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Syphilis 梅毒 - 無痛硬下疳 Chancre
Condyloma lata 扁平濕疣
H. ducrey - 軟性痛下疳 Chancroid
Gonorrhoae 淋病雙球菌
Chalmydia trachomatis 砂眼披衣菌 - 非淋菌性尿道炎, 花柳性淋巴肉芽腫
S. saprophyticus 腐生葡萄球菌
S. agalactiae 無乳鏈球菌 ( GBS )
Trichomonas 陰道滴蟲 - trichomonalvaginitis
HSV2 - Genital herpse 疱疹
HPV 6 & 11 - Condyloma acumilatum 尖銳濕疣 = 菜花 Warts
Pox virus 痘病毒 - Molluscum contagiosum 傳染性軟疣
- Condyloma lata : 二期梅毒, 扁平濕疣 lata
- Condyloma acumilatum : HPV 6,11 尖銳濕疣 菜花 genital wart
Syphilis 梅毒
G (-) 螺旋菌
Chancre 無痛硬下疳
Condyloma lata 扁平濕疣
皮膚, 心血管 (Aneurysm)
Neuro 脊髓癆
Chalmydia trachomatis 砂眼披衣菌
Nongonococcal urethritis
C. trachomatis infection is the most frequently reported STI
Men : urethritis, epididymitis, proctitis,
or Reiter’s syndrome (urethritis, conjunctivitis, and rash).
Women : asymptomatic cervicitis, PID
Nucleic acid amplification testing is the preferred test for diagnosis
Single-dose azithromycin or twice-a-day doxycycline for 7 days.
砂眼 : ABC
非淋菌性尿道炎 NGU : D-K, 也會披衣菌結膜炎
花柳性淋巴肉芽腫 LGV : L1-3
一開始生殖器小水泡, 不痛不留疤
之後鼠蹊部淋巴腫大
Chlamydia cervicitis
( 而 Chalmydia pneumonia 是 atypical pneumonia )
Reactive arthritis (Reiter's syndrome)
Seronegative spondyloarthropathy
Acute, asymmetric oligoarthritis occurring 2 to 6 weeks after an infectious illness
Chlamydia (Common)
Salmonella, Shigella, Yersinia, and Campylobacter,
and possible agents include Escherichia coli and Clostridium difficile.
Typically involves the lower extremities,
including the feet. Back and buttock pain may occur
Treatment : supportive, with emphasis on pain control with NSAID
Chlamydia-induced reactive arthritis, using rifampin 300 mg daily combined with
either doxycycline 100 mg twice daily or azithromycin 500 mg daily
Gonorrhea 淋病
Nesisseria gonorrhoae
Gonococcus
G (-)
Second most commonly reported STI
男性
尿道炎 膿尿
Gonorrheal infection is usually symptomatic in men
Rectal infection with mucopurulent anal discharge and pain
女性
Most gonococcal infections in women are asymptomatic
and often coexist with chlamydial infection.
Cervicitis, PID,
Fitz-Hugh–Curtis syndrome
Disseminated gonococcal infection
Petechial or pustular acral skin lesions on an erythematous base,
asymmetric arthralgias, tenosynovitis or septic arthritis,
and fever or general malaise.
Dual therapy with ceftriaxone 250 milligrams IM
plus single-dose azithromycin 1 g PO
for the treatment of gonorrhea
Gonococcemia requires hospitalization
for IV administration of antibiotics
and evaluation for possible endocarditis and meningitis.
H. ducrey 杜克嗜血桿菌
G (-)
Chancroid 軟性痛下疳
痛的 ulcer + Lymph node
Painful genital ulcers and lymphadenitis
Painful, supporative lymph node, lymph nodes
may become necrotic or pus-filled, known as buboes
Increases HIV transmission and often is accompanied by other infections.
When chancroid is present, 10% of infected patients in the
United States also have HSV or T. pallidum
Culturing has a sensitivity of <80%.
Azithromycin PO in a single dose,
Ceftriaxone IM in a single dose,
Ciprofloxacin for 3 days
Incision and drainage or aspiration of buboes
can be considered for symptomatic relief
S saprophyticus 腐生葡萄球菌
性生活頻繁女性之尿道感染
S agalactiae 無乳鏈球菌 ( GBS )
新生兒敗血症 腦膜炎
女性 STD :
Chalmydia 最多
Gonorrhea
Trichomonas ( 黃綠 )
HPV 6,11
Syphilis
HSV, HIV
Mycoplasma
女性陰道感染 :
Bacteria : 魚味, Gardenella vaginalis, clue cell, whiff test
Candida : 起司, 會陰部搔癢刺痛, 解尿痛性交痛
Trichomoniasis 黃綠, Strawberry cervix
生殖器潰瘍的鑑別診斷
感染性成因：大部分為性傳染病
- HSV：HSV-1 / HSV-2
- T. pallidum：造成梅毒 (Syphilis) 的病原體
- Chlamydia trachomatis serovars L1-3：Lymphogranuloma venereum
- Haemophilus ducreyi：Chancroid
- Klebsiella granulomatis：Donovanosis
- 非性傳染病的成因：少見, tuberculosis、amebiasis、leishmaniasis
非傳染性 :
- Fixed drug eruption
- Behcet syndrome：口腔/生殖器反覆潰瘍，合併視力受損
- 惡性腫瘤, Crohn’s disease, 創傷
Painful ulceration：HSV, chancroid
UTI symptoms： STD
是否合併全身症狀：HSV, 二期梅毒, LGV
反覆發生要想到 : HSV, Behcet syndrome, Fixed drug eruption
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