Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
 Home | Pathology Group MembersOur Hospital  Search This Website:
        Vulvar & Perineal Lesions, Biopsy & Lab Testing
      
Sexually Transmitted Disease Lesions:
Especially when faced with the patient who has a genital/perineal "sore" that is painful and circumstances are suboptimal for biopsy and/or cytology "scapings", there are serological means that might make a diagnosis from the serum in a single "red top tube" blood specimen. Remember that STDs are not infrequently present as mixes of several STD organisms. In addition to the below info, check the specific disease info sheet pages at the CDC website and/or major reference lab websites. By a brief telephone call wiith your local pathologist, you may be able to submit smears, PCR swabs, culture specimen, serum, & a shave biopsy and ask for him/her to help progressively & cost effectively apply just the tests needed to clinch or rule out a diagnosis. Some of the below are NOT STDs but are in the STD diferential diagnosis (DDX).
<
 DXable from serum? DXable from cytology? DXable from biopsy? DXable from other means?
herpes , ulcer yes: serology & PCR Tzank prep or DIF smear yes  
syphilis
(painless ulcer...chancre)
yes: RPR & FTA-abs no yes, may be difficult yes but dark field wet prep not worth the effort
chancroid, ulcer (Haemophilus ducreyi) yes: PCR Gram stain: gn cocco-bacilli bubo groin node  
LGV (lymphogranuloma venereum...due to some serovars L1, L2, & L3 of Chlamydia trachomatis & primary lesion is painless herpetiform ulcer) yes: serology & PCR of smears or active tissue placed in M4 or M5 Mayo Clinic transport media usually not

(1) secondary stage groin node bubo = can bracket into "likely".

(2) tertiary stage proctitis.

 

granuloma inguinale (ulcer)

(Calymmatobacterium granulomatosis)

(only 100 reported cases per year in USA)

  Gram stain: gn pleomorphic bacillus by smearing fresh cut surface of BX of ulcer edge, crush prep of biopsy portion, or swab smear of surface onto glass slide and stain with Wright's or Giemsa...see the small straight or curved pleomorphic bacilli with rounded ends and polar granules..."safety pin". When many are in a macrophage, the composite cell is a Donovan body. no node enlargement due to C. gran. but may get due to super-infection of other bacteria
Neisseria gonorrhea (exudate)   Gram stain: gn intracellular diplococcus swab PCR; culture  
Chlamydia     swab or tissue or saline washings PCR as with LGV  
herpes (HSV I & II) yes... HERE   yes and/or swab PCR Tzank & DFA smears & culture
HPV, trichomonas, bacterial vaginosis     liquid-based Pap smear sample  
HIV genital ulcer yes      
Behcet's (not an STD)        
cancer (not an STD)        
mono (EBV) ulcer3 (not an STD) yes   swab PCR; culture  
CMV ulcer 3(not an STD) yes   swab PCR; culture  
Brucellosis ulcer 3(not an STD)        
other primary infectious organism associated ulcers3 (typhoid, etc.) (not an STD)        
Lipschtz ulcer of teens & young women3 (not an STD) no   no  
caustic causes3 (not an STD)        
dermatoses causes3 (fixed drug, EM, Stevens-Johnson syndrome, inflammatory bowel disease, aphtosis) (not an STD)     yes; maybe even skin DIF battery  

References:

  1. Specialty Labs website.
  2. eMedicine website, by topic via Google.
  3. European J.

(posted 3 August 2005; latest update 27 July 2008)

 
© Copyright 1999 - 2006, all rights reserved, Pathology Associates Of Lexington, P.A.