Path: STDs

Question 1

What is endarteritis obliterans?

Answer 1

underlying pathophysiology of syphilis:
initiated by invasion of small arteries and arterioles
perivascular lymphoplasmacytic infiltrate
endothelial hypertrophy and proliferation
intimal fibrosis via fibroblast proliferation
ischemic necrosis
focal granulomas

Question 2

What is the timing of events in primary syph?

Answer 2

incubation avg 21 days (9-90)
chancre heals in 3-6 wks
regional lymphadenopathy 1-2 wks after chancre, may persist for months
secondary begins 2-10 wks after - chancre may still be there

Question 3

What is a condyloma lata?

Answer 3

part of secondary syph - areas of coalesced papules teeming w spirochetes, highly infectious

Question 4

What are general features of the secondary stage of syph?

Answer 4

constitutional symptoms

resolves after about 6 wks

Question 5

What are the different types of neurosyphilis?

Answer 5

asymptomatic but may have CSF abnormalities
meningovascular: inflammatory w EO leading to infarcts
parenchymatous: degenerative w neuron destruction in cortex –> paresis
tabes dorsalis: demyelination of post columns, dorsal roots and ganglia –> ataxia, foot drop, paresthesias

Question 6

What are the CV effects of tertiary syph?

Answer 6

EO of vasa vasorum of aorta
medial necrosis and destruction of elastic tissue
saccular aneurysms in ascending aorta
cusp distortion, aortic regurgitation
coronary artery stenosis
linear calcifications on CXR

Question 7

What are the features of early congenital syph?

Answer 7

desquamating cutaneous lesions on palms, soles, perineum
snuffles = chronic rhinitis
hepatomegaly, extramedullary hepatopoiesis, portal tract inflammation
osteo/perichondrotis - nasal bridge, tibia
interstitial fibrosis in lungs

Question 8

What are the features of late congenital syph?

Answer 8

Hutchinson’s triad: notched central incisors, interstitial keratitis w blindness, deafness from 8th CN damage
Clutton’s joints: bilateral knee degeneration
gummas –> saddle nose, tibia
new bone formation and bowing of shins

Question 9

What are the specific treponemal tests used?

Answer 9

FTA-abs, EIA (for high volume), TPPA
testing always better for secondary>primary>tertiary
TPPA more specific than EIA

Question 10

What type of syph is VDRL a better test for?

Answer 10

neurosyph

Question 11

What kinds of cells are used to culture chlamydia?

Answer 11

McCoy cells

Question 12

What histology is present in LGV?

Answer 12

stellate, suppurating granulomas in ulcerating lesions and involved lymph nodes