82 STD's

Question 1

syphilis, manifestations (general)

Answer 1

mucocutaneous: genital ulcers to widespread papulosquamous eruptions to granulomatous nodules

Question 2

what % of untreated syphilis progress to 3° disease

Answer 2

33%, with 17% presenting with benign gummas, 8% CVD, and 8% neurosyphilis

Question 3

unethical study with infected black men

Answer 3

Tuskegee study

Question 4

5 diseases caused by treponemal species

Answer 4

venereal syphilis (pallidum), yaws (pallidum pertenue), endermic syphilis (pallidum endemicum), pinta (carateum), and periodontal disease (deticola, socraskii)

Question 5

what % of 2° syphilis relapses (i.e. happens again within a 1-2 year period) ?

Answer 5

25%

Question 6

latency, def

Answer 6

positive serologic test without clinical signs or sxs; infectivity may occur intermittently w presence of treponemes in the bloodstream; response to treatment is indicated by decline in RPR or VDRL titer; if treatment failure, most examine CSF

Question 7

3° syphilis, immunological features

Answer 7

small number of organisms and high cellular immune reactivity against the organism; organisms in tissues (CNS, CV system, etc) lead to damage related to host delayed-type hypersensitivity reaction –> local inflammation and gummas

Question 8

syphilis increases risk of

Answer 8

HIV infection

Question 9

chancre

Answer 9

1° syphilis; single, indolent, round/oval, indurated ulcer with regional LAD usually 3 week after sexual contact, heal spontaneously w/in a few weeks; in women they may go unnoticed esp when located intravaginally

Question 10

lab dx of syphilis

Answer 10

treponemes on darkfield microscopy of chancre fluid (most sensitive and specific), ab’s to cardiolipin (80%, i.e. non-tremonemal tests, measured by RPR or VDRL; correlate w disease activity and response to tx), ab’s to T pallidum surface proteins (treponemal tests: T pallidum hemagglutination test, TPHA; FTA-ABS) - ab’s positive for life so cannot differentiate stage of syphilis

Question 11

2° syphilis

Answer 11

hematogenous and lymphatic spread, 3-10 mo after sex contact; usually generalized, non-pruritic papulosquamous eruption (pink to violaceous to red-brown), mucosal aphthae, condyloma data in moist regions, LAD

Question 12

condyloma lata

Answer 12

manifestation of 2° syphilis

Question 13

necklace of Venus

Answer 13

manifestation of 2° syphilis, hypopigmented macule on the neck

Question 14

collarette of Biett

Answer 14

manifestation of 2° syphilis , symmetric papules and plaques with collarette of scale on palms and soles

Question 15

moth eaten alopecia

Answer 15

manifestation of 2° syphilis

Question 16

gummas

Answer 16

locally destructive lesions in skin, bone, liver, and other organs; nodular or noduloulcerative, arciform pattern; involute with scarring; disappear with tx

Question 17

neurosyphilis occurs …

Answer 17

at any stage, though classically late

Question 18

tabes dorsalis, manifestations

Answer 18

diplopia, painful paresthesias, loss of vibratory and position sense, reduced reflexes in the legs, ataxia, sphincter dysfunction, visceral pain (crisis), Argyll Robertson pupils

Question 19

stigmata of congenital syphilis

Answer 19

rhagades (radial scars at sites of previous periorificial fissures), hutchinson teeth, saddle nose, saber shins, deafness

Question 20

non-treponemal tests and response to tx

Answer 20

must see a 4-fold decline in titers 1 year after appropriate tx, otherwise, tx failure

Question 21

false-positive non-treponemal tests in:

Answer 21

pregnancy, autoimmune diseases, drug abuse, lymphoma, infectious disease (e.g. malaria), vaccinations, hepatic cirrhosis, APL syndrome, idiopathic/familial

Question 22

tx of syphilis

Answer 22

1°: penicillin G (benzathine penicillin 2.4 million units IM as a single dose); azithromycin 2g PO as a single dose
latent/2°: penicillin G IM weekly for 3 doses
neurosyphilis/ocular: aqueous penicillin G, 3-4 million units IV a4h for 10-14 days

Question 23

acute onset of fever, headache, and myalgias upon tx of early syphilis

Answer 23

Jarisch-Herxheimer reaction

Question 24

N gonorrheae pathogenesis

Answer 24

invades human cells, adhesion through pili, need iron and high CO2 to grow

Question 25

gonorrhea, disseminated infection manifestations

Answer 25

arthritis, fevers, tenosynovitis, aural cutaneous pustules, scalp abscesses (in neonates), endocarditis, meningitis

Question 26

gonorrhea, % that lack sxs

Answer 26

up to 10% of infected men and 50% of infected women

Question 27

gonococcal infection in men

Answer 27

dysuria and urethral discharge that is purulent and profuse; unilateral testicular pain and swelling accompanied by urethritis

Question 28

extragenital gonorrhea

Answer 28

pharyngeal (usually asx), rectal (asx in 50% of cases), ophthalmia (blindness)

Question 29

arthritis-dermtosis syndrome (aka gonococcemia)

Answer 29

fever, joint pain, paucilesional eruption of hemorrhagic pustules; tenosynovitis of larger joints

Question 30

what stains gonococci

Answer 30

gram stain and methylene blue

Question 31

tx of uncomplicated gonococcal infections

Answer 31

ceftriaxone 250 mg IM single dose + azithromycin 1 g PO single dose (for dual treatment of chlamydia)

Question 32

chancroid, features

Answer 32

purulent, often multiple ulcers, soft undermine edges, PAINFUL; also painful inguinal lymphadenitis - unilateral, inguinal buboes may rupture and lead to ulceration; Haemophilus ducreyi; usually low-income countries; tx like gonorrhea

Question 33

causes of PAINFUL genital ulcers:

Answer 33

herpes (2>1), chancroid (Haemophilus ducreyi)

Question 34

causes of PAINLESS genital ulcers:

Answer 34

primary syphilis, LGV (Chlamydia trachomatis serovars L1-3), Donovanosis (Klebsiella)

Question 35

lymphogranuloma venereum

Answer 35

caused by Chlamydia trachomatis serovars L1-3; endemic in part of Africa, Asia, S America; disease progresses through 3 stages: infection of genital mucosa, inguinal LAD (unilateral) with overlying erythema, and firm mass/bubo w spont drainage (through sinus tracts) and involution; also ano-genito-rectal syndrome (e.g. proctocolitis); treatment: doxycycline 100 mg PO twice daily for 3 weeks

Question 36

Donovanosis (granuloma inguinale)

Answer 36

a rare, chronic, progressive ulcerative bacterial infection w Klebsiella granulomatis; microorganisms are found with macrophages in smears or bx specimens (Donovan bodies), ulcers in the genital region