[GUM] Genital Ulcers Flashcards
what is syphilis?
an STI caused by Treponema pallidum, usually occurs through exposure to genital / mucous membrane lesions
what are the risk factors of syphilis?
- men who have sex with men (MSM)
- multiple sexual partners
- illicit drug use
- co-infection with HIV / other STIs
how is a dx of syphilis made?
microscopy +/- serology (treponemal and non-treponemal)
what other tests can you do for syphilis?
- CSF sample (neurosyphilis)
- CXR (aortic aneurysm / calcification)
pt has a painful genital ulcer. what are your differentials?
- chancroid
- genital herpes
- HIV (with herpes coinfection)
- warts
pt has a painless genital ulcer. what are your differentials?
- syphilis
- lymphogranuloma venerum
what are some non-infective differentials for genital ulcers?
- lichen planus
- eczema / psoriasis
- Behcet’s
what are the stages of syphilis?
- primary
- secondary
- latent
- tertiary
- congenital
- neurosyphilis
what is the time from initial infection for primary syphilis?
9-90 days
what are the clinical features of primary syphilis?
- painless anogenital ulcer (chancre)
- heals spontaneously, may not be noticed
what serological tests can you do for syphilis (1˚, 2˚ and 3˚)?
treponemal test + RPR/VDRL
RPR = rapid plasma reagin VDRL = venereal disease research laboratory test
what is the time from initial infection for secondary syphilis?
4-8 weeks
what are the clinical features of secondary syphilis?
- systemic disease with rash
- vasculitis
what is the time from initial infection for latent syphilis?
<2 years (early) or >2 years (late)
what are the clinical features of latent syphilis?
asx infection
what serological tests can you do for latent syphilis?
EIA = enzyme immunoassay
checks for syphilis antibodies
what is the time from initial infection for tertiary syphilis?
years
what are the clinical features of tertiary syphilis?
end-organ complications:
- cardiovascular (aortic regurgitation/aneurysm)
- neurosyphilis
- gummata
what are the clinical features of congenital syphilis?
- stillbirth
- miscarriage
- perinatal morbidity / mortality
what serological tests can you do for congenital syphilis?
maternal treponemal + non-treponemal + infant VDRL/RPR
what is the time from initial infection for neurosyphilis?
any
what are the clinical features of neurosyphilis?
- visual disturbances
- tabes dorsalis
- general paresis
what serological tests can you do for neurosyphilis?
CSF VDRL + TPHA / TPPA or FTA-ABS
what is used to treat neurosyphilis?
IV aqueous benzylpenicillin (10-14 days)
