DR10.1-11 | Sexually Transmitted Diseases — Glossary

A framework for taking a sexual history covering Partners, Practices, Protection from STIs, Past history of STIs, and Pregnancy intention.

A risk-reduction message summarised as Abstinence, Be faithful, and correct and consistent Condom use, individualised to the patient rather than recited as a slogan.

Application of 5% acetic acid which turns HPV-affected epithelium white, helping reveal subclinical genital warts.

The clinical criteria for BV — thin grey discharge, vaginal pH >4.5, positive whiff (amine) test, and clue cells; at least three of four are required.

A short-acting intravenous penicillin used for neurosyphilis and congenital syphilis because it achieves the high (including CSF) concentrations those conditions require.

A small pupil that accommodates (constricts to a near target) but does not react to light, characteristic of neurosyphilis.

Withdrawal of pus from a fluctuant bubo through adjacent healthy skin with a needle; the correct procedure, in contrast to incision which risks chronic sinus formation.

A polymicrobial dysbiosis in which Lactobacillus is replaced by Gardnerella and anaerobes, producing a thin grey malodorous discharge; diagnosed by the Amsel criteria.

A long-acting (depot) intramuscular penicillin that maintains low treponemicidal blood levels for weeks; the first-line treatment for most stages of syphilis.

A reactive non-treponemal test (VDRL/RPR) with a negative treponemal test, caused by conditions such as pregnancy, SLE, malaria, or other infections rather than true syphilis.

Screening for cervical dysplasia caused by high-risk HPV, recommended for women including those presenting with genital warts.

Inflammation of the cervix, often due to gonorrhoea or chlamydia; in syndromic management grouped with urethral/anorectal discharge under Kit 1 (grey).

The lesion of primary syphilis: a single, painless, indurated ulcer with a clean base at the site of inoculation, with non-tender bilateral inguinal lymphadenopathy.

A sexually transmitted painful genital ulcer caused by Haemophilus ducreyi, characteristically soft and ragged with a tender suppurative inguinal bubo.

An impartial witness, ideally a same-sex nurse or health worker, present during an intimate examination to protect both patient and examiner; their presence is documented.

An obligate intracellular bacterium causing non-gonococcal urethritis; it does not Gram-stain and is not seen on a routine urethral smear.

The three invasive (lymphotropic) serovars of C. trachomatis responsible for LGV, distinct from the non-invasive genital serovars D-K.

Vaginal epithelial cells coated with coccobacilli so that their borders appear stippled and indistinct; seen on saline wet mount in bacterial vaginosis.

A NACO pre-packed, ready-to-dispense set of medicines numbered and colour-coded to a specific STI syndrome; contents are revised periodically and should be confirmed against the current guideline.

Moist, broad, wart-like papules in warm intertriginous areas seen in secondary syphilis; highly infectious.

Flat, moist, broad-based lesions of secondary syphilis (VDRL/RPR positive) that mimic genital warts but require entirely different management.

The clinician's duty to protect a patient's personal and sexual health information, with any legal limits explained to the patient at the outset.

Syphilis acquired transplacentally, producing early signs (snuffles, hepatosplenomegaly, rash) and late stigmata (Hutchinson's triad, saddle nose).

Aqueous crystalline penicillin G 50,000 units/kg/dose IV (every 12 h for the first 7 days then every 8 h) or procaine penicillin G 50,000 units/kg IM daily, for a total of 10 days; confirm dosing against current national guidance.

Identifying and treating the sexual partners of an index patient to interrupt transmission, in India typically via the anonymous contact-slip method.

A partner-notification technique in which the index patient is given referral slips to pass to recent partners, inviting them for evaluation and presumptive treatment without naming the index patient.

Provider-applied freezing of warts with liquid nitrogen; safe in pregnancy and suitable for many sites.

A microscopy technique used to visualise motile Treponema pallidum directly from a syphilitic ulcer exudate.

A microscopy technique that directly visualises motile Treponema pallidum in exudate from a genital chancre or moist lesion; not valid on oral lesions because of commensal treponemes.

A couple in which one partner is HIV-positive and the other HIV-negative, requiring careful counselling that balances confidentiality with transmission prevention.

An unpleasant reaction (flushing, nausea, palpitations) when alcohol is taken with metronidazole; patients must be warned to avoid alcohol during treatment.

Bipolar-staining, encapsulated intracytoplasmic organisms seen within large mononuclear cells on a Giemsa- or Wright-stained tissue smear, diagnostic of donovanosis.

A genital ulcer disease caused by Klebsiella granulomatis (formerly Calymmatobacterium granulomatis), giving a painless, beefy-red, friable ulcer without true lymphadenopathy.

An alternative treatment for penicillin-allergic NON-pregnant patients (100 mg twice daily, 14 days early / 28 days late); contraindicated in pregnancy.

Pain or burning during micturition, a common symptom of urethritis.

High-risk HPV proteins that inactivate the tumour-suppressors p53 (E6) and Rb (E7), driving malignant transformation.

Latent syphilis acquired within the preceding 2 years; treated with a single dose of benzathine penicillin G 2.4 million units IM.

Treatment chosen on the basis of the most probable causative organisms for a clinical presentation, given before (or without) laboratory confirmation.

Inflammation of the epididymis and testis, a complication of untreated urethritis that can impair fertility.

A wave-like sensation on palpation indicating a collection of pus or fluid within a swollen lymph node (a bubo) or abscess.

A two-dilution change in the non-treponemal titre (e.g. 1:32 to 1:8); a fourfold fall indicates treatment success, a fourfold rise indicates failure or re-infection.

An HIV test that detects both p24 antigen and antibody, allowing earlier detection (window roughly 10–33 days) than antibody-only tests.

Fluorescent Treponemal Antibody Absorption test — a sensitive treponemal confirmatory test, often the earliest to become positive.

Chronic disfiguring swelling of the genitalia from lymphatic fibrosis, a late complication of untreated LGV.

An ulcerative lesion of the genitalia; managed as either non-herpetic (syphilis and chancroid, Kit 3 white) or herpetic (HSV, Kit 4 blue) based on morphology and pain.

Soft, cauliflower-like anogenital growths caused by human papillomavirus, chiefly low-risk types 6 and 11.

The declining susceptibility of Neisseria gonorrhoeae to antibiotics, including cephalosporins, tracked by global surveillance and a major public-health concern.

Urethritis caused by Neisseria gonorrhoeae, classically producing copious purulent discharge and intracellular Gram-negative diplococci on smear.

Inflammation of lymph nodes with granuloma formation, as occurs in the regional nodes in LGV.

Inguinal lymphadenopathy above and below the inguinal ligament producing a groove, characteristic of LGV.

A groove produced when the inguinal ligament bisects enlarged inguinal and femoral node masses; a clinical pointer to LGV, present in only a minority of cases.

The Gram-negative coccobacillus that causes chancroid; seen as 'school-of-fish' chains on Gram stain (sensitivity ~50%).

Genital infection by herpes simplex virus (chiefly HSV-2) causing painful grouped vesicles and shallow ulcers, with recurrences from latent virus in dorsal root ganglia.

The principal oncogenic HPV types, responsible for most cervical and other anogenital cancers via E6/E7 oncoproteins.

Immunisation against HPV; the quadrivalent vaccine covers types 6, 11, 16, 18 and the nonavalent vaccine adds further high-risk types, preventing warts and oncogenic infection.

A small non-enveloped double-stranded DNA virus that infects basal keratinocytes; low-risk types cause warts, high-risk types cause anogenital cancers.

The late congenital syphilis triad of Hutchinson's teeth, interstitial keratitis, and eighth-nerve (sensorineural) deafness.

Integrated Counselling and Testing Centre — the NACP service point where HIV counselling and testing, including mandated pre-test counselling, are delivered.

A patient-applied immune-response modifier for genital warts, applied over several weeks; avoided in pregnancy.

Firmness or hardening of the tissue at the edge or base of an ulcer, palpable on examination; characteristic of the syphilitic chancre.

The WHO framework defining the five key moments for hand hygiene to prevent healthcare-associated transmission.

The patient's voluntary agreement to be tested after being given adequate information about the test, its implications, and their right to decline.

A swollen, sometimes suppurative inguinal lymph node, characteristically caused by lymphogranuloma venereum or chancroid; managed with Kit 6 (yellow).

The superficial and deep lymph node groups in the groin that drain the external genitalia, perineum, and lower limb.

Pairs of cocci seen inside neutrophils on a Gram-stained urethral smear; a presumptive marker of gonococcal infection.

A self-limiting febrile reaction (fever, rigors, headache, myalgia, transient rash worsening) within ~24 hours of the first penicillin dose, caused by antigen release from dying spirochaetes — not a penicillin allergy; do not stop penicillin.

The encapsulated Gram-negative intracellular bacterium (formerly Calymmatobacterium granulomatis) that causes donovanosis.

A potassium hydroxide preparation that dissolves host cells, revealing fungal pseudohyphae and budding yeast in candidiasis.

A vacuolated squamous epithelial cell with a perinuclear halo, characteristic of HPV infection.

Latent syphilis of more than 2 years or unknown duration; treated with benzathine penicillin G 2.4 million units IM weekly for 3 doses.

The asymptomatic stage with positive serology and no clinical signs; early latent is within 2 years of infection, late latent is more than 2 years or of unknown duration.

The HPV types responsible for the majority of genital warts; they cause benign proliferation and are not oncogenic.

An STI caused by Chlamydia trachomatis serovars L1–L3 that can present with an inguinal bubo (Kit 6, yellow).

Gently expressing discharge by stroking the urethra from base to meatus when no spontaneous discharge is present, to obtain a sample.

Dome-shaped, umbilicated papules with a central cheesy core, caused by a poxvirus; a differential of genital warts.

A greyish, painless erosion of the oral or genital mucosa seen in secondary syphilis.

The cytological hallmark of herpesvirus infection on a Tzanck smear; not specific to HSV-2, so PCR is needed for confirmation and typing.

A small bacterium increasingly recognised as a cause of non-gonococcal and persistent urethritis, with growing antimicrobial resistance.

National AIDS Control Organisation — the division of India's Ministry of Health and Family Welfare that runs the National AIDS Control Programme and issues the STI/RTI management guidelines, including the colour-coded kits.

The NACO colour-coded syndromic kit for urethral discharge (and anorectal discharge and cervicitis), combining anti-gonococcal and anti-chlamydial cover, per current NACO guidance.

The NACO colour-coded syndromic kit for vaginal discharge, metronidazole- and clotrimazole-based, per current NACO guidance.

The NACO syndromic kit for non-herpetic genital ulcer disease, providing empirical cover for both syphilis and chancroid (contents revised periodically — confirm against current NACO guidance).

The NACO syndromic kits for genital ulcer disease: Kit 3 (white) for non-herpetic ulcers (syphilis and chancroid, antibacterial) and Kit 4 (blue) for herpetic ulcers (antiviral); contents revised periodically.

The colour-coded NACO syndromic-management kit for inguinal bubo, doxycycline-based, per current NACO guidance.

The NACO algorithm step assessing cervicitis risk factors to decide whether to add cervicitis cover (Kit 1) to vaginal-discharge treatment (Kit 2).

Colour-coded pre-packaged drug kits issued under India's National AIDS Control Organisation programme for the syndromic treatment of STIs; e.g. Kit 3 (white) and Kit 4 (blue) for genital ulcers, per current NACO guidance.

India's national programme for HIV/AIDS prevention and control, under which STI/RTI services and the syndromic kits are delivered.

A Gram-negative diplococcus, the cause of gonococcal urethritis, seen as intracellular diplococci within neutrophils on a urethral smear.

Central nervous system involvement by syphilis, including tabes dorsalis, general paresis, and the Argyll Robertson pupil; diagnosed with CSF examination including CSF-VDRL.

Requires intravenous aqueous crystalline penicillin G (3–4 million units every 4 hours for 10–14 days) because benzathine penicillin does not reach treponemicidal levels in the CSF.

Urethritis not caused by the gonococcus, most commonly due to Chlamydia trachomatis, also Mycoplasma genitalium and Ureaplasma.

A negative HIV screening result, which cannot exclude infection if the patient is still within the window period after a recent exposure.

A serological test (VDRL or RPR) detecting antibody to cardiolipin; used for screening and for monitoring treatment by titre, but prone to biological false positives.

The quantitative VDRL/RPR result used to monitor treatment response; a fourfold (two-dilution) fall by 6–12 months indicates an adequate response.

The bedside triage of a genital ulcer by pain: painful ulcers suggest chancroid or herpes, painless ulcers suggest syphilis, LGV (early), or donovanosis.

The process of informing and arranging treatment for the sexual partner(s) of a patient with an STI, to interrupt transmission.

Treating the patient's sexual partner(s) regardless of symptoms to cure the patient, prevent reinfection, and interrupt transmission.

A normal anatomical variant forming a ring of tiny uniform papules at the coronal margin of the glans; not an STI and not to be treated.

Ascending infection of the female upper genital tract presenting as lower abdominal pain with cervical motion tenderness; treated with Kit 5 (red).

A controlled, incremental administration of penicillin to a penicillin-allergic patient (notably in pregnancy) so that penicillin — the only adequate treatment — can be given safely.

A patient-applied antimitotic treatment for genital warts, applied in cycles; contraindicated in pregnancy because it is teratogenic.

The counselling conducted after an HIV test that covers disclosure of the result, its meaning, and linkage to care or ongoing prevention support.

Prevention of Parent-to-Child Transmission — the programme under which pregnant women are offered routine HIV (and syphilis) screening to protect the infant.

The antenatal screen-and-treat approach that detects reactive maternal serology and treats with penicillin urgently to prevent congenital syphilis.

The counselling conducted before an HIV test that covers risk assessment, voluntary informed consent, and explanation of the window period and what the test will and will not show.

Treating a recent sexual contact of a confirmed syphilis case before their own serology returns, to prevent disease and onward transmission.

Treating a partner or patient for an infection that is considered likely on epidemiological grounds, without individual confirmatory testing.

An intramuscular penicillin preparation used as an alternative regimen in congenital syphilis (and some neurosyphilis protocols).

Inflammation of the rectum and colon, a complication of LGV particularly after receptive anal exposure.

A subcutaneous granuloma in donovanosis that mimics an enlarged inguinal lymph node but is not true lymphadenopathy.

A positive HIV screening result, which requires the established confirmatory pathway and supportive post-test counselling.

Enlargement of the lymph nodes draining the site of infection; in genital ulcers these are the inguinal nodes.

Categorising a patient's level of STI/HIV risk (e.g. lower, moderate, higher) from the sexual history in order to tailor counselling and testing.

Rapid Plasma Reagin — a non-treponemal test similar in principle and use to the VDRL.

A normal-saline preparation examined immediately under the microscope for clue cells (BV) and motile trichomonads (trichomoniasis).

The parallel-chain arrangement of Gram-negative coccobacilli on a Gram stain of chancroid exudate (also called rail-track).

A structured enquiry into a patient's sexual partners, practices, protection use, past infections, and pregnancy intentions, used to assess risk and guide screening and counselling.

Punctate haemorrhagic spots on the cervix, pathognomonic of trichomoniasis but seen clinically in only a minority of cases.

Continuous antiviral treatment (e.g. daily acyclovir or valacyclovir) for patients with frequent herpes recurrences, to reduce frequency and transmission.

A clinically recognisable cluster of symptoms and signs that, in STI care, is used to select empirical treatment covering all the common organisms that produce that cluster.

Treating a patient on the basis of a recognised clinical syndrome at first contact, rather than waiting for organism-specific laboratory confirmation.

A public-health strategy that treats a sexually transmitted infection according to the recognisable group of symptoms and signs (the syndrome) the patient presents with, rather than waiting to identify the causative organism.

Late syphilis comprising gummata, cardiovascular syphilis (aortitis, aortic regurgitation), and neurosyphilis, developing in a minority of untreated patients after years.

The four integral components of every STI consultation: contact tracing (partner notification), counselling, compliance with treatment, and condom promotion.

An antibody-only HIV test, which may take up to about 45 days after exposure to become reactive.

A point-of-care preparation made by crushing a small piece of ulcer tissue on a slide and staining it (Giemsa) to look for Donovan bodies.

Treponema pallidum Haemagglutination Assay — a treponemal confirmatory test for syphilis.

Failure of the non-treponemal titre to fall fourfold, or a sustained fourfold rise, prompting re-evaluation (including for neurosyphilis), re-treatment, and partner assessment.

The spirochaete bacterium that causes syphilis; thin, motile, microaerophilic, and uncultivable on ordinary media, visualised by dark-ground microscopy.

A confirmatory serological test (TPHA, FTA-ABS, or TPPA) detecting antibody to T. pallidum antigens; remains reactive for life and is not used for monitoring.

A provider-applied chemical ablative treatment for genital warts that is safe in pregnancy.

A sexually transmitted infection by the flagellated protozoan Trichomonas vaginalis, producing a frothy yellow-green discharge and motile flagellates on wet mount; requires partner treatment.

A bedside cytology smear from a lesion base showing multinucleated giant cells in herpesvirus infection; supportive but not specific for HSV-2 (also positive in HSV-1 and varicella-zoster).

An ulcer margin that overhangs the base, classically described in chancroid.

An abnormal discharge from the urethra (purulent, mucopurulent, or mucoid), a recognised STI syndrome managed syndromically.

Discharge from the urethra (usually with dysuria) treated empirically for gonorrhoea and chlamydia; mapped to Kit 1 (grey).

A Gram-stained slide prepared from a urethral swab, examined for neutrophils and intracellular Gram-negative diplococci.

A NACO syndromic category covering pathological vaginal discharge, commonly due to bacterial vaginosis, vulvovaginal candidiasis, or trichomoniasis.

Normally acidic (about 3.8-4.5) due to Lactobacillus lactic acid; raised above 4.5 in bacterial vaginosis and trichomoniasis, normal in candidiasis.

Venereal Disease Research Laboratory test — a non-treponemal flocculation test used to screen for syphilis and to monitor treatment response by titre.

An overgrowth of Candida (usually C. albicans) causing a curdy white discharge and intense itch, with pseudohyphae and budding yeast on KOH mount.

A test in which 10% KOH is added to the discharge; a fishy amine odour is positive and classically supports bacterial vaginosis (from polyamine production).

The interval after infection during which a diagnostic test (e.g. serology) can read falsely negative — one reason laboratory confirmation may not help at the first STI visit.