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Color Atlas & Synopsis of Sexually Transmitted Diseases

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Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

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Color Atlas & Synopsis of Sexually Transmitted Diseases THIRD EDITION

H. Hunter Handsfield, MD Clinical Professor of Medicine University of Washington Center for AIDS and STD Senior Research Leader Battelle Centers for Public Health Research and Evaluation Seattle, Washington

New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto

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Color Atlas & Synopsis of Sexually Transmitted Diseases, Third Edition Copyright © 2011, 2001, 1991 by The McGraw-Hill Companies, Inc. All rightsreserved. Printed in China. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without prior written permission of the publisher.

1 2 3 4 5 6 7 8 9 10 CTP/CTP 14 13 12 11 ISBN 978-0-07-162437-4 MHID 0-07-162437-6 This book was set in Berkeley Book by Glyph International Ltd. The editors were James Shanahan and Christie Naglieri. The production supervisor was Sherri Souffrance. Project management was provided by Anupriya Tyagi, Glyph International. The designer was Mary McKeon; the cover design was by Pehrsson Design. China Translation & Printing, Ltd. was printer and binder.

Library of Congress Cataloging-in-Publication Data Handsfield, H. Hunter. Color atlas and synopsis of sexually transmitted diseases / by H. Hunter Handsfield.—3rd ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-07-162437-4 (pbk.) ISBN-10: 0-07-162437-6 (pbk.) 1. Sexually transmitted diseases—Atlases. 2. Sexually transmitted diseases—Outlines, syllabi, etc. I. Title. [DNLM: 1. Sexually Transmitted Diseases—Atlases. WC 17] RC200.H36 2011 616.95′1—dc22 2010041685 INTERNATIONAL EDITION MHID: 0-07-176818-1; ISBN: 978-0-07-176818-4 McGraw-Hill books are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]

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For Evan, Nate, and Rowan

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Contents Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix List of Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Section I Overview of Sexually Transmitted Diseases. . . . . . . . . . . . . . . . . . . . . . . 1 1 Clinical Approach to Patients with STDs or at Risk . . . . . . . . . . . . . . . . . . . . . 3 2 Global Epidemiology, Prevention and Management of Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Section II Bacterial Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . 31 3 4 5 6 7

Chlamydial Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Chancroid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Donovanosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Section III Viral Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . 107 8 9 10 11 12

Genital Herpes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Human Papillomavirus Infection and Genital Warts. . . . . . . . . . . . . . . . . . . 133 Molluscum Contagiosum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Human Immunodeficiency Virus Infection . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Blood-Borne Viruses: Viral Hepatitis, Epstein-Barr Virus, Cytomegalovirus, and Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Section IV Cutaneous Infestations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 13 Pediculosis Pubis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 14 Scabies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

Section V Clinical Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 15 16 17 18 19 20 21 22

Nongonococcal Urethritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Epididymitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Reactive Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Mucopurulent Cervicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Vaginal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 Pelvic Inflammatory Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 Proctitis, Colitis, and Enteritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 Nonsexually Transmitted Genital Conditions. . . . . . . . . . . . . . . . . . . . . . . . 289

Appendix Medical and Sexual History, Physical Examination, and Laboratory Evaluation of STD Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323

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Contributors Laura Sangaré, PhD, MPH Senior Fellow Department of Global Health University of Washington Seattle, Washington Chapter 2: Global Epidemiology, Prevention and Management of Sexually Transmitted Diseases

Judd L. Walson, MD, MPH Assistant Professor Departments of Global Health, Medicine (Infectious Disease), Pediatrics, and Epidemiology University of Washington Seattle, Washington Chapter 2: Global Epidemiology, Prevention and Management of Sexually Transmitted Diseases

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Preface Sexually transmitted diseases (STDs) are among the most common afflictions in most societie. Awareness of STDs, including HIV infection and AIDS, is high among young people in all industrialized countries and among most health care providers, a welcome change over the two decades since the first edition of this book was published. However, the general awareness by clinicians and at-risk populations does not consistently translate into accurate knowledge or clinical practice. Many young people have serious misunderstandings about STDs, with both denial by some at obvious risk and inflated fear of contagion by others. Almost all clinicians now can list Chlamydia trachomatis and human papillomavirus as sexually transmitted pathogens, yet STD screening is undertaken far less frequently than recommended. The vaccines against STDs are underutilized, treatment often is inconsistent with authoritative guidelines, and partners of infected persons often go untreated. This is understandable; most clinicians receive little training in STD management, and even training in HIV/AIDS often is insufficient. Further, despite the high frequency of STDs, they are not so common that most providers see infected patients daily. Except in selected settings like reproductive health, student health, and STD clinics, most patients seemingly are not at high risk and STDs are diagnosed with modest frequency. Color Atlas and Synopsis of Sexually Transmitted Diseases is designed primarily for clinicians who find themselves caring for patients with STD or at risk, sometimes to their surprise, and need an easy-to-use aid to diagnosis, treatment, and prevention. At the same time, it contains sufficient detail to be useful for continuing education and review by highly experienced clinicians. The clinical and diagnostic procedures described are within the capabilities of the basically trained clinician and most medical offices and laboratories in industrialized countries. The epidemiologic emphasis and treatment recommendations are primarily those current in the United States, but for this edition every chapter has been modified to enhance its utility in developing countries and other resource-limited settings, and a new chapter reviews the global epidemiology of STDs. I have attempted to integrate the atlas components with the synopsis and to strike a balance between them, and users are encouraged not only to examine the photographs but to read the text and case histories. Indeed, one clinical chapter has no photographs at all. This book also can serve as a visual aid in counseling patients and will be useful to many health educators, clinic managers, and health administrators. Finally, our patients participate much more actively in their care than in the past, and the worldwide revolution in information technology has dramatically enhanced many persons’ access to technical information and their ability to assimilate it. With these trends in mind, this book also is designed in part for persons with STDs or at risk, many of whom will find it useful in understanding their own infections, assessing their risk, or judging the importance of symptoms that may require clinical assessment. The case histories are real, although some are composites of two or more patients. Most of the photographs illustrate the patients described, but some were matched with other patients whose histories ix

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were better known. For several cases from past years, the tests performed or treatments given have been updated to conform with current recommendations. The text of all chapters has been extensively rewritten to incorporate changes in epidemiology, diagnosis, and treatment since the previous edition, and the chapter on HIV infection has been greatly expanded. About a quarter of the photographs are new, and almost all the Suggested Reading citations are new and recent. As for most books, this one has been aided by generous professional and personal support from numerous colleagues. The many who contributed clinical photographs are acknowledged in the legends; I thank them very much. My own collection of photographs began almost four decades ago and the provenance of some is uncertain; I apologize to the owners if some are not properly credited. Special thanks are due to colleagues who reviewed drafts, served as sounding boards on controversial topics, or supported me in important ways throughout my career. These include King Holmes, Larry Corey, Ned Hook, Matt Golden, Jeanne Marrazzo, Connie Celum, Sevgi Aral, Sheila Lukehart, Bob Wood, Bob Harrington, and not least Walt Stamm, whose untimely demise was a tragic loss for our field and a source of continuing sadness. Judd Walson and Laura Sangaré lent their expertise to write the new chapter on global health aspects of STDs. My editor, Jim Shanahan, remained a gentleman through all his prodding over my tardiness in getting to work on this edition, and Christie Naglieri expertly handled all the production details. Finally, I thank my wife, Patricia McInturff, for her love and support. H. Hunter Handsfield, MD Seattle, Washington

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List of Abbreviations AGUS AIDS AIN ARS ART ARV ASCUS bid BV BVAB CBC CDC CMV CRP CSF CSW DALYs DGI DNA EBV EIA ELISA EPT ESR FTA-ABS GND GUD HAV HBsAg HBV HCV HDV

atypical glandular cells of undetermined significance acquired immunodeficiency syndrome anal intraepithelial neoplasia acute retroviral syndrome antiretroviral therapy antiretroviral [drug] atypical squamous cells of undetermined significance twice a day bacterial vaginosis bacterial vaginosis associated bacteria complete blood count Centers for Disease Control and Prevention cytomegalovirus C-reactive protein cerebrospinal fluid commercial sex worker disability-adjusted life years disseminated gonococcal infection deoxyribonucleic acid Epstein-Barr virus enzyme immunoassay enzyme-linked immunosorbent assay expedited partner therapy erythrocyte sedimentation rate fluorescent treponemal antibody-absorbed test gram-negative diplococci genital ulcer disease hepatitis A virus Hepatitis B surface antigen hepatitis B virus hepatitis C virus hepatitis D virus xi

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HHV-8 HIV HLA HPV HSIL HSV HTLV ICGND IDU IgG IgM IM IUD IV LGV LSIL MCV MHA-TP MPC MSM NAAT NGU NSU OHL PCR PDPT PEP PID PIN PITC PMN PO PrEP qid RNA RPR SDA STD STI tid

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human herpesvirus 8 human immunodeficiency virus histocompatibility locus A human papillomavirus high-grade squamous intraepithelial lesion herpes simplex virus human T-cell lymphotropic virus intracellular gram-negative diplococci injection drug use/user immunoglobulin G immunoglobulin M intramuscularly intrauterine device intravenously lymphogranuloma venereum low-grade squamous intraepithelial lesion molluscum contagiosum virus microhemagglutination assay for Treponema pallidum mucopurulent cervicitis men who have sex with men nucleic acid amplification test nongonococcal urethritis nonspecific urethritis oral hairy leukoplakia polymerase chain reaction patient-delivered partner therapy post-exposure prophylaxis pelvic inflammatory disease penile intraepithelial neoplasia provider-initiated testing and counseling polymorphonuclear [leukocyte] orally, by mouth pre-exposure prophylaxis four times a day ribonucleic acid rapid plasma reagin test strand displacement assay sexually transmitted disease sexually transmitted infection three times a day

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transcription-mediated amplification Treponema pallidum hemagglutination test Treponema pallidum particle agglutination test toluidine red unheated serum reagin test urinary tract infection vaginal intraepithelial neoplasia venereal disease Venereal Disease Research Laboratory test vulvar intraepithelial neoplasia vulvovaginal candidiasis white blood cell [count] World Health Organization women who have sex with women

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List of Abbreviations

TMA TPHA TPPA TRUST UTI VaIN VD VDRL VIN VVC WBC WHO WSW

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