Sexually Transmitted Bacterial Infections

Sexually Transmitted Bacterial Infections Mind Map

Sexually transmitted bacterial infections are illustrated in the nighttime strip club scene to anchor the concept of bacterial venereal diseases. Syphilis is represented by a spiraling rocket to emphasize the spiral morphology of spirochetes, while chancroid is depicted as chains, symbolizing the painful genital ulcers caused by Haemophilus ducreyi. Gonorrhea is portrayed as MAC the detective, reminding us of Neisseria gonorrhoeae with its diagnostic and often investigative clinical presentation in genital, rectal, and pharyngeal disease. The lime van symbolizes lymphogranuloma venereum, caused by Chlamydia trachomatis serovars L1–L3, which classically progresses from transient genital ulcers to painful inguinal lymphadenopathy. Finally, the grandmother from England represents granuloma inguinale, or donovanosis, caused by Klebsiella granulomatis, which presents with beefy red ulcerative genital lesions.

Bacterial Venereal Diseases

• Spiraling rocket = Spirochetes of syphilis
• Chains = Chancroid
• MAC the detective = Gonorrhea
• Lime van = Lymphogranuloma venereum
• Grandma from England = Granuloma inguinale

Chancroid (Haemophilus ducreyi)

Chancroid is caused by Haemophilus ducreyi, illustrated by the chains with the doll crying to highlight the painful nature of this infection. The red oval purse signifies its classification as a gram-negative coccobacillus. Clinically, chancroid is characterized by painful purulent ulcers with ragged undermined borders and a fibrinous base, depicted by the red ragged crater. These lesions can occur in opposition and form “kissing ulcers” when two skin surfaces touch. Regional lymphadenitis, often painful and unilateral, is represented by the shattered pearl necklace and cars parked on only one side of the road. Treatment is symbolized by the Z-crow for azithromycin. On histology, the school of fish sign is classically seen, particularly with Giemsa stain, represented by the pink/purple group with fish and gem. Finally, the woman in fishnet stockings reminds us that sex workers are a major reservoir of infection, emphasizing the epidemiology of chancroid.

Chancroid

• Chains = Chancroid
• Crying = Haemophilus ducreyi
• Red oval purse = Gram negative coccobacilli
• In pain = Painful purulent ulcers
• Red ragged crater = Ragged undermined borders and fibrinous base
• Kissing in crater = Kissing ulcers from apposition of skin with initial ulcer
• Shattered pearl necklace = Painful inguinal lymphadenitis
• Cars only on one side of road = Typically unilateral
• Z-crow = Azithromycin for treatment
• Pink/purple group with fish = School of fish sign on histology
• Gem = With Giemsa stain
• Woman in fishnet stockings = Prostitutes are a major reservoir

Gonorrhea (Neisseria gonorrhoeae)

Gonorrhea is represented by MAC the detective, highlighting its link to deficiencies in the complement pathway C5–9, which form the membrane attack complex, increasing susceptibility to infection. The red trench coat signifies Neisseria gonorrhoeae, a gram-negative diplococcus. If disseminated hematogenously, gonorrhea can present as the arthritis-dermatosis syndrome. Clinical findings include hemorrhagic acral pustules depicted as red and white bumps on the hands, arthritis of larger joints shown by pain lines around the knees, and fever represented by the detective being on fire. A red stain on the pants reminds us that dissemination is more common during menstruation. For treatment, ceftriaxone is symbolized by 3 axes, and azithromycin by the Z-crow. Diagnosis is best made by culture, represented by the petri dish advertisement, with Thayer Martin media specifically highlighted by the TM symbol.

Gonorrhea

• MAC the detective = Gonorrhea
• Red trench coat = Neisseria gonorrhoeae is gram-negative diplococci
• Spilled red drink = If hematogenous dissemination occurs, arthritis-dermatosis syndrome can occur
• Red and white bumps on the hands = Hemorrhagic acral pustules
• Pain lines around the knees = Arthritis of larger joints
• On fire = Fever
• Red stain on pants = More common in menstruation
• Route 5-9 = More common in C5-9 complement deficiencies which form the membrane attack complex (MAC)
• 3 axes = Ceftriaxone
• Z-Crow = Azithromycin
• Petri dish advertisement = Cultures gold standard for diagnosis
• TM = Thayer Martin media is used

Lymphogranuloma Venereum (Chlamydia trachomatis L1–L3)

Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serotypes L1–L3, represented by the lime van with a clamshell and the boys making L signs on their foreheads. It progresses through 3 clinical stages. Stage I presents as a painless ulcer that resolves, depicted by the happy boy holding an eraser. Stage II is marked by unilateral painful inguinal lymphadenopathy, shown by the teenage boy drinking red boba and white tea, with spilled boba on one thigh and pain lines, highlighting buboes. The groove sign, with enlarged nodes above and below the Poupart ligament, is represented by the groovy poptart. Buboes may rupture, leading to pus drainage and sinus tracts, symbolized by spilled white tea. Stage III, shown by the old man sitting on a red spiky chair, represents the ano-genito-rectal syndrome, which manifests with proctocolitis, perirectal abscesses, fistulas, strictures, and stenoses occurring months to years later. LGV is more common in males than females. Histologically, Gamna-Favre bodies within macrophages, seen on Giemsa stain, are diagnostic. Treatment is with doxycycline, represented by the cycle.

Lymphogranuloma Venereum

• Lime van = Lymphogranuloma venereum
• Clamshell = Chlamydia trachomatis
• 3 boys making L on their forehead = Serotypes L1–L3

Stages

• Happy boy holding up an eraser = Stage I is painless ulcer which resolves
• Teenage boy drinking red Boba, white tea = Stage II has buboes (unilateral painful enlarged inguinal lymph nodes)
• Spilled Boba on 1 thigh = Unilateral, erythematous enlarged inguinal lymph nodes
• Pain lines = Painful
• Groovy poptart = Groove sign is enlarged nodes above and below Poupart ligament
• White tea spilled = Buboes may rupture → pus drainage and sinus tracts
• Old man = Stage III occurs months to years after stage II
• Sitting on a red spiky chair = Ano-genito-rectal syndrome → proctocolitis, perirectal abscesses, fistulas, strictures/stenoses

Associations

• Cycle = Doxycycline for treatment
• Only males = M > F
• Special gamma flavored Boba locked in cage = Gamna-Favre bodies in macrophages
• Gem = Seen with Giemsa stain

Granuloma Inguinale (Donovanosis, Klebsiella granulomatis)

Granuloma inguinale, also known as donovanosis, is caused by Klebsiella granulomatis, represented by the grandma from England holding a red club. The organism is an intracellular gram-negative bacillus, symbolized by the red color. Clinically, the infection begins as a painless ulcer, depicted by the smiling face, that evolves into a lesion with beefy red friable granulation tissue, shown by the home-style red beef. These ulcers often become secondarily infected, producing a foul odor, symbolized by the stench. Treatment is with azithromycin, represented by the Z-crow. Histologically, the diagnostic finding is Donovan bodies, characterized by a safety pin appearance within macrophages, shown by the safety pin and grandson Don. These structures can be identified using Giemsa or Wright stain, symbolized by the gem.

Granuloma Inguinale

• Grandma from England = Granuloma inguinale
• Holding a red club = Klebsiella granulomatis
• Red = Intracellular gram-negative bacillus
• Smiling = Painless ulcer
• Home style red beef = Ulcer with beefy red, friable granulation tissue
• Stench = Secondary infections → bad odor
• Z-Crow = Azithromycin for treatment
• Safety pin + grandson Don = “Safety pin” Donovan bodies on histology
• Gem = On Giemsa stain or Wright stain