HSV, Syphilis, Chancroid

Question 0

HSV prodromal symptoms?

Answer 0

Burning, itching, tingling

Question 1

Neonatal herpes infection – types of disease? Majority due to exposure when? The rest?

Answer 1

1. Disseminated infection
2. Encephalitis, eyes, skin, mucosa
3. Asymptomatic

Exposure to fluids/secretions of genital tract

5 to 10% – antepartum period Transplacentally (During primary episodes or significant virema)

Question 2

Drugs used against HSV-1 and HSV-2? Effect of drugs?

Answer 2

Acyclovir – reduces viral shedding, pain, faster healing of lesions

Also valacyclovir, famciclovir

Question 3

Mother with HSV – Prior to labor?

If positive?

Answer 3

1. Question about presence of prodromal symptoms
2. Examination of perianal area + speculum examination of the vagina and cervix for lesions

If positive, C-section

Question 5

Tests for syphilis which become negative with effective treatment? Which will remain positive for life?

Answer 5

Non-treponemal test – VDRL, RPR (venereal disease research laboratory, rapid plasma reagin)

Specific serologic tests – MHA-TP, FTA-ABS (Micro-hemagglutinin antibody against Treponema pallidum and fluorescent-labeled treponemal antibody absorption)

Question 6

Patient with genital ulcer – next steps?

Answer 6

1 RPR (if positive, give IM penicillin) + HSV viral culture (if positive give acyclovir)

2. If both negative, perform dark field microscopy (If positive give IV penicillin)
3. If negative, biopsy and presume chancroid

Question 7

When to hospitalized for HSV?

Answer 7

Encephalopathy or urinary retention

Question 8

Syphilis – timing of:

1. incubation period?
2. Primary?
3. Secondary?
4. Latent period?

Answer 8

1. 10-90 days
2. Three weeks after exposure lasting 2-6 weeks without therapy
3. 9 weeks after primary chancre
4. Early latent (less than 1 year in duration) versus late latent (over 1 year in duration)

Question 9

Features of primary syphilis? Secondary? Tertiary?

Answer 9

1. Indurated nontender chancre
2. Maculopapular rash on palms and soles + condylomata lata
3. Optic atrophy, tabes dorsalis, aortic aneurysms (cardiac & effects)

Question 10

Syphilis – treatment (for varying disease states, if allergic, pregnant)

Answer 10

1. One injection of penicillin if primary, secondary, early latent disease
2. Three weekly injections of IM penicillin if late latent or tertiary disease
3. if neurosyphilis – IV penicillin
4. If allergic to penicillin – erythromycin or doxycycline
5. Pregnant – penicillin is the only effective treatment to prevent congenital syphilis

Question 11

Post therapy follow-up for syphilis? Expectations?

Answer 11

Nontreponemal test every three months for one year – expect fourfold fall in three months reaching a negative titer in one year

If no falls in titer, do LP to rule out neurosyphilis

Question 12

Gram stain of ulcer with ragged edges on necrotic base? Tx?

Answer 12

Chancroid – Gram stain shows “school of fish”

Azithromycin or IM Ceftriaxone

Question 14

Presentation of HSV versus syphilis versus chancroid

Answer 14

Painful, multiple ulcers, constitutional symptoms, inguinal adenopathy

Painless, single ulcer with well demarcated border and clean base, painless or slightly painful inguinal adenopathy

Painful, multiple ulcers, irregular borders with necrotic bases, painful inguinal adenopathy