Diagnosis-sexually transmitted infections

(MMWR 2021;70:1; JAMA 2022;327:161)

• Syphilis: 1st step is treponemal test: IgG to T. pallidum. ⊕ for life. 2nd step: confirm w/ non-treponemal test (VDRL/RPR titer). Should ↓ 4-fold w/ Rx. Neurosyphilis: LP not needed if only ocular or otic sx. CSF VDRL may be ⊖.
• LGV: clinical dx + ⊕ rectal C. trachomatis NAAT + r/o other causes of proctitis
• Donovanosis: bx w/ Donovan bodies (encapsuled GNR) in monocytes/macrophages
• Genital herpes: clinical dx; confirm w/ PCR, viral cx from lesion
• Chancroid: clinical dx; r/o syphilis & HSV

(MMWR 2021;70:1; JAMA 2022;327:161)

• NAAT (vaginal/cervical/urine ♀; urine ♂), mycoplasma testing not widely available
• For GC/CT, strongly suggest urine + rectal/pharyngeal swab if history of oral or anal sex
• Trichomoniasis: motile trichomonads on wet mount
• Bacterial vaginosis: clue cells on wet mount; ⊕ whiff test; vaginal culture