6. MTB Step 3 - Ulcerative Genital Diseases

Question 1

CHANCROID

What is the Most Common Bacterial Cause of a Chancroid?

Answer 1

Haemophilus ducreyi - Gram-negative coccobacilli

Question 2

CHANCROID

What is the Most Common Clinical Manifestation of a Chancroid?

Answer 2

PAINFUL ulcer

Question 3

CHANCROID

1. What is the Best INITIAL Test for Chancroid?
2. What is the Most ACCURATE Test for Chancroid?

Answer 3

1. Best INITIAL Test = Gram stain (gram-negative coccobacilli)
2. Most ACCURATE Test = Culture (Nairobi medium or Mueller-Hinton agar)

Question 4

CHANCROID

What are (2) Antibiotics used to treat a Chancroid?

Answer 4

1. Ceftriaxone (IM)
2. Azithromycin (PO)

Question 5

LYMPHOGRANULOMA VENEREUM (LGV)

What are (2) Clinical Manifestations of LGV?

Answer 5

1. Large Tender Lymph nodes (“Buboes” may develop a suppurating, draining sinus tract)
2. Ulcer

Question 6

LYMPHOGRANULOMA VENEREUM (LGV)

How do you Diagnose LGV?

Answer 6

Serology + for Chlamydia trachomatis

Question 7

LYMPHOGRANULOMA VENEREUM (LGV)

What are (2) Antibiotics and (1) Procedural Treatments for LGV?

Answer 7

Antibiotics:

1. Azithromycin, or
2. Doxycycline

Procedure:

1. Aspirate the Bubo

Question 8

HERPES SIMPLEX VIRUS (Genital Herpes)

What is the Clinical Presentation of Genital Herpes?

Answer 8

Multiple Vesicles on genitalia (+/- inguinal adenopathy)

Question 9

HERPES SIMPLEX VIRUS (Genital Herpes)

How is Genital Herpes (HSV) diagnosed?

Answer 9

1. When there are Clear Vesicular Lesions present, go straight to Treatment.
2. If the Roofs come off the Vesicles and the Lesions become ulcers of unclear etiology:

• Best INITIAL Test = Tzanck prep
• Most ACCURATE Test = PCR

Question 10

HERPES SIMPLEX VIRUS (Genital Herpes)

What are (3) Medications used to treat Genital Herpes (HSV)?

Answer 10

7 - 10 Days of one of the following:

1. Acyclovir (safe in pregnancy) (use Foscarnet if herpes is resistant to acyclovir)
2. Valacyclovir
3. Famciclovir

Question 11

HERPES SIMPLEX VIRUS (Genital Herpes)

What is the ONLY Diagnostic Method to determine Viral Sensitivity for Genital Herpes (HSV)?

Answer 11

Viral Culture

Question 12

SYPHILIS

What is the responsible Pathogen for Syphilis?

Answer 12

Treponema pallidum

Question 13

SYPHILIS

What are (2) Clinical Manifestations of PRIMARY Syphilis?

Answer 13

1. Chancre
2. +/- Adenopathy

Question 14

SYPHILIS

What is the Best INITIAL Test for PRIMARY Syphilis?

Answer 14

Darkfield Microscopy

VDRL or RPR are only 75% sensitive in Primary Syphilis

Question 15

SYPHILIS

What is the Best INITIAL Treatment for PRIMARY Syphilis?

Answer 15

Penicillin - Single IM shot

Penicillin Allergy –> Doxycycline

Question 16

SYPHILIS

1. What are (3) Characteristic Symptoms of a Jarisch-Herxheimer reaction?
2. What causes a Jarisch-Herxheimer reaction?
3. What is the Treatment for Jarisch-Herxheimer reaction?

Answer 16

1. Fever, Headache, Myalgia developing 24-hours after treatment for PRIMARY Syphilis.
2. It’s a Benign, Self-Limited reaction caused by the release of Pyrogens from dying Treponemal.
3. Treat symptoms with Aspirin.

Question 17

SYPHILIS

What are (4) Clinical Manifestations of SECONDARY Syphilis?

Answer 17

1. Condylomata Lata
2. Rash
3. Alopecia Areata
4. Mucous Patch

Question 18

SYPHILIS

What are the (2) Best INITIAL Tests that can be used for diagnosing SECONDARY Syphilis?

Answer 18

Both are 100% Sensitive:

1. RPR or
2. FTA

Question 19

SYPHILIS

What is the Best INITIAL Treatment for SECONDARY Syphilis?

Answer 19

Penicillin - Single IM shot

Penicillin Allergy –> Doxycycline (same as primary syphilis)

Question 20

SYPHILIS

What are (5) possible Clinical Manifestations of TERTIARY Syphilis?

Answer 20

1. Tabes Dorsalis (neurologic)
2. Argyll-Robertson Pupil (neurologic)
3. General Paresis (neurologic)
4. Gumma (rare)
5. Aortitis (rare)

Question 21

SYPHILIS

What are the (2) Best INITIAL Tests for TERTIARY Syphilis?

Answer 21

1. RPR (75% Sensitive in blood)
2. FTA (95% Sensitive in blood)

Question 22

SYPHILIS

What is the Most ACCURATE Test for TERTIARY Syphilis?

Answer 22

FTA of CSF (100% Sensitive in CSF)

Question 23

SYPHILIS

What is the Best Treatment for TERTIARY Syphilis?

Answer 23

Penicillin (IV)

Desensitize if Penicillin-allergic

Question 24

GRANULOMA INGUINALE

What is the Clinical Manifestation for Granuloma Inguinale?

Answer 24

Rare, Beefy Red genital lesion that Ulcerates

Question 25

GRANULOMA INGUINALE

How is Granuloma Inguinale diagnosed?

Answer 25

Biopsy or “Touch Prep”

Klebsiella granulomatis, “DONOVAN bodies”

Question 26

GRANULOMA INGUINALE

What are (3) Medications used to Treat Granuloma Inguinale?

Answer 26

1. TMP/SMX (Bactrim)
2. Azithromycin
3. Doxycycline

Question 27

WARTS

How are ALL Warts (condylomata acuminata, verrucous wart, molluscum contagiosum) diagnosed?

Answer 27

Appearance (how they look)

Question 28

WARTS

What are ALL Warts (condylomata acuminata, verrucous wart, molluscum contagiosum) caused by?

Answer 28

Human Papillomavirus (HPV)

Question 29

WARTS

How are ALL Warts (condylomata acuminata, verrucous wart, molluscum contagiosum) treated?

Answer 29

Mechanical Removal

1. Surgically (large warts)
2. Imiquimod = immunostimulant –> sloughing off of wart
3. Cryotherapy, Laser removal, Trichloroacetic Acid