🦠 Sexually Transmitted Diseases · Gonorrhea · Chlamydia · Syphilis · HSV · HPV · PID

Schwartz Clinical Handbook — Chapter 70 · Urethritis/cervicitis · Genital ulcer · Vaginal discharge · Pelvic inflammatory disease · NAAT · Empiric therapy

Select genital discharge (purulent, mucoid), dysuria, ulcers (painful vs painless), rash (palms/soles), inguinal lymphadenopathy, pelvic pain, and pregnancy status → differentiate gonorrhea, chlamydia, syphilis, HSV, chancroid, LGV, and PID. Empiric treatment and partner management.
⚠️ Red flags: pelvic pain + cervical motion tenderness + fever → PID (inpatient if pregnant, severe, or TOA).

📋 Step 1 — Discharge, ulcer & pelvic pain
📌 Diagnostic impressions
📖 Schwartz Ch 70

Select urethral/vaginal discharge (purulent, mucoid), dysuria, genital ulcers (painful HSV, painless chancre), rash (palms/soles secondary syphilis), inguinal adenopathy (LGV, chancroid), pelvic pain, and pregnancy → differentiate gonorrhea, chlamydia, syphilis, HSV, chancroid, LGV, PID, and trichomoniasis.

✔️ Gonorrhea: purulent discharge, dysuria, co‑infection with chlamydia common.
✔️ Chlamydia: mucoid discharge, often asymptomatic, PID risk.
✔️ Syphilis: painless chancre (primary), maculopapular rash palms/soles (secondary).
✔️ HSV: painful grouped vesicles, recurrent, treat with acyclovir.
✔️ PID: cervical motion tenderness, fever, elevated CRP, treat with ceftriaxone + doxycycline.
📘 Schwartz pearls (Chapter 70)
• GC/Chlamydia: NAAT (urine, cervical, urethral). Empiric ceftriaxone + azithromycin/doxycycline.
• Syphilis: RPR/VDRL, confirm with treponemal test. Benzathine penicillin G.
• HSV: PCR or culture. Acyclovir, valacyclovir. Suppression for frequent recurrences.
• HPV: genital warts, treat with cryotherapy, podophyllin, imiquimod.
• PID: inpatient if pregnant, severe, or TOA. Ceftriaxone + doxycycline ± metronidazole.