Human Papilloma virus (HPV). There are over 70 different types of the virus.
Different types of the virus are associated with distinct clinical manifestations.
6, 11, 42, 43, 44, 54
Genital warts, laryngeal papillomas
16, 18, 31, 33, 39, 45, 51, 52
Dysplasia and carcinoma of the cervix
Other types cause warts of the skin such as plantar warts.
Genital warts caused by HPV 6 and 11 are the most common STD in the United
States. Over a million cases are seen per year.
HPV DNA (types 16, 18 mostly) has been found in over 90% of the cervical
carcinomas and is believed to be the major cause of invasive cervical carcinoma.
Transmission of the virus is not very well understood.
Direct contact with the lesion is believed to result in spread of the disease.
Soft, fleshy, cauliflower-like lesions on
the skin, genitalia, perineum, and perianal
regions. The HPV infected cells of the cervix do not have any recognizable
lesion. Only after the addition of dilute acetic acid can one see an "acetowhite"
Chlamydia enter the body through small breaks or abrasions in the
skin and induce a local genital lesion as well as regional lymph node involvement
and systemic effects because macrophages phagocytize them and carry them
around as intracellular parasites.
The histologic picture of the initial genital lesion is essentially that
of a nonspecific granuloma.
Inguinal lymphadenopathy is extensive and may split the inguinal mass into
1/2s separated by Poupart's ligament, producing
an almost pathopneumonic groove sign for LGV.
E. Diagnosis is based on
LGV complement fixation test (LGV-CFT) not very sensitive or specific.
Look for a four-fold rise in titer between acute and convalescence serum.
Ultimate isolation of the organism using tissue culture (LGV grows well
in McCoy cells). -- Culturing the organism is not routinely attempted
the initial lesion is very transient and the lymphadenitis resolves in
several months; serious disease is rare and rectal stricture is the most
Doxycycline 100 mg orally twice a day for 21 days or Erythromycin base
500 mg orally four times a day for 21 days.
Surgical drainage of pus and correction of rectal strictures as well as
Check patient at weekly intervals for resolution of lesions.
Check sex partners.
called lupoid ulceration granuloma of the pudenda and granuloma contagiosa)
is a chronic, indolent, ulcerative, granulomatous disease of the skin and
Calymmatobacterium granulomatis is the etiological agent; it is
a Gram -rod with characteristic bipolar staining so they have a safety
pin-like appearance in stained tissue preparation. -- We call them Donovan
It is endemic in the tropics and very rare in the U.S.; probably < 100
A venereal disease that is sexually transmitted but is not very contagious.
Genital lesions are present in 90% of infected patients and in 80% of these
there is no other area of involvement.
Initially the lesions are papules that tend to ulcerate slowly.
The ulcerated lesions are irregular in shape with a rolled border on a
beefy red, cobblestone base (image 1
Patients develop subcutaneous granulomas in the inguinal regions; they
do not involve the lymph nodes usually, so we call them pseudo-buboes.
D. Pathology and pathogenesis
The organism gains entry by direct inoculation through skin abrasions or
One or more indurated papules form which progress to characteristic ulceration.
The most important sign is the presence of mononuclear cells with intra
cytoplasmic vacuoles packed with the bacteria or Donovan
bodies as they are called.
Evaluate the nature of the lesion (nodules which erode to form painless,
beefy, granulomatous ulcers) and sexual history.
Demonstrate the pathopneumonic enlarged mononuclear cells containing vacuoles
filled with Donovan bodies.
In order of preference:
Trimethoprim-sulfamethoxazole one double-strength tablet orally twice a
day for a minimum of 3 weeks, OR
Doxycycline 100 mg orally twice a day for a minimum of 3 weeks.
Ciprofloxacin 750 mg orally twice a day for a minimum of 3 weeks, OR
Erythromycin base 500 mg orally four times a day for a minimum of 3 weeks.