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| Vulvar & Perineal
Lesions, Biopsy & Lab Testing |
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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). |
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DXable from serum? |
DXable from cytology? |
DXable from biopsy? |
DXable from other means? |
| herpes , ulcer |
yes: serology & PCR |
Tzank prep or DIF smear |
yes |
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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 |
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| 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. |
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granuloma inguinale (ulcer)
(Calymmatobacterium granulomatosis)
(only 100 reported cases per year in USA) |
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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) |
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Gram stain: gn intracellular diplococcus |
swab PCR; culture |
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| Chlamydia |
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swab or tissue or saline washings PCR as with LGV |
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| herpes (HSV I & II) |
yes... HERE |
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yes and/or swab PCR |
Tzank & DFA smears & culture |
| HPV, trichomonas, bacterial vaginosis |
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liquid-based Pap smear sample |
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| HIV genital ulcer |
yes |
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| Behcet's (not an STD) |
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| cancer (not an STD) |
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| mono (EBV) ulcer3 (not an STD) |
yes |
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swab PCR; culture |
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| CMV ulcer 3(not an STD) |
yes |
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swab PCR; culture |
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| Brucellosis ulcer 3(not an STD) |
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| other primary infectious organism associated ulcers3 (typhoid, etc.) (not an STD) |
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| Lipschtz ulcer of teens & young women3 (not an STD) |
no |
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no |
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| caustic causes3 (not an STD) |
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| dermatoses causes3 (fixed drug, EM, Stevens-Johnson syndrome, inflammatory bowel disease, aphtosis) (not an STD) |
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yes; maybe even skin DIF battery |
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References:
- Specialty Labs website.
- eMedicine website, by topic via Google.
- European J.
(posted 3 August 2005; latest update 27 July 2008) |
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© Copyright
1999 - 2006, all rights reserved, Pathology Associates Of Lexington,
P.A. |
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