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Bhutani’s Color Atlas of Sexually Transmitted Infections
Neena Khanna, Sushruta Kathuria
SECTION 1: EPIDEMIOLOGY
CHAPTER 1:
Epidemiology of Sexually Transmitted Infections
DEFINITIONS
Sexually Transmitted Infections (STIs)
Sexually Transmitted Diseases (STDs)
Epidemiology
Incidence
Prevalence
Point Prevalence
Period Prevalence
Person-Years
GLOBAL INCIDENCE AND PREVALENCEOF STIS
SCENARIO IN INDIA
STI SYNDROMES
SECTION 2: BACTERIAL SEXUALLY TRANSMITTED INFECTIONS
CHAPTER 2:
Syphilis
ETIOLOGY
Etiological Agent
Transmission
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
CLINICAL FEATURES
Incubation Period
Stages
Primary Syphilis
Chancre
Lymphadenopathy
Secondary Stage
Cutaneous lesions
Mucosal lesions
Hair
Lymphadenopathy
Systemic involvement
Latent syphilis
Tertiary Syphilis
Benign tertiary syphilis
Neurosyphilis
Cardiovascular syphilis
Congenital Syphilis (Prenatal Syphilis)
Clinical features
HIV AND SYPHILIS
DIAGNOSTIC TESTS
Detection of T. pallidum
Serological Tests for Syphilis (STS)
Biopsy
CSF Evaluation
DIAGNOSTIC ALGORITHMS
Primary Syphilis
Secondary Syphilis
Latent Syphilis
Tertiary Syphilis
In HIV-infected
Neurosyphilis
Congenital Syphilis
In mother
In Neonate
TREATMENT
Early Syphilis
Late Syphilis
Latent syphilis
Late syphilis without CNS involvement
Neurosyphilis
Syphilis in Pregnancy
Syphilis in HIV Positive Patients
Jarisch-Herxheimer Reaction (JHR)
SURVEILLANCE/FOLLOW-UP
Follow-up in Early Syphilis
Follow-up in Late Syphilis
Retreatment
Management of Sex Partners
CHAPTER 3:
Chancroid
ETIOLOGY
Etiological Agent
Transmission
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
CLINICAL FEATURES
Incubation Period
Morphology
Sites
Lymphadenopathy
Variants
COMPLICATIONS
HIV AND CHANCROID
DIAGNOSIS
Based on Clinical Features
Laboratory Investigations
Isolation and Identification of Organism
Other Tests
TREATMENT
Specific Treatment
General Measures
Partner Management
Pregnant Woman
In HIV Infected
Follow-up
Other Considerations
CHAPTER 4:
Lymphogranuloma Venereum
ETIOLOGY
Etiological Agent
Transmission
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
CLINICAL FEATURES
Incubation Period
Morphology
Primary Stage
Secondary Stage (Inguinal Syndrome)
Tertiary Stage (Genito-Ano-Rectal Syndrome)
Skin Findings Associated with LGV
COMPLICATIONS
Of Secondary Stage
Of Tertiary Stage
HIV AND LGV
DIAGNOSIS
Based on Clinical Features
Laboratory Investigations
Isolation and Identification of Organism
Serological Tests
Others
TREATMENT
Specific Treatment
General Measures
Partner Management
Pregnant Woman
In HIV Infected
Follow-up
Other Considerations
CHAPTER 5:
Donovanosis
ETIOLOGY
Etiological Agent
Transmission
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
CLINICAL FEATURES
Incubation Period
Morphology
Sites of Lesions
Variants
COMPLICATIONS
HIV AND DONOVANOSIS
DIAGNOSIS
Based on Clinical Features
Laboratory Investigations
Isolation and Identification of Organism
Others
TREATMENT
Specific Treatment
Partner Management
Pregnant Woman
Follow-up
Other Considerations
CHAPTER 6:
Gonorrhoea
ETIOLOGY
Etiological Agent
Transmission
EPIDEMIOLOGY
CLINICAL FEATURES
Incubation Period
Signs and Symptoms in Males
Signs and Symptoms in Females
Oropharyngeal Infection
Gonococcal Conjunctivitis
COMPLICATIONS
DIAGNOSIS
Based on Clinical Features
Lab Investigations
Demonstration of organism
Serology
TREATMENT
Specific Treatment
Special Situations
Partner Management
Pregnant Woman
In HIV Infected
Follow-up
Other considerations
CHAPTER 7:
Non-Gonococcal Urethritis and Genital Tract Infections
DEFINITIONS
ETIOLOGY
Etiological Agents
Transmission
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
CLINICAL FEATURES
Incubation Period
Signs and Symptoms in Males
Signs and Symptoms in Females
Nongonococcal Conjunctivitis
COMPLICATIONS
HIV AND NONGONOCOCCAL GENITAL TRACT INFECTIONS (NGGTI)
DIAGNOSIS
Based on Clinical Features
Laboratory Investigations
For chlamydial infection
For mycoplasma and ureaplasma infections
For T.vaginalis
TREATMENT
SEXUALLY ACQUIRED REACTIVE ARTHRITIS
Epidemiology
Geographic distribution
Demographic distribution
Etiology
CLINICAL FEATURES
Incubation Period
Manifestations
COMPLICATIONS
DIAGNOSIS
Based on Clinical Features
Laboratory Investigations
TREATMENT
SECTION 3: VIRAL SEXUALLY TRANSMITTED INFECTIONS
CHAPTER 8:
Genital Herpes
ETIOLOGY
Etiological Agent
Transmission
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
CLINICAL FEATURES
Incubation Period
Classification
Morphology
Primary GH
First episode GH
Recurrent GH
Sites of Lesions
Variants
COMPLICATIONS
GENITAL HERPES AND HIV
DIAGNOSIS
Based on Clinical Features
Laboratory Investigations
Demonstration of organism
Serology
Biopsy
TREATMENT
Counseling
Specific Treatment
First episode of GH
Recurrent GH
GH in HIV Infection
Episodic therapy
Suppressive therapy
Acyclovir Resistance
GH in Pregnancy
Prevention of neonatal herpes
Treatment in pregnancy
OTHER TREATMENT CONSIDERATIONS
Partner Management
Other Considerations
CHAPTER 9:
Anogenital Warts
ETIOLOGY
Etiological Agent
Transmission
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
CLINICAL FEATURES
Incubation Period
Symptoms
Morphology
Sites of Lesions
COMPLICATIONS
ANOGENITAL WARTS AND HIV
DIAGNOSIS
Based on Clinical Features
Laboratory Investigations
Biopsy
Other tests
TREATMENT
Counseling
Treatments Available
Topical applications
Physical modalities
Cryotherapy
Surgical therapy
Radiofrequency ablation
Treatment Protocols for Special Sites
Cervical warts
Vaginal warts
Meatal warts
Anal warts
Vaccines
CHAPTER 10:
Genital Molluscum Contagiosum
ETIOLOGY
Etiological Agent
Transmission
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
CLINICAL FEATURES
Incubation Period
Morphology
Sites of Lesions
Variants
COMPLICATIONS
MOLLUSCUM CONTAGIOSUM IN HIV
DIAGNOSIS
Based on Clinical Features
Laboratory Investigations
TREATMENT
Other Treatment Considerations
CHAPTER 11:
Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
ETIOLOGY
Etiological Agent
Transmission
Pathogenesis
HIV replication cycle
Host's response
CLINICAL FEATURES
Course
Stages of Disease
Cutaneous Manifestations
Infections
Bacterial infections
Fungal infections
Non-infectious cutaneous manifestations
Others
HIV and STIs
DIAGNOSIS
Tests for Diagnosis of HIV infection
Serological tests
Virological tests
Viral culture
Other Tests
TREATMENT
Counseling
Antiretroviral therapy
Antiretroviral drugs
Indications
Drug Regimens
Monitoring of HAART
Drugs for Opportunistic Infections
SECTION 4: MISCELLANEOUS
CHAPTER 12:
Balanitis and Balanoposthitis
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
ETIOLOGY
Etiological Agents
Predisposing Factors
CLINICAL FEATURES
Symptoms
Signs
COMPLICATIONS
INVESTIGATIONS
Identification of Pathogen
Skin Biopsy
TREATMENT
SPECIFIC DISEASES
Candidal Balanoposthitis
Zoon's Balanitis
Circinate Balanitis
CHAPTER 13:
Vaginal Discharge
EPIDEMIOLOGY
Geographic Distribution
Demographic Distribution
ETIOLOGY
CLINICAL FEATURES
History
Examination
Features of Individual Infections
Gonococcal cervicitis
Chlamydial cervicitis
Candidal vulvovaginitis
Trichomonas vaginitis
Bacterial vaginosis
HIV AND PATHOGENS OF VAGINITIS
COMPLICATIONS
DIAGNOSIS
Based on Clinical Features
Laboratory Investigations (Table 13.2)
For diagnosis of cervicitis
For chlamydial cervicitis
For gonococcal infections
For mycoplasma and ureaplasma
For T. vaginalis
For candida
For bacterial vaginosis
TREATMENT (TABLE 13.3)
Management of Sex Partners
CHAPTER 14:
Sexually Transmitted Infestations
PEDICULOSIS PUBIS
Epidemiology
Geographic distribution
Demographic distribution
Etiology
Etiological agent
Transmission
Clinical Features
Manifestations
Complications
Diagnosis
Based on clinical features
Laboratory Investigations
Treatment
SCABIES
Epidemiology
Geographic distribution
Demographic distribution
Etiology
Etiological agent
Transmission
Clinical Features
Incubation period
History
Morphology
Sites of lesions
Variants
Complications
Scabies and HIV
Diagnosis
Based on clinical features
Laboratory investigations
Treatment (Table 14.1)
Antiscabicidal drugs
Applications
OTHER MEASURES
CHAPTER 15:
Non-venereal Genital Conditions
ECTOPIC SEBACEOUS GLANDS
Etiology
Clinical Features
Morphology
Sites
Treatment
PEARLY PENILE PAPULES
Clinical Features
Morphology
Sites
Treatment
LICHEN SCLEROSUS (LS)
Epidemiology
Etiology
Clinical Features
Symptoms
Morphology
Sites of lesions
Complications
Diagnosis
Based on clinical features
Laboratory investigations
Treatment
Topical therapy
Physical modalities
ZOON'S BALANITIS
PAPULONECROTIC TUBERCULIDE OF GENITALIA
Epidemiology
Pathogenesis
Clinical Features
Morphology
Diagnosis
Diagnostic criteria
Treatment
PSEUDOEPITHELIOMATOUS KERATOTIC AND MICACEOUS BALANITIS
Epidemiology
Etiology
Clinical Features
Histopathology
Treatment
PSORIASIS
Morphology
Sites
Treatment
LICHEN PLANUS
Morphology
Sites
Treatment
CHAPTER 16:
Premalignant and Malignant Lesions of Genitals
SQUAMOUS CELL CARCINOMA IN SITU
Nomenclature
Epidemiology
Etiology
Predisposing factors include
Clinical Features
Bowenoid papulosis
Erythroplasia of Queyrat
Bowen's disease
Complications
Malignant transformation
Diagnosis
Histopathology
Treatment
SQUAMOUS CELL CARCINOMA
Epidemiology
Etiology
Clinical features
Morphology
Sites of lesions
Complications
Diagnosis
Histopathology
Treatment
CHAPTER 17:
Sexually Transmitted Infestations
GENITAL HERPES (GH)
Interaction of GH and Pregnancy
Effect of GH on Pregnancy
Effect of Pregnancy on GH
Treatment
ANOGENITAL WARTS (AGW)
Interaction of AGW and Pregnancy
Effect of AGW on Pregnancy
Effect of pregnancy on AGW
Treatment
SYPHILIS
Interaction of Syphilis and Pregnancy
Effect of syphilis on pregnancy
Effect of pregnancy on syphilis
Treatment
Of pregnant women
Of newborn
CHANCROID
Interaction of Chancroid and Pregnancy
Effect of chancroid on pregnancy
Effect of pregnancy on chancroid
Treatment
DONOVANOSIS
Interaction of Donovanosis and Pregnancy
Effect of donovanosis on pregnancy
Effect of pregnancy on donovanosis
Treatment
LYMPHOGRANULOMA VENEREUM (LGV)
Interaction of LGV and Pregnancy
Effect of LGV on pregnancy
Effect of pregnancy on LGV
Treatment
GONORRHOEA
Interaction of Gonorrhoea and Pregnancy
Effect of gonorrhoea on pregnancy
Effect of pregnancy on gonorrhoea
Treatment
UREAPLASMA AND MYCOPLASMA
Effect of Ureaplasma and Mycoplasma on Pregnancy
BACTERIAL VAGINOSIS (BV)
Interaction of BV and Pregnancy
Effect of BV on pregnancy
Effect of pregnancy on BV
Treatment
TRICHOMONIASIS
Interaction of Trichomoniasis and Pregnancy
Effect of trichomoniasis on pregnancy
Effect of pregnancy on trichomoniasis
Treatment
VULVOVAGINAL CANDIDIASIS (VVC)
Interaction of VVC and Pregnancy
Effect of VVC on Pregnancy
Effect of Pregnancy on VVC
Treatment
CHAPTER 18:
Sexually Transmitted Infections in Adolescents
EPIDEMIOLOGY
Prevalence
Predisposing Factors
MANAGEMENT OF STIS IN ADOLESCENCE
PREVENTION
GUIDELINES FOR SCREENING
SECTION 5: ANNEXURES
ANNEXURE 1:
Relevant Anatomy of Male Genital Tract
PENIS
URETHRA
SCROTUM AND CONTENTS
Scrotum
Testes
Epididymis
GLANDS
LYMPHATIC DRAINAGE
ANNEXURE 2:
Relevant Anatomy of Female Genital Tract
VULVA
INTERNAL STRUCTURES
Vagina
Cervix
GLANDS
ANNEXURE 3:
STI Syndromes
INDEX
TOC
Index
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