Sexually Transmitted Diseases (STDs)

Abnormal looking cervix can be seen commonly in gynecology in day to day practice. It becomes necessary to differentiate between normal physiological changes brought by normal menstrual cycle from the anatomical and pathological disorders. Colposcopic examination of cervix with a stereoscopic binocular magnifying glasses is extremely helpful for identification of the possible etiology behind and exclusion of any cancerous growth to establish the diagnosis. The etiologic reasons of abnormal cervix can be physiological, infectious, abnormal growth and iatrogenic. This article provides a step-by-step approach to differentiating them.

Treponema pallidum is member of family Spirochaetaceae. They are Gram negative bacteria, but some regard them too thin to be Gram stained. It is a delicate, tightly spiraled, motile spirochete having tapered ends. It is microaerophilic bacteria that cannot be grown on standard culture media. These microbes are poorly stained, so not detected by conventional light microscopy.

In 1889, Auguste Ducrey at the University of Naples published his research about the causing agent of chancroid associated with the presence of genital ulcers, Haemophilus ducreyi, which is a gram-negative bacillus, was named after the scientist.  Chancroid is a highly contagious sexually transmitted disease (STD) presenting with extremely painful genital ulcers accompanied by enlarged inguinal lymph nodes (buboes). 

In 1955, a cause of nonspecific vaginitis (bacterial vaginosis) was described by two scientists: Gardner and Dukes. The bug was named Haemophilus vaginalis, later the name was changed to Corynebacterium vaginale, and finally, the bacterium responsible for the condition obtained the name Gardnerella vaginalis (1980) after the scientist who discovered it. Gardnerella vaginosisis a non-specific infection of the vaginal tract caused by gram negative bacteria named as Gardnerella vaginalis. This condition is not regarded as sexually transmitted disease, but sexual activity enhances the development of the infection.

The causative factor of syphilis is Treponema pallidum (TP), family motile Spirochaetaceae, which is very common all over the world. TP can be transmitted via close sexual contact or transplacentally (vertical way). Also, syphilis can be acquired or congenital, both of them having early and late stages. TP invades the host body through the breaches in the squamous or columnar epithelium affecting lymphatic nodes and disseminates with the blood stream to all parts of the body.

Candidiasis is an opportunistic fungal infection that can affect the gastrointestinal tract, skin, or be systemic in immunocompromised patients. Clinical presentation is different from one patient to another and is dependent on the severity of immunosuppression and the anatomical site of the infection. Patients with candidiasis need topical antifungals for localized disease and systemic antifungals for esophagitis and systemic candidiasis. The important distinction between patients with neutropenia and without neutropenia can affect the choice of antifungals in systemic candidiasis.

Pelvic inflammatory disease is infectious in etiology and is closely linked to sexually transmitted disease. Pelvic inflammatory disease is common in the United States with an estimated incidence of 2.5 million. The condition can be diagnosed clinically, with lower abdominal pain, cervical motion tenderness, an elevated erythrocyte sedimentation rate and fever. Once diagnosed, the patient should be put on empirical antibiotic therapy that should cover gonorrhea, chlamydia, gram-negative organisms and anaerobes. Patients with complications, such as abscess formation or sepsis, might benefit from laparoscopic surgery.

Herpes simplex virus infections are caused by either herpes simplex virus type 1 or 2. Type 1 viruses are more commonly associated with non-genital herpes, while type 2 viruses are more likely to be responsible for genital herpes diseases. The most common presenting sign is ulcers. While the healing process is usually excellent and subsequent scarring is very rare, topical and systemic antiviral therapy might be indicated to fasten the healing process, or prevent complications in the immunosuppressed.