Sexually transmitted differential diagnosis

Question 1

Chancre DDX

Answer 1

Chlamydia - painful (soft) “weepy”
Chancroid - painful (soft) “bloody”
Syphilis - painless (hard)

Question 2

Chlamydia DDX

Answer 2

chlamydia
lymphogranuloma venereum (scar tissue in lymphatics)
PID
Reiters disease/ Reactive arthritis (HLAB27) (feet)

Question 3

Causes of PID

Answer 3

e.coli
chlamydia
gonorrhea
staph infection

Question 4

Asymptomatic female DDX

Answer 4

chlamydia
gonorrhea (knee)
human papilloma virus HPV

Question 5

Asymptomatic male DDX

Answer 5

trichomonas

candida albicans

Question 6

Most common STD in US

Answer 6

Chlamydia

Question 7

• yellow, odorless discharge
• painful soft lesions
• reiter’s (reactive arthritis) (feet)

Answer 7

Chlamydia

Question 8

• Gram negative
• copious clear discharge
• tonsillitis, pharyngitis => arthritis (knee)

Answer 8

Gonorrhea

- Neisseria Gonorrhea

Question 9

• painful vesicles
• latency
• red lesions with yellow oozing center
• watery discharge
• type I and II recturrent
• prodrome of itching

Answer 9

Herpes

Question 10

• Protozoa

- greenish yellow, itchy, foul discharge

Answer 10

Trichomonas

- trichomonas vaginalis

Question 11

• Haemophilus Ducrey (soft chancre)
• lesions rapidly ulcerate and bleed
• large painful ulcers, pus => buboes

Answer 11

Chancroid

- “How he do cry, he has a bloody chancre on his wanker bloody buboes”

Question 12

• thrush, yeast, fungus, moniliasis
• gram positive*
• white cheese material covers vaginal walls

Answer 12

Candidiasis

- candida albicans

Question 13

• Primary: 4-8 weeks

- (one) painless lesion, hard, firm

Answer 13

Syphilis one

Question 14

Treponema Pallidum (spirochete)

Answer 14

Syphilis

– spirochete = congenital = crosses placenta

Question 15

• appears 12 weeks later
• rash persists for months (80%)
• lymphadenopathy (50%)
• condylomata lata (warts)
• alopecia (hair loss)

Answer 15

Syphilis 2 (skin)

Question 16

• Gumma (skin, visceral granulomatous lesion)
• General paresis (damentia)
• Argyll Robertson pupil
• Tabes Dorsalis - posterior column tracts
• positive romberg’s test
• charcot’s joints
• specific test - FTA

Answer 16

Symphilis 3 (inside)

Question 17

Adults get what stages of syphilis?

Answer 17

1,2,3

Question 18

• Hutchinson’s triad = _____, ____, and ____

- associated with?

Answer 18

saddle nose, interstitial keratoses (hardening of eyes), peg teeth
– Congenital syphilis

Question 19

What do syphilis and herpes have in common?

Answer 19

• periods of latency

- DRG

Question 20

• caused by chlamydia

- enlarged regional inguinal lymph nodes that may lead to elephantiasis and rectal strictures and abscesses

Answer 20

Lymphogranuloma venerum

Question 21

• Donovania Granulomatous
• painless, velvety, slow going
• Bright beefy red granulomatous lesions
• Donavon bodies

Answer 21

Granuloma inguinale

Question 22

• Human papilloma virus (16&18)
• Condylomata acuminata
• cervical dysplasia leads to cervical cancer
• usually small, itchy, cluster
• speculum = SCREEN
• PAP = confirm (specific test)

Answer 22

Genital Warts

Question 23

• multiple skin tags that exfoliate, waxy papules

Answer 23

Molluscum Contagiosum

Question 24

• Autoimmune
• most common Bulla lesion
• lethal
• South americans
• IgG

Answer 24

Pemphigoid

Question 25

• genital and extensor lesions
• bulla
• papules
• IgA
• gluten sensitivity
• hereditary (black, asians)

Answer 25

Dermatitis Herpetiformis (aka ichthyosis bullous siemens)