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First, the stop blocks the center of the beam of light that would
otherwise fill the objective lens.
Procedure
The illumination needs to be aligned and adjusted to achieve the best
image.
Look at the sample and slowly lower the condenser until the
sample is visible against a dark background and in sharpest
contrast.
Finally, adjust the view of the image with the fine focus knob.
http://public.wsu.edu/~omoto/papers/darkfield.html
http://www.cdc.gov/std/syphilis/manual-1998/CHAPT5.pdf
http://www.ruf.rice.edu/~bioslabs/methods/microscopy/dfield.htm
l
Specimen
1. The ideal specimen for darkfield examination is a serous fluid that
is rich in T. pallidum but that contains few blood cells (treponemes
may be obscured if many cells are present).
2. Consider every genital lesion in sexually active patients as syphilis
until subjected to a darkfield examination and proven otherwise.
Other lesions on the skin or mucous membranes should also be
examined when syphilis is suspected.
3. Darkfield examination of oral lesions is not recommended. All
positive darkfield tests with mouth specimens must be confirmed
by a direct fluorescent antibody test. The indigenous flora of the
oral cavity frequently contain a spiral organism, T. denticola, which is
indistinguishable from T. pallidum.
4. If topical antimicrobial therapy has been applied to a syphilitic lesion,
it may not be possible to demonstrate motile T. pallidum, even if
several specimens are examined. In this instance, an aspirated
sample from an enlarged regional lymph node may be used
for diagnosis.
Collection
1. Lesions
a.
b.
c.
d.
e.
Reference :
http://www.cdc.gov/std/syphilis/manual-1998/CHAPT5.pdf
antimalarials,
angiotensin-converting
enzyme
inhibitors,
beta
blockers, lithium, salicylates, or corticosteroids
Lack of male circumcision
Multiple sex partners, lifetime or current
Nonrecognition of ulcers in prodrome stage
Serodiscordant sex partners (i.e., one partner with herpes simplex
virus and one without)
Unprotected sexual contact
Unprotected skin-to-skin contact with ulcers
LABORATORY EVALUATION
Laboratory evaluation of an initial genital ulcer outbreak should
include culture or polymerase chain reaction testing for HSV
infection, HSV type-specific serology, serologic testing for
syphilis, and culture forH. ducreyi in settings with a high
prevalence of chancroid.
-
HSV Infection
o
Syphilis
o
Reference :
-
http://www.aafp.org/afp/2003/0715/p283.html
Chancroid
o
of T.
lymphogranuloma venereum
o
PALPATION
- Palpate any abnormality of the penis, noting any tenderness or
induration.
- Palpate the shaft of the penis between your thumb and first two
fingers, noting any induration. Palpation of the shaft may be
omitted in a young, asymptomatic male patient.
- If you retract the foreskin, replace it before proceeding on to
examine the scrotum.
The Scrotum and Its Contents
INSPECTION
Inspect the scrotum, including:
_ The skin. Lift up the scrotum so that you can see its posterior surface.
_ The scrotal contours. Note any swelling, lumps, or veins.
PALPATION
- Palpate each testis and epididymis between your thumb and first
two fingers.
o Note size, shape, consistency, and tenderness; feel for
any nodules.
o Pressure on the testis normally produces a deep visceral
pain.
- Palpate each spermatic cord, including the vas deferens,
between your thumb and fingers from the epididymis to the
superficial inguinal ring.
o Note any nodules or swellings.
o Swelling in the scrotum other than the testicles can be
evaluated by transillumination. After darkening the room,
shine the beam of a strong flashlight from behind the
scrotum through the mass. Look for transmission of the
light as a red glow.
Reference :
- Bates Guide to Physical Examination and History Taking