Exam 2 - Syphilis and Chancroid

Question 1

Most common organism causing syphilis

Answer 1

Spirochete (treponema pallidum)

Question 2

Syphilis: general presentation

Answer 2

Genital ulcerative disease that can become a systemic illness

Question 3

True/false: Syphilis may be asymptomatic or have several physical characteristics suggestive of other conditions

Answer 3

True

Question 4

Primary stage of syphilis

Answer 4

Chancre is a painless indurated ulcerated lesion (usually develops after 10-90 days)

• Presents as papule filled with purulent discharge containing spirochaete and highly infectious
• Erodes into a nontender, well delineated area of induration
• Point of entry for other infections (e.g. STIs, herpes, HIV)

May heal spontaneously in 2-8 weeks

Question 5

Secondary stage of syphilis

Answer 5

Undiagnosed, untreated infection may progress to systemic illness 4-10 weeks after initial infection

• Rash that appears on palms, soles, trunk
• Alopecia, condylomata lata, mucocutaneous lesions
• Systemic viral-like symptoms: low grade fever, malaise, headache, sore throat, generalized adenopathy

Question 6

What are condylomata lata?

Answer 6

Highly contagious, flat, moist warts that occur in skin folds (e.g. vulva and perianal area)

Seen in secondary stage of syphilis

Question 7

Latent (hidden) stage of syphilis

Answer 7

Following resolution of secondary syphilis symptoms

• If untreated, infected person will not have symptoms for a period of time, but still be contagious
• Those infected >1 year are classified as being in the late latent stage of syphilis or syphilis of unknown duration

Question 8

Tertiary (late) stage of syphilis

Answer 8

Can be 1-30 years later

• Gummatous lesions throughout body
• Granulomas throughout the body –> causes extensive damage, CVD (e.g. aortic valve disease, aortic aneurysm, CAD)

Question 9

During what stage can neurosyphilis occur?

Answer 9

Can occur during any stage

Symptoms: CN dysfunction, meningitis, stroke, altered MS, auditory or ophthalmic abnormalities

Question 10

Syphilis: screening and diagnosis

Answer 10

• Definitive diagnosis of early syphilis through examining exudate from lesion/tissue with darkfield microscopy
  
  • Presumptive diagnosis via non-treponemal test (e.g. VDRL or RPR)
  • Followed by confirmatory fluorescent treponemal antibody absorption test (FTA-ABS) or passive particle agglutination assay (TP-PA)

Question 11

Syphilis: differential diagnosis

Answer 11

• Chancroid
• HSV
• HIV
• Condyloma
• Scabies
• Drug eruption

Question 12

Syphilis: treatment for primary and secondary infection

Answer 12

Benzathine PCN G 2.4 million units IM single dose

Alternatives

• Doxycycline 100mg PO BID for 14 days
• Tetracycline 500mg QID for 14 days

Question 13

Syphilis: treatment for tertiary infection

Answer 13

Benzathine PCN G 2.4 million units IM once a week for three doses

Question 14

Syphilis: treatment during pregnancy

Answer 14

Benzathine PCN G 2.4 million units IM single dose

• PCN allergic patients should be desensitized
• Monitor for Jarisch-Herxheimer reaction
• May cause preterm labor or fetal distress in first 24 hours of treatment

Question 15

What are chancroids?

Answer 15

Soft, painful lesions with associated inguinal lymphadenopathy that is transmitted through mucous membranes during sex (NOT like syphilis chancre)

• Can progress to superlative large lesions and become necrotic (e.g. boboes)

Question 16

Most common organism causing chancroids

Answer 16

Haemophilus ducreyi

Question 17

True/false: Chancroids are a risk factor for transmitting HIV

Answer 17

True

Question 18

Where would you most likely find an increased incidence of chancroids in the U.S.?

Answer 18

Southwestern U.S. and more common in sex workers

Question 19

Chancroid: diagnostic testing

Answer 19

Diagnosis presumed with 1+ painful genital ulcers in region of lymphadenopathy

• Rule out syphilis and HSV

Question 20

Chancroid: treatment

Answer 20

• Azithromycin
• Ceftriazone
• Ciprofloxacin
• Erythromycin