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85 Cards in this Set
- Front
- Back
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Latin name for syphillis
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Treponema pallidum
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Stages of syphillis
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Primary: painless ulcer (chancre)
Secondary: fever, adenopahty, headaches, myalgias, weight loss, rash Tertiary: neuro, aortitis |
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How long after infection with syphillis does ulcer appear?
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10-90d (avg 21)
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Classic syphillitic chancre (though not most common):
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Painless, firm, round, nodular edges
Heals in 3-6 weeks |
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How long for a syphillitic chancre to heal?
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3-6 weeks
In HIV, atypical and persistent |
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Where do you see the rash of secondary syphillis?
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Across body, including palms and soles
Mucous membrane lesions (condyloma lata) Dime sized, scaly, coppery Can look like viral exanthem Can lead to alopecia/hair loss, esp eyebrows |
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When does secondary syphillis rash appear?
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4-10 months after pirmary
May wax and wane for months Eventually resolves |
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When does tertiary sypillis appear?
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Years after infection
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What portion of those infected with syphillis get tertiary?
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1/3
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What organ systems affected in tertiary syphillis?
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Nervous system (eyes, 8th nerve (deafness/vertigo),
Cardiovascular (aoritis, endarteritis, aneurysm) Gummatous (big erosive granulomas...liver, bones, testes, skin) Fever, jaundice, anemia, nighttime skeletal pain |
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How to diagnose syphillis:
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Primary: darkfield exam seeking spirochetes
Serology may be negative No cx. No PCR |
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What are the non-treponemal syphillis serologic tests?
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(Non-treponemal) RPR, VDRL, ART, STS
Levels correlate with dz activity 4-fold change (2 dilutions) meaningful Usually become non-reactive after treatment (may take years) |
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What are the treponemal syphillis serological tests?
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Treponemal antibody tests
FTA-ABS MHA-TP TP-PA Levels don't correlate with dz activity...most positive forever. If treated in primary stage, 15-20% will turn negative |
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What may cause a false-positive non-treponemal syphillis test?
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Lupus
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What may cause a false positive trponemal syphillis test?
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Prior infection with other treponema
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How do you dx neurosyphillis?
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Serology tests insensitive/nonspecific
CSF-VDRL (insensitive but specific) CSF FTA-AB (sensitive, but not specific) CSF WBC and protein abnormalities (can show syphillis even if above negative) Follow to evaluate treatment efficacy |
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How to treat primary, secondary and early latent (up to one year) syphillis:
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Benzathine PCN G 2.4 million IM x 1
Alternatives: Tetracyc or doxy x 14d Rocephin 1gm qd x 14 d Azithro 2g x 1 (but resistance) |
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How to treat late latent (>1 year since infection) syphillis
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Benzathine PCN G 2.4 million units IM Q week x 3 weeks
Alt: Tetracycline or doxy x 28 d Rocephin/Azithro untested |
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What can you treat pregnant women with in pregnancy for syphillis?
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Erythromycin
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Treatment for neurosyphillis:
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Aqueous crystalline PCN G IV 18-24 million unitis divide q4 hours x 10-14 days
Alt: Procain PCN G 2.4million units QD x 14d PLUS probenicid 500mg QID x 14 d Rocephin 2g 1V x 10-14d WHO says tetracycline/doxy x 30d Some add Benzathine PCN q wk x 3 |
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How to decide to treat for congenital syphillis?
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ID syphillis in mother
Is mom adequately treated? Clinical/lab/radiological evidence of dz in infant? Compare maternal and infant non-treponemal serology titres |
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What is the most common cause of genital ulcer dz in africa?
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Herpes
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True or false: Most herpes infections are asymptomatic
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TRUE. Can still shed virus
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Describe herpes ulcer:
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Initially vessicle
Rupture to form shallow ulcers Painful, multiple |
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Which form of herpes has more severe primary disease?
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HSV I
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Which form of herpes has more frequent relapses?
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HSV II
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Complications of HSV?
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Congenital HSV
HSV encephalitis (HSVI) /meningitis (from HSV I and II) |
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When might a mom pass HSV to infant?
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Most risK; Primary HSV late in pregnancy
Recurrent outbreak at delivery Hx of outbreaks but non at delivery |
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How to dx HSV?
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Direct from the lesion (culture, direct fluorescent antibody, direct antigen, Tzank)
Serology (are type specific) PCR (useful in CSF) |
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Treatment of HSV?
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Acyclovir/Valcyclovir/Famvir
For primary and recurrent dz To reduce transmission |
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What organism causes chancroid?
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Hemophillus ducreyi
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Where is chancroid commonly found?
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Africa, SE asia, Caribbean
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What are common coinfections of chancroid?
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HIV
Syphillis |
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Is the ulcer of chancroid painful?
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YES
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What are chancroid ulcers associated with?
PATHOGNOMONIC |
Painful buboes (lymph nodes) that may suppurate and drain
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How to dx chancroid?
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Try to culture (sensitivity <80%)
PCR (not FDA approved) Clinical |
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Treatment of chancroid?
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Azithro 1g
Rocephin 250mg x 1 Cipro 500mg bid x 3 d Emycin 500mg tid x 3d |
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What's the difference between chancre and chancroid?
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Chancre is the non-painful lesion of primary syphillis
Chancroid is an illness of painful ulcer and buboes |
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What organism causes lyphogranularum vereneum (LGV)?
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Chlamydia trachomatis L1, L2, L3
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Are the ulcers of LGV painful?
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NO
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Are the lymph nodes of LGV painful?
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Yes
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Geographic distribution of LGV?
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SE asia, africa, central america, caribbean
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How many stages of LGV disease?
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3
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What is the first stage of LGV?
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Painless ulcers 3d-6wks after exposure
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What is second stage of LGV?
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2-6 wks after stage 1 and ulcers resolve. Painful, unilateral, lymphadenopathy. 1/3 supperate; rest become hard mass
fever, myalgias, arthralgias In women, 70% get no inguinal nodes but back pain from painful pelvic nodes Systemic spread: arthritis, hepatitis, pneumonitis |
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What are the systemic symptoms (occasional) of LGV?
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Arthritis
Hepatitis Pneumonitis |
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What is the third stage of LGV?
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Genitoanorectal syndrome
Women > Men Fever, pain, tenesmus, pruritis Purulent/bloody diarrhea Proctocolitis Abscesses, fistulas, strictures Elephantiasis of genitals MAY BE FATAL |
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In what population is LGV an emerging opportunisitic infection?
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Gay men in Europe
Anorectal form, normally seen in women (3rd stage) |
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Diagnosis of LGV?
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Culture (specialized cell media)
Serology (complement fixation titres > 1:64 |
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Treatment of LGV?
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Doxy 100 BID x 21d
Emycin 500 qid x 21d Maybe azith 1g x 3 wks Aspirate buboes (DO NOT INCISE) |
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What is Donovanosis?
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Caused by Klebsiella granulomatis
Granuloma Inguinale |
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What is the organism causing granuloma inguinale
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Klebsiella granulomatis
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Geographic distribution of granuloma inguinale?
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India, PNG, austrailasia, s. africa
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Are the ulcerations of granuloma inguinale painful?
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No
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Describe the ulcers of granuloma inguinale...
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Painless
Beefy red, bleed easily Sclerotic/hypertrophic/necrotic May be superinfected |
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Diagnosis of granuloma inguinale?
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Donovan bodies seen on tissue crush biopsy
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Treatment of granuloma inguinale
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doxy 100mg BID x 3 weeks
Bactrim ds bid x 3 weeks Cipro 750 bid x 3 weeks Eymcin 500 qid x 3 weeks Zithro 1g x 3 weeks |
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When might granuloma inguinale relapse?
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6-18 months
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Which STDs cause ulcerations?
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Syphillis
HSV Chancroid Lymphgranularum venerum Granuloma inguinale (donovanosis) |
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Of the ulcerating STDs, which ones have lymphadenopathy?
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HSV (painful)
Chancroid (painful buboes) LGV (LATER painful and hard buboes) |
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Of the ulcerating stds, which ones are painful?
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HSV
Chancroid |
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Of the ulcerating STDs, which ones are painless?
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Syphillis
LGV Granuloma inguinale |
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What organism causes gonorrhea?
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Neisseria gonorrhoea
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What is the presentation of gonorrhea in men?
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Painful urethritis
Occasionally epididimitis |
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What is the presentation of gonorrhea in women?
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Mucopurulent cervicitis
Vag d/c Dypsarenia Urethritis PID TOA Extension to liver capsule (Fitz-Hugh Curtis syndrome) |
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What is the syndrome of liver pain in gonorrhea called?
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Fitz Hugh Curtis syndrome
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other
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andere
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Describe disseminated gonococcal infection
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After 1-2% of mucosla infections
Petecchial/pustular skin lesions Migratory polyarthralgias Tenosynovitis (wrists, hand, achilles) Fever Septic arthritis (knee) Meningitis Endocarditis |
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Describe neonatal gonococcal dz
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Ophthalmia neonatorum (severe conjnctivitis 2-5 d post birth)
Sepsis Arthritis Inflammation at monitor sites |
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What organism causes ophthalmia neonatorum?
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Gonorrhea
(also chlamydia, moraxella) |
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Are the lymph nodes of LGV painful?
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Yes
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Geographic distribution of LGV?
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SE asia, africa, central america, caribbean
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How many stages of LGV disease?
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3
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What is the first stage of LGV?
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Painless ulcers 3d-6wks after exposure
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What is second stage of LGV?
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2-6 wks after stage 1 and ulcers resolve. Painful, unilateral, lymphadenopathy. 1/3 supperate; rest become hard mass
fever, myalgias, arthralgias In women, 70% get no inguinal nodes but back pain from painful pelvic nodes Systemic spread: arthritis, hepatitis, pneumonitis |
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What are the systemic symptoms (occasional) of LGV?
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Arthritis
Hepatitis Pneumonitis |
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What is the third stage of LGV?
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Genitoanorectal syndrome
Women > Men Fever, pain, tenesmus, pruritis Purulent/bloody diarrhea Proctocolitis Abscesses, fistulas, strictures Elephantiasis of genitals MAY BE FATAL |
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In what population is LGV an emerging opportunisitic infection?
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Gay men in Europe
Anorectal form, normally seen in women (3rd stage) |
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Diagnosis of LGV?
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Culture (specialized cell media)
Serology (complement fixation titres > 1:64 |
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Treatment of LGV?
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Doxy 100 BID x 21d
Emycin 500 qid x 21d Maybe azith 1g x 3 wks Aspirate buboes (DO NOT INCISE) |
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Symptoms of trichomonas vaginalis?
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White frothy discharge
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Treatment of trichomonas?
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Flagyl, Tinidazole
Treat partner |
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Diagnosis of trichomonas?
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Wet mount
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Bacterial vaginosis symptoms?
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Malodorous vaginal discharge
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Treatment of BV?
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Flagyl, tinidazole (high recurrence rate - 30%)
Treating partner doesn't help |
