Condyloma Acuminatum (Genital Warts)
Caused by Human Papillomavirus (HPV).
Exophytic, cauliflower-like lesions.
Typically found on moist surfaces: perianal area, vaginal introitus, vagina,
labia, and vulva.
labia, and vulva.
Can also occur on dry surfaces like the shaft of the penis.
Condyloma lata: Flat papules of secondary syphilis, painless ulcers.
Chancroid: Caused by Haemophilus ducreyi, characterized by painful ulcers.
Curable Non-Ulcerative STDs
Gonorrhea
Chlamydia
Trichomoniasis
Vaginitis
Most common cause: Candida.
Second most common cause: Trichomonas vaginalis.
Vulvar Intraepithelial Disease/Pre-malignant Lesion
Paget’s Disease.
Most common lesion of the vulva: Condyloma acuminata (Genital warts).
Bartholin Cyst
Results from obstruction of the Bartholin duct.
Soft, painless mass.
Most commonly infected by Gonorrhea, less commonly by Staphylococcus aureus.
Infected cyst is called Bartholin abscess, which is painful.
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Bacterial Vaginosis vs. Trichomonas Vaginalis
Bacterial Vaginosis
Clue cells and fishy smell, painless.
Thin, grayish-white discharge, often fishy-smelling after sexual intercourse.
Amsel’s Criteria (requires at least 3 out of 4):
Thin, homogeneous discharge coating the vaginal walls.
Clue cells on microscopy (vaginal epithelial cells covered with bacteria).
Vaginal pH > 4.5.
Positive “whiff test” (fishy odor when 10% KOH is added).
Nugent scoring (Gram stain-based scoring system) for a definitive diagnosis.
Can cause early miscarriage and pre-term birth (most common cause).
Trichomonas Vaginalis
Microscopic examination: Wet mount reveals motile T. vaginalis (pear-shaped
with flagella).
with flagella).
NAAT (Nucleic Acid Amplification Test) for high sensitivity and specificity.
Per speculum: Erythematous plaques, punctate “strawberry cervix.”
Normal pH.
Symptoms: Pain during intercourse, burning sensation, itching.
Offensive, foul-smelling, green/gray/pink frothy, yellow vaginal discharge.
Treat with Metronidazole for both partners.
Can cause pregnancy complications, including low birth weight and premature
rupture of membranes.
rupture of membranes.
| Feature | Bacterial Vaginosis | Trichomonas Vaginalis |
|---|---|---|
| Cause | Overgrowth of anaerobic bacteria | Trichomonas vaginalis (protozoan parasite) |
| Discharge Characteristics | Thin, grayish-white, homogeneous, fishy odor | Green, gray, pink frothy, yellow discharge |
| Pain/Itching | Painless | Painful intercourse, burning sensation, itching |
| Microscopic Findings | Clue cells (vaginal epithelial cells covered with bacteria) | Motile pear-shaped organisms with flagella |
| pH | > 4.5 | Normal pH |
| Diagnostic Test | Amsel’s criteria, Nugent scoring (Gram stain) | NAAT (Nucleic Acid Amplification Test), Wet mount microscopy |
| Treatment | Metronidazole or Clindamycin | Metronidazole (both partners) |
| Impact on Pregnancy | Can cause early miscarriage and pre-term birth | Low birth weight, premature rupture of membranes |
