GENITAL ULCERS Flashcards
Enumerate the 4 types of genital ulcers
Syphilis Granuloma Inguinale Lymphogranuloma Venereum Chancroid
Describe the Primary lesion of Syphilis
Primary lesion: painless papule CHANCRE
Heals spontaneously within 2-6 weeks (high rate of transmission)
Describe the Secondary lesion of Syphilis
Secondary lesion: red macules & papules over palms and soles
• Condyloma lata or latum | 4
• Due to hematogenous spread of spirochetes
Describe the Latent Stage of Syphilis
Latent stage
• Lasts 2-20 years
• Infectious during 1st year
Describe the Tertiary Lesion of Syphilis
gummas (cold abscess)
Potentially destructive on different organ systems (CVS, CNS, MSK)
Diagnosis of Syphillis
Dark field microscopy or direct fluorescent antibody tests
Serologic tests (for screening) Non specific tests (RPR & VDRL) • Screening and monitoring treatment response • (+) after 4-6 weeks from exposure • Prozone phenomenon: false positive result due to excess of anticardiolipin antibody
• If (+): do a specific test Specific tests (TPI, FTA-ABS, MHA-TP) • False (+) in lupus
Treatment of Syphilis
Penicillin G (high dose) Tetracycline/Doxycycline
Granuloma
Inguinale
(Donovanosis) Causative agent
Klebsiella
granulomatosis
Granuloma
Inguinale
(Donovanosis)
Describe this disease
Not highly contagious and requires chronic exposure to acquire
disease
Starts as a nodule, becomes a painless ulcer surrounded by
granuloma tissue
Beefy red appearance of ulcer (bleeds easily when touched)
Chronic ulcerative bacterial infection of the skin and subcutaneous
tissue of the vulva
• Spread sexually & through nonsexual close contact
Granuloma
Inguinale
(Donovanosis)
diagnosis
Donovan bodies in smears & specimens
from ulcers through special silver stains
• Bipolar/safety pin appearance
Granuloma
Inguinale
(Donovanosis)
treatment
Doxycycline Alternative: Azithromycin, Ciprofloxacin, Trimethoprim – sulfamethoxazole Continue therapy until lesions have healed completely
DONOVAN - DOXY
DODO
Examine sex partners if they have had sexual contact 60 days preceding onset of symptoms
Lymphogranuloma
Venereum
causative agent
Etiology: Chlamydia
trachomatis
Secondary phase: painful adenopathy in inguinal and perirectal areas
• If untreated, infected nodes matte together (bubo)
• Classic clinical sign: groove sign (double genitocrural fold;
depression between groups of inflamed nodes)
Tertiary phase: rupture of bubo w/ formation of draining sinuses & fistulas
Lymphogranuloma
Venereum
describe this disease
Chronic infection of lymphatic tissue
Primary infection: shallow painless ulcer that heals rapidly without therapy
Lymphogranuloma
Venereum
diagnosis
Direct immunofluorescence or nucleic
acid detection from pus or aspirate of
tender lymphadenopathy
Lymphogranuloma
Venereum
treatment
Doxycycline Alternative: erythromycin base Fluctuant nodes – aspirate to prevent sinus formation
