Sexually transmitted infections

Question 1

What type of organism causes syphilis?

Answer 1

Treponema pallidum, gram negative spirochete

Question 2

What is the difference between the early and late effects of congenital syphilis?

Answer 2

Early congenital (<2 years old)

Late congenital (>2 years old)

Question 3

What are the early congenital signs of syphilis?

Answer 3

Snuffles, dactylitis, Parrot’s pseudoparalysis, epiphysitis, and hepatitis

Snuffles is one of earliest signs, that and bulous erosions. Snuffles is the mucus seen around the nose and mouth of newborns with congenital syphilis that has lots of spirochetes in it

Question 4

What are some late congenital signs of syphilis?

Answer 4

Keratitis, mulberry molars, Hutchinson’s teeth (notched/peg-shaped incisors), rhagades (linear scars at angles of mouth), saddle nose, Higoumenakis syndrome, Clutton’s joints, optic atrophy, corneal opacities, CN8 deafness

Question 5

What distinguishes primary syphilis and how long is the incubation period?

Answer 5

The primary chancre is the distinguishing factor. The average period is 3 weeks til chancre but can be 10-90 days

Question 6

How long does it take for the RPR or VRDL to be positive?

Answer 6

4-5 weeks

Question 7

How long does it take for the FTA-ABS for syphilis to be positive?

Answer 7

Positive by 3 weeks

Question 8

How early can the IgM Elisa pick up syphilis?

Answer 8

Within a week, it is the earliest positive turning test

Question 9

What is the clinical presentation of syphilis chancre?

Answer 9

Painless, well defined, indurated ulcer. Often a/w enlarged lymph nodes

Question 10

What things can cause false + VRDL?

Answer 10

Viruses: CMV, EBV, hepatitis

Drugs: Hydralazine, chlorpromazine, others

Rheumatologic disease: rheumatic fever, RA, lupus/APLS

Other infxns: leprosy, malaria,

Question 11

How long after the presentation of the chancre does secondary syphilis emerge?

Answer 11

Usually, 3-10 weeks after the chancre

Question 12

How long does the rash of secondary syphilis usually last?

Answer 12

Usually lasts 3-12 weeks but can relapse in 25%

Question 13

What are the common clinical findings of secondary syphilis?

Answer 13

Prodrome: malaise, fever, lymph node enlargement, arthralgia

Papulosquamous/maculopapular generalized rash that is classically “copper-colored” w/ papules/plaques on palms and soles

Can have moth-eaten alopecia

split papules

condyloma lata, mucous patches in the oropharynx, hypopigmented macules on neck

Question 14

If you see a papule at the corner of the mouth in someone w/ syphilis that is split in half by the angle of the mouth (half on each side), what is this?

Answer 14

Split papule or syphilitic perléche

Question 15

How long after secondary syphilis does tertiary syphilis occur?

Answer 15

If it occurs, it usually occurs months to years after secondary rash (period in between is called latency)

Question 16

What lesions are seen in tertiary syphilis?

Answer 16

• Gummas (skin, bone, liver, organs)
• Aortitis (cardiovascular syphilis)
• tabes dorsalis, paresis, meningitis, ataxia, optic atrophy, argyll-Robertson papule

Question 17

What test should be checked if you see a chancre or new dx of syphilis?

Answer 17

HIV, increased risk of co-infection in any dz that causes genital ulcers

Question 18

What tests can be used to track treatment in syphilis?

Answer 18

RPR/VRDL, the treponema tests will not respond with tx, will remain +

Question 19

What is the most sensitive and specific test for the diagnosis of primary syphilis?

Answer 19

Darkfield examination

Question 20

What is the histology of secondary syphilis?

Answer 20

Slender, elongated psoriasiform epidermal hyperplasia and lichenoid interface changes and dirty dermal inflammatory infiltrate with a mix of cell types, cell debris and often lots of plasma cells

Question 21

What organism causes chancroid?

Answer 21

Hemophilus ducreyi (gram-negative coccobacilli)

Question 22

Clinical presentation of chancroid?

Answer 22

Painful “you cry with ducreyi” purulent ulcers w/ ragged/undermined borders and fibrinous base in the genitals or other (mouth, anus)

• Kissing lesions can occur

Question 23

What is the treatment for syphilis?

Answer 23

Penicillin G

Question 24

What is the treatment for chancroid?

Answer 24

Azithromycin (1gm PO x 1 dose)

Question 25

What can be seen on a smear from a chancroid ulcer?

Answer 25

“School of fish” appearance on Giemsa stain of exudate

Question 26

What organism causes gonorrhea?

Answer 26

Neisseria gonorrhoeae (gram-negative diplococci)

Question 27

What are the findings associated with gonorrhea?

Answer 27

Most findings not cutaneous

Cutaneous findings: hemorrhagic acral pustules w/ arthritis of larger joints and fever if hematogenous dissemination occurs

Question 28

Treatment for gonorrhea?

Answer 28

Ceftriaxone 250mg IM x1 + Azithromycin 1gm PO x1

Co-infection with chlamydia often seen hence the combination therapy of ceftriaxone and azithro

Question 29

In what disease do you get the “groove sign”

Answer 29

Lymphogranuloma venereum

-Buboes

Question 30

What organism causes lymphogranuloma venereum?

Answer 30

Chlamydia trachoma’s (serotypes L1-3)

Question 31

What is the first stage of lymphogranuloma venerum?

Answer 31

Stage 1: Occurs after 3-12 days of incubation, painless ulcer which resolves (transient)

Question 32

What is the second stage of lymphogranuloma venerum?

Answer 32

After 10-30 days up to 6 months after stage 1: buboes occur, are often unilateral and painful, erythematous, w/ groove sign.

• These buboes can rupture with pus drainage and sinus tracts

Question 33

What causes the groove sign?

Answer 33

Enlarged inguinal nodes split by the Poupart ligament

Question 34

What is the third stage of lymphogranuloma venereum?

Answer 34

Stage 3: months to years after stage 2 and is ano-genito-rectal syndrome: proctocolitis w/ perirectal abscesses, fistulas, strictures stenoses, and lymphorrhoids (perirectal/intestinal lymphatic hyperplasia

Question 35

What is the treatment for lymphogranuloma venereum?

Answer 35

Doxycycline 100mg PO BID, for 21 days

Question 36

What is seen on Giemsa stain in excavate from lymphogranuloma venereum?

Answer 36

Gamma-favre bodies which are macrophages on Giemsa

Question 37

What organism causes granuloma inguinale?

Answer 37

Kelbsiella granulomatis (gram negative bacillus)

Question 38

What is the clinical presentation of granuloma inguinale?

Answer 38

Enlarging chronic ulcer with beefy red friable hypertrophic granulation tissue

• Get pseudobuboes which are nodules in the genital area

Question 39

What are the most common sites of granuloma inguinale?

Answer 39

prepuce/glans/frenulum/coronal sulcus in men; vulvar area in women

Question 40

Treatment for granuloma inguinale?

Answer 40

Azithro 1gm PO once weekly or 500mg daily for at least 3 weeks and until all lesions have resolved

Question 41

What are seen in a stain of exudate from granuloma inguinale?

Answer 41

Safety pin Donovan bodies (wright or Giemsa stain)