[GUM] Genital Ulcers

Question 1

what is syphilis?

Answer 1

an STI caused by Treponema pallidum, usually occurs through exposure to genital / mucous membrane lesions

Question 2

what are the risk factors of syphilis?

Answer 2

• men who have sex with men (MSM)
• multiple sexual partners
• illicit drug use
• co-infection with HIV / other STIs

Question 3

how is a dx of syphilis made?

Answer 3

microscopy +/- serology (treponemal and non-treponemal)

Question 4

what other tests can you do for syphilis?

Answer 4

• CSF sample (neurosyphilis)

- CXR (aortic aneurysm / calcification)

Question 5

pt has a painful genital ulcer. what are your differentials?

Answer 5

• chancroid
• genital herpes
• HIV (with herpes coinfection)
• warts

Question 6

pt has a painless genital ulcer. what are your differentials?

Answer 6

• syphilis

- lymphogranuloma venerum

Question 7

what are some non-infective differentials for genital ulcers?

Answer 7

• lichen planus
• eczema / psoriasis
• Behcet’s

Question 8

what are the stages of syphilis?

Answer 8

1. primary
2. secondary
3. latent
4. tertiary
5. congenital
6. neurosyphilis

Question 9

what is the time from initial infection for primary syphilis?

Answer 9

9-90 days

Question 10

what are the clinical features of primary syphilis?

Answer 10

• painless anogenital ulcer (chancre)

- heals spontaneously, may not be noticed

Question 11

what serological tests can you do for syphilis (1˚, 2˚ and 3˚)?

Answer 11

treponemal test + RPR/VDRL

RPR = rapid plasma reagin
VDRL = venereal disease research laboratory test

Question 12

what is the time from initial infection for secondary syphilis?

Answer 12

4-8 weeks

Question 13

what are the clinical features of secondary syphilis?

Answer 13

• systemic disease with rash

- vasculitis

Question 14

what is the time from initial infection for latent syphilis?

Answer 14

<2 years (early) or >2 years (late)

Question 15

what are the clinical features of latent syphilis?

Answer 15

asx infection

Question 16

what serological tests can you do for latent syphilis?

Answer 16

EIA = enzyme immunoassay

checks for syphilis antibodies

Question 17

what is the time from initial infection for tertiary syphilis?

Answer 17

years

Question 18

what are the clinical features of tertiary syphilis?

Answer 18

end-organ complications:

• cardiovascular (aortic regurgitation/aneurysm)
• neurosyphilis
• gummata

Question 19

what are the clinical features of congenital syphilis?

Answer 19

• stillbirth
• miscarriage
• perinatal morbidity / mortality

Question 20

what serological tests can you do for congenital syphilis?

Answer 20

maternal treponemal + non-treponemal + infant VDRL/RPR

Question 21

what is the time from initial infection for neurosyphilis?

Answer 21

any

Question 22

what are the clinical features of neurosyphilis?

Answer 22

• visual disturbances
• tabes dorsalis
• general paresis

Question 23

what serological tests can you do for neurosyphilis?

Answer 23

CSF VDRL + TPHA / TPPA or FTA-ABS

Question 24

what is used to treat neurosyphilis?

Answer 24

IV aqueous benzylpenicillin (10-14 days)

Question 25

what is used to treat latent syphilis?

Answer 25

IM benzathine benzylpenicillin once only

Question 26

what is used to treat syphilis (1˚, 2˚ and 3˚)?

Answer 26

IM benzathine benzylpenicillin 3 doses over 2 weeks

Question 27

what is the Jarish-Herxheimer reaction?

Answer 27

an acute febrile illness occurring within the first 24 hours after treatment

sx: acute fever, headache, myalgia

Question 28

painless ulcer, painful unilateral inguinal lymphadenopathy and proctocolitis. dx?

Answer 28

LGV (lymphogranuloma venerum)

Question 29

painful ulcer and lymphadenopathy. dx?

Answer 29

chancroid

Question 30

what is the 1st line ix for syphilis if a lesion is present?

Answer 30

dark field microscopy from the lesion

+ve result = coiled spirochaete bacterium with corkscrew appearance and motility

Question 31

what is the 1st line ix for syphilis if no lesion is present?

Answer 31

treponema serological testing (several types), +ve in active/past infection

Question 32

what should be done if you diagnose a pt with syphilis?

Answer 32

refer to GUM to ensure appropriate testing, contact tracing and notification

Question 33

why is it important to get early rx for syphilis?

Answer 33

curative and prevents long term complications