82 STD's Flashcards
syphilis, manifestations (general)
mucocutaneous: genital ulcers to widespread papulosquamous eruptions to granulomatous nodules
what % of untreated syphilis progress to 3° disease
33%, with 17% presenting with benign gummas, 8% CVD, and 8% neurosyphilis
unethical study with infected black men
Tuskegee study
5 diseases caused by treponemal species
venereal syphilis (pallidum), yaws (pallidum pertenue), endermic syphilis (pallidum endemicum), pinta (carateum), and periodontal disease (deticola, socraskii)
what % of 2° syphilis relapses (i.e. happens again within a 1-2 year period) ?
25%
latency, def
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
3° syphilis, immunological features
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
syphilis increases risk of
HIV infection
chancre
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
lab dx of syphilis
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
2° syphilis
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
condyloma lata
manifestation of 2° syphilis
necklace of Venus
manifestation of 2° syphilis, hypopigmented macule on the neck
collarette of Biett
manifestation of 2° syphilis , symmetric papules and plaques with collarette of scale on palms and soles
moth eaten alopecia
manifestation of 2° syphilis
gummas
locally destructive lesions in skin, bone, liver, and other organs; nodular or noduloulcerative, arciform pattern; involute with scarring; disappear with tx
neurosyphilis occurs …
at any stage, though classically late
tabes dorsalis, manifestations
diplopia, painful paresthesias, loss of vibratory and position sense, reduced reflexes in the legs, ataxia, sphincter dysfunction, visceral pain (crisis), Argyll Robertson pupils
stigmata of congenital syphilis
rhagades (radial scars at sites of previous periorificial fissures), hutchinson teeth, saddle nose, saber shins, deafness
non-treponemal tests and response to tx
must see a 4-fold decline in titers 1 year after appropriate tx, otherwise, tx failure
false-positive non-treponemal tests in:
pregnancy, autoimmune diseases, drug abuse, lymphoma, infectious disease (e.g. malaria), vaccinations, hepatic cirrhosis, APL syndrome, idiopathic/familial
tx of syphilis
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
acute onset of fever, headache, and myalgias upon tx of early syphilis
Jarisch-Herxheimer reaction
N gonorrheae pathogenesis
invades human cells, adhesion through pili, need iron and high CO2 to grow
gonorrhea, disseminated infection manifestations
arthritis, fevers, tenosynovitis, aural cutaneous pustules, scalp abscesses (in neonates), endocarditis, meningitis
gonorrhea, % that lack sxs
up to 10% of infected men and 50% of infected women
gonococcal infection in men
dysuria and urethral discharge that is purulent and profuse; unilateral testicular pain and swelling accompanied by urethritis
extragenital gonorrhea
pharyngeal (usually asx), rectal (asx in 50% of cases), ophthalmia (blindness)
arthritis-dermtosis syndrome (aka gonococcemia)
fever, joint pain, paucilesional eruption of hemorrhagic pustules; tenosynovitis of larger joints
what stains gonococci
gram stain and methylene blue
tx of uncomplicated gonococcal infections
ceftriaxone 250 mg IM single dose + azithromycin 1 g PO single dose (for dual treatment of chlamydia)
chancroid, features
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
causes of PAINFUL genital ulcers:
herpes (2>1), chancroid (Haemophilus ducreyi)
causes of PAINLESS genital ulcers:
primary syphilis, LGV (Chlamydia trachomatis serovars L1-3), Donovanosis (Klebsiella)
lymphogranuloma venereum
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
Donovanosis (granuloma inguinale)
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
