[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)
what is used to treat latent syphilis?
IM benzathine benzylpenicillin once only
what is used to treat syphilis (1˚, 2˚ and 3˚)?
IM benzathine benzylpenicillin 3 doses over 2 weeks
what is the Jarish-Herxheimer reaction?
an acute febrile illness occurring within the first 24 hours after treatment
sx: acute fever, headache, myalgia
painless ulcer, painful unilateral inguinal lymphadenopathy and proctocolitis. dx?
LGV (lymphogranuloma venerum)
painful ulcer and lymphadenopathy. dx?
chancroid
what is the 1st line ix for syphilis if a lesion is present?
dark field microscopy from the lesion
+ve result = coiled spirochaete bacterium with corkscrew appearance and motility
what is the 1st line ix for syphilis if no lesion is present?
treponema serological testing (several types), +ve in active/past infection
what should be done if you diagnose a pt with syphilis?
refer to GUM to ensure appropriate testing, contact tracing and notification
why is it important to get early rx for syphilis?
curative and prevents long term complications
