Sexually Transmissible Infections in Clinical Practice (eBook)

Foreword 4
Preface 5
Acknowledgments 7
Contents 8
Section A 16
1 A Man Requesting a Sexual Health Screen 17
What History Would You Obtain from Robert? 17
Outline the Physical Examination You Would Perform and Indicate Which Microbiological Tests You Would Undertake in This Case 20
2 A Woman Requesting a Sexual Health Screen 26
What History Would You Obtain from Mary? 26
Outline the Physical Examination You Would Perform and Indicate Which Microbiological Tests You Would Undertake in This Case 28
3 A Female Sex Industry Worker Requesting a Sexual Health Screen 33
What Tests Would You Undertake Now, and Against Which Infection Might You Consider Vaccinating Her? 33
4 A Gay Man Requesting a Sexual Health Screen 38
What History Would You Obtain from James? 38
Outline the Physical Examination You Would Perform and Indicate Which Microbiological Tests You Would Undertake in This Case 39
How Do You Interpret the Hepatitis A and B Serology Results? 43
5 A Man with Urethral Discharge (1) 45
What Additional History Would You Elicit? 45
What Do You Do Next? 45
Peter Attends the Clinic. What Do You, as a Sexual Health Specialist Do Next? 46
What Investigations Would You Undertake? 46
What is the Probable Diagnosis, and What is the Most Likely Causative Organism? 47
What Is Your Next Step in Management? 49
You Opt to Give Him a Single Oral Dose of Azithromycin. What Else Do You Do? 50
Would You Offer a Test of Cure? 51
What Are the Complications of Untreated Urethral Chlamydial Infection in a Man? 51
6 A Female Contact of a Man with Presumed Non-gonococcal Urethritis 52
What Is the Natural History of Chlamydial Infection in Women in a Woman? 54
What Is Your Immediate Management of This Case? 54
What Action Would You Take With Respect to Her Ex-boyfriend? 55
Under These Circumstances, What Possible Action can be Taken? 56
7 Urethral Discharge (2) 58
How Would You Manage His Case? 58
What Do You See, and What Is the Most Likely Diagnosis? 58
What Do You Do Next? 60
How Does This Knowledge Influence Your Management? 61
What Other Treatment Would You Consider? 63
What Else Would You Do? 63
What Advice Do You Give, and How Would You Persuade Him to Get His Wife to Attend the Clinic? 64
What Is Your Next Course of Action? 64
Is a Test of Cure Indicated? 65
What Are the Complications of Untreated Urethral Gonorrhoea in a Man? 65
8 A Female Contact of a Man with Gonorrhoea 67
What Tests Would You Undertake to Diagnose or Exclude Infection With Neisseria Gonorrhoeae? 67
What Do You Do? 67
How Would You Manage Her Case? 69
What Would You Do Next? 70
What Do You Do Next? 70
What Are the Complications of Untreated Gonorrhoea in a Woman? 71
9 A Woman wih Increased Vaginal Discharge (1) 72
What Points in the History Would You Wish to Elicit? 72
What is the Most Likely Diagnosis? 73
Is Bacterial Vaginosis Still the Most Likely Diagnosis? 74
If You Wished to Clinch the Diagnosis, What Bedside Tests Might You Undertake? 74
What Would You Expect to See If You Examined Microscopically a Gram-stained Smear of the Discharge? 75
How Would You Manage Your Patient with Bacterial Vaginosis? 75
How Would You Manage Her Sexual Partner? 76
10 Vaginal Discharge (2) 78
What Conditions Would You Consider in the Differential Diagnosis? 78
What Investigations Would You Undertake? 79
What Treatment Would You Provide, and What Follow-Up Would You Offer? 80
What Are the Clinical Features of Trichomoniasis in Men, and How Is the Condition Diagnosed? 82
11 Pruritus Vulvae 84
What is the Most Likely Diagnosis? 84
What Treatment Do You Offer? 84
What Conditions May Pre-dispose to Acute Vulvovaginal Candidiasis? 86
12 A Man with a Red, Itchy Penis 88
What Is This Condition, and What Are Possible Causes? 88
What Investigations Would You Undertake in This Case? 90
How Would You Treat This Patient, and How Would You Manage the Other Causes of Irritant or Infective Balanoposthitis? 91
13 A Man with Scrotal Pain 92
What Are the Causes of Acute Scrotal Pain? 92
What Is the Most Likely Diagnosis? 92
What Are the Causes of Acute Epididymo-Orchitis? 93
If There had been no Significant Improvement at This Time, What Conditions Would You Then Consider? 96
14 A Young Woman with Abdominal Pain (1) 98
What Conditions Do You Consider in the Differential Diagnosis? 98
What Are the Most Likely Diagnoses? 99
What Is Your Next Course of Action? 100
15 A Young Woman with Genital Lumps 103
What Conditions Would You Consider in the Differential Diagnosis? 103
What Information Do You Provide? 105
How Would You Manage the Warts in This Case? 105
What Is Your Further Management? 108
What Is Her Risk of Infecting Him, and Will Condom Use Prevent Transmission of HPV? 109
16 A Young Woman with Genital Ulceration 112
What Is the Most Likely Diagnosis? 112
Do These Findings Confirm the Diagnosis of Primary Genital Herpes? 113
What Is Your Immediate Management of Your Patient? 116
17 A Woman with Recurrent Genital Herpes 120
What Management Options Are Available for the Treatment of Recurrent Genital Herpes? 120
What Steps Can Be Taken to Prevent Transmission of Infection to William? 123
What Advice Would You Give Now? 124
18 A Gay Man with a Genital Ulcer 126
What Further History Would You Wish to Elicit? 126
What Do You Do Next? 127
What Is the Most Likely Diagnosis? 128
How Would You Confirm the Diagnosis? 129
What Is the Antimicrobial Agent of Choice, How Would You Administer It, and What Possible Reaction to Treatment Would You Warn Him of? 130
What Else Would You Do? 131
What Is the Natural History of Untreated Early Syphilis? 132
19 An African Man with a Skin Rash 133
20 A Gay Man with Anal Discharge 139
What Is the Most Likely Cause of His Symptoms, and What Are Possible Causes? 139
What Is Your Immediate Management? 140
21 A Gay Man with a Rash, Lymphadenopathy,and Fever 143
What Conditions Might Cause These Symptoms? 143
Has the Physical Examination Help in the Differential Diagnosis? 146
How Would You Interpret These Laboratory Findings? 146
Section B 149
22 A Young Man with Persistent Urethral Symptoms 150
How Would You Account for the Recurrence of His Presumed Urethritis? 150
How Would You Manage This Case? 151
What Would You Do Next? 152
What Do You Do Next? 152
23 A Man with Severe Dysuria 154
What Two Sexually Transmissible Infections Would You Consider as the Most Likely Cause of His Urethritis? 154
How Would You Manage This Case? 156
24 A Young Man with a Painful Swollen Knee Joint 157
What Sexually Transmissible Infections May Be Associated with Arthritis? 157
What Diagnoses Would You Consider? 158
How Do You Interpret These Laboratory Findings? 163
What Is the Most Likely Diagnosis and What Is the Initial Management? 164
Have These Further Results Aided in the Diagnosis? 165
What Is the Course of SARA? 166
25 A Woman with Recurrent Pruritus Vulvae 168
What Would You Do Next? 168
What Treatment Would You Offer Margaret? 171
26 A Woman with Pruritus Vulvae (2) 173
What Is the Most Likely Diagnosis, and What Is Your Immediate Management? 173
27 A Young Woman with Abdominal Pain 176
What Conditions Would You Consider as Causes of Her Abdominal Symptoms? 176
Do the Clinical and Laboratory Findings Aid the Differential Diagnosis? 177
28 Gonococcal and Chlamydial Infections in a Pregnant Woman 179
What Would Be Your Choice of Antimicrobial Agent(s) in This Case? 180
What Are the Risks of Untreated Gonococcal and Chlamydial Infections in Pregnant Women? 182
29 A Pregnant Woman with Genital Herpes 185
How Would You Manage This Case? 185
What Advice Would You Give? 187
30 A Pregnant Woman with Genital Warts 188
What Do You Tell Her? 188
31 A Gay Man with Diarrhea 192
What Sexually Transmissible Infections Would You Consider in the Differential Diagnosis? 192
Do the Clinical Findings Help Narrow the Differential Diagnosis? 194
How Do You Interpret the Results of the Parasitological Investigations? 195
How Would You Treat Samuel? 197
32 A Gay Man with Jaundice 199
What Conditions May Cause His Symptoms? 199
How Is Hepatitis B Transmitted? 201
What Clinical Features May Be Associated with Acute Hepatitis B Virus Infection? 202
Although Not the Causes of the Hepatitis in this Case, How are Hepatitis A, Cytomegalovirus and EpsteinBarr Virus Transmitted? 203
What Is the Course of Acute Hepatitis B, and How Would You Manage This Man? 204
How Do You Interpret These Results? 205
33 A Pregnant Woman Who is a Contact of a Man with Infectious Syphilis 206
What Are the Risks of Untreated Early Syphilis in a Pregnant Woman? 206
How Do You Interpret These Results? 207
How Would You Treat This Patient? 207
How Do You Interpret These Results, and How Would You Manage the Neonate? 208
34 An HIV-Infected Man with Anal Pain, Anal Discharge, and Bleeding 210
What Diagnoses Do You Consider? 211
How Do the Clinical Findings Aid the Differential Diagnosis? 212
What Is Your Immediate Management of This Case? 213
How Do You Interpret These Results? 213
35 A Young Girl with Anogenital Lumps 219
How Do You Explain the Presence of Anogenital Warts in a Pre-pubertal Child, and What History Would You Wish to Elicit from the Mother? 219
What Investigations Might You Consider in This Case, and with Which Agencies Might You Wish to Liase? 220
How Would You Treat These Warts? 222
Further Reading 224
Index 228