Bafl Exam 3: Bacterial Stds And Syphilis

Front 1

Syphilis has enhanced expression of what co-HIV receptor?

Back 1

CCR-5

Front 2

How long after infection does the primary lesion of syphilis develop? What is the primary lesion? Causative agent?

Back 2

Treponema pallidum

Primary lesion develops 10-90 days after infection as a painless ulcer (genital > lips > tongue > breast > index finger > anus)

Front 3

What is the most sensitive and specific method for diagnosis of primary syphilis?

Back 3

dark field microscopy

Front 4

What can cause a false positive RPR?

Back 4

vaccinations, infections, pregnancy, SLE, liver dz, IVDU, advancing age

Front 5

What is the prozone phenomenon?

Back 5

Large amount of antibody blocks the antibody-antigen reaction, causing a false negative test

MC associated with secondary syphilis, HIV co infection, and pregnancy

Front 6

stage of syphilis?

Back 6

secondary!

Front 7

Clinical manifestations of secondary syphilis? When do they occur?

Back 7

80% develop a generalized, non pruritic papulosquamous eruption, condyloma lata, corymbose syphilis (flower cluster of lesions), patchy 'moth eaten' alopecia

Occurs simultaneously about 6-9 weeks after primary genital ulcer heals; lasts 4-12 weeks

Front 8

Syphilitic latency is the period between healing of clinical lesions and appearance of late manifestation. Diagnostic profile of latent syphilis?

Back 8

1/3 will have non reactive RPR and be asymptomatic for the rest of their lives (only the FTA-ABS will remain positive)

1/3 will remain asymptomatic but will be RPR, VDRL, FTA-ABS positive

1/3 will develop tertiary syphilis

Front 9

+RPR

Back 9

GUMMA!

Tertiary syphilis. Destructive lesions in skin, bones, liver and other organs.

Front 10

Loss of sensation, pain and swelling. What is the most common cause?

Back 10

Charcot joint

MC cause is diabetic neuropathy, can also be seen in tertiary syphilis

Front 11

Cardiac complications of tertiary syphilis?

Back 11

Cardiovascular syphilis typically after 15-20 years. Occurs in 8-10% of untreated individuals. Predilection for vasa vasorum of proximal aorta --> aortic aneurysm

Front 12

Neurosyphilis can occur at any stage of syphilis (may present earlier if HIV co infection). What is Tabes Dorsalis?

Back 12

diplopia, lightening pains, loss of vibratory and position sense, reduced reflex in legs, ataxia, argyll robertson pupils, sphincter dysfunction

Front 13

What is Hutchinson's Triad?

Back 13

Interstitial keratitis, peg shaped incisors, neural deafness

Front 14

Signs of early congenital syphilis?

Back 14

saddle nose, frontal bossing, saber shins, hutchinsons teeth, mulberry molars, rhagades, deafness, interstitial keratitis

Front 15

Treatment for syphilis?

Back 15

Normal: 2-4 milliunits x 1 of PCN G

HIV: 2-4 milliunits x 3 of PCN G

Front 16

After treatment of syphilis, how often do you have to follow up RPR?

Back 16

CDC recommends checking at 6 and 12 months for normal people, 3,6,9,12,24 months for HIV co infection

Front 17

Causative agent of gonorrhea?

Back 17

neisseria gonorrhea (gram negative diplococci)

Front 18

Clinical features of gonorrhea in men? Complications?

Back 18

dysuria and purulent discharge

epididymitis, prostatitis, vesiculitis

Front 19

Clinical features of gonorrhea in women?

Back 19

Primary site of infection is endocervix --> discharge, dysuria, intermenstrual bleeding, menorrhagia

Front 20

SX of PID?

Back 20

lower abdominal pain, adnexal tenderness, fever, leukocytosis

Front 21

What is Fitz Hugh Curtis syndrome?

Back 21

peri hepatitis + PID

Front 22

Risk factors for disseminated gonococcal infection?

Back 22

Gonococcemia: risk factors include menstruation, complement deficiency

Front 23

Treatment for gonorrhea?

Back 23

Ceftriaxone 250mg x1

Empirically treat for chlamydial infection as well: azithromycin 1gm x 1, or doxy 100mg po BID x 7 days

Front 24

Cause of chancroid?

Back 24

Haemophilus ducreyi

PAINFUL genital ulcer

Front 25

Lymphogranuloma venerguem is caused by?

Back 25

chlamydia trachomatis, L 1-3

Front 26

Clinical features of LGV?

Back 26

painless genital ulcer, groove sign (inguinal lymphadenopathy), bubos

Front 27

Treatment?

Back 27

Groove sign of LGV!

doxycycline 100mg BID x 3 weeks

Front 28

Donovanosis is caused by?

Back 28

Klebsiella granulomatis

Front 29

Clinical features of donovanosis?

Back 29

painless, beefy red, friable genital ulcer

Front 30

DDX for painful genital ulcers?

Back 30

herpes (HSV), chancroid (h ducreyi), crohns

Front 31

DDX for painless genital ulcers?

Back 31

primary syphilis (t pallidum), LGV (c trachomatis), donovanosis (klebsiella)