Color Atlas & Synopsis of Sexually Transmitted Diseases

346 Pages·2011·207.11 MB·English

by  Hunter Handsfield

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Color Atlas & Synopsis of
Sexually Transmitted Diseases
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Notice
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Color Atlas & Synopsis of
Sexually Transmitted Diseases
T H I R D E D I T I O N
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 re-
produced 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 Chlamydial Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
4 Gonorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5 Syphilis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
6 Chancroid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
7 Donovanosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Section III Viral Sexually Transmitted Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . 107
8 Genital Herpes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
9 Human Papillomavirus Infection and Genital Warts. . . . . . . . . . . . . . . . . . . 133
10 Molluscum Contagiosum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
11 Human Immunodeficiency Virus Infection. . . . . . . . . . . . . . . . . . . . . . . . . . 157
12 Blood- Borne Viruses: Viral Hepatitis, E pstein- Barr
Virus, Cytomegalovirus, and Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Section IV Cutaneous Infestations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
13 Pediculosis Pubis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
14 Scabies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Section V Clinical Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
15 Nongonococcal Urethritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
16 Epididymitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
17 Reactive Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
18 Mucopurulent Cervicitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
19 Vaginal Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
20 Pelvic Inflammatory Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
21 Proctitis, Colitis, and Enteritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
22 Nonsexually Transmitted Genital Conditions. . . . . . . . . . . . . . . . . . . . . . . . 289
AppendixMedical and Sexual History, Physical Examination, and
Laboratory Evaluation of STD Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
vii
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Contributors
Laura Sangaré, PhD, MPH Judd L.Walson, MD, MPH
Senior Fellow Assistant Professor
Department of Global Health Departments of Global Health,
University of Washington Medicine (Infectious Disease),
Seattle, Washington Pediatrics, and Epidemiology
Chapter 2: Global Epidemiology, University of Washington
Prevention and Management of Sexually Seattle, Washington
Transmitted Diseases 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 mis-
understandings about STDs, with both denial by some at obvious risk and inflated fear of contagion by
others. Almost all clinicians now can list Chlamydia trachomatisand human papillomavirus as sexually
transmitted pathogens, yet STD screening is undertaken far less frequently than recommended. The vac-
cines 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 train-
ing 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 Diseasesis 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 pro-
cedures described are within the capabilities of the basically trained clinician and most medical offices
and laboratories in industrialized countries. The epidemiologic emphasis and treatment recommenda-
tions 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 re-
views 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 pho-
tographs 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 educa-
tors, 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 pho-
tographs illustrate the patients described, but some were matched with other patients whose histories
ix