactobcilli Culture
vaginal discharge
vaginitis cervicitis -
urethral discharge
Local complications Salphingitis, Epidymitis, Bartholin Abscess, Penile Oedema, Peri Urethral Abscess
DGI
GONORRHOEA
Caused by Neisseria gonorrhoeae
Clinical manifestations urethritis cervicitis vulvo-vaginitis ophthalmia neonatorum rectal gonorrhoea pharyngeal gonorrhoea
Specimen urethral or cervical swab ( preparation of smears and inoculation of cultures best done at bed side )
Lab tests :-
Culture - on Thayer Martin medium New York City medium etc. transport in Amies transport medium -further identification by biochemicals
Antibiotic susceptibility testing - Disk diffusion test - Beta lactamase test - Minimum inhibitory concentration (MIC)
CHLAMYDIA
Caused by Chlamydia trachomatis serovar D - K
Clinical manifestations non gonococcal urethritis post gonococcal urethritis (15-30%) epididymo-orchitis cervicitis endometritis salpingitis pelvic inflammatory disease ophthalmia neonatorum
Specimen - urethral, cervical or eye swab first voided urine
Lab tests Gram stain of urethral swab , > 5 PMNL/ 1000 x - or early morning smear : EMS - or sediment of first voided urine with >15 PMNL/ 400 x Culture most sensitive and specific - tissue culture on McCoy cell line Detection of Antigen - ELISA - Direct immunofluorescence - PCR Serology is not usually used