Sexually transmitted infections Flashcards
What type of organism causes syphilis?
Treponema pallidum, gram negative spirochete
What is the difference between the early and late effects of congenital syphilis?
Early congenital (<2 years old)
Late congenital (>2 years old)
What are the early congenital signs of syphilis?
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
What are some late congenital signs of syphilis?
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
What distinguishes primary syphilis and how long is the incubation period?
The primary chancre is the distinguishing factor. The average period is 3 weeks til chancre but can be 10-90 days
How long does it take for the RPR or VRDL to be positive?
4-5 weeks
How long does it take for the FTA-ABS for syphilis to be positive?
Positive by 3 weeks
How early can the IgM Elisa pick up syphilis?
Within a week, it is the earliest positive turning test
What is the clinical presentation of syphilis chancre?
Painless, well defined, indurated ulcer. Often a/w enlarged lymph nodes
What things can cause false + VRDL?
Viruses: CMV, EBV, hepatitis
Drugs: Hydralazine, chlorpromazine, others
Rheumatologic disease: rheumatic fever, RA, lupus/APLS
Other infxns: leprosy, malaria,
How long after the presentation of the chancre does secondary syphilis emerge?
Usually, 3-10 weeks after the chancre
How long does the rash of secondary syphilis usually last?
Usually lasts 3-12 weeks but can relapse in 25%
What are the common clinical findings of secondary syphilis?
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
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?
Split papule or syphilitic perléche
How long after secondary syphilis does tertiary syphilis occur?
If it occurs, it usually occurs months to years after secondary rash (period in between is called latency)
What lesions are seen in tertiary syphilis?
- Gummas (skin, bone, liver, organs)
- Aortitis (cardiovascular syphilis)
- tabes dorsalis, paresis, meningitis, ataxia, optic atrophy, argyll-Robertson papule
What test should be checked if you see a chancre or new dx of syphilis?
HIV, increased risk of co-infection in any dz that causes genital ulcers
What tests can be used to track treatment in syphilis?
RPR/VRDL, the treponema tests will not respond with tx, will remain +
What is the most sensitive and specific test for the diagnosis of primary syphilis?
Darkfield examination
What is the histology of secondary syphilis?
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
What organism causes chancroid?
Hemophilus ducreyi (gram-negative coccobacilli)
Clinical presentation of chancroid?
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
What is the treatment for syphilis?
Penicillin G
What is the treatment for chancroid?
Azithromycin (1gm PO x 1 dose)
What can be seen on a smear from a chancroid ulcer?
“School of fish” appearance on Giemsa stain of exudate
What organism causes gonorrhea?
Neisseria gonorrhoeae (gram-negative diplococci)
What are the findings associated with gonorrhea?
Most findings not cutaneous
Cutaneous findings: hemorrhagic acral pustules w/ arthritis of larger joints and fever if hematogenous dissemination occurs
Treatment for gonorrhea?
Ceftriaxone 250mg IM x1 + Azithromycin 1gm PO x1
Co-infection with chlamydia often seen hence the combination therapy of ceftriaxone and azithro
In what disease do you get the “groove sign”
Lymphogranuloma venereum
-Buboes
What organism causes lymphogranuloma venereum?
Chlamydia trachoma’s (serotypes L1-3)
What is the first stage of lymphogranuloma venerum?
Stage 1: Occurs after 3-12 days of incubation, painless ulcer which resolves (transient)
What is the second stage of lymphogranuloma venerum?
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
What causes the groove sign?
Enlarged inguinal nodes split by the Poupart ligament
What is the third stage of lymphogranuloma venereum?
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
What is the treatment for lymphogranuloma venereum?
Doxycycline 100mg PO BID, for 21 days
What is seen on Giemsa stain in excavate from lymphogranuloma venereum?
Gamma-favre bodies which are macrophages on Giemsa
What organism causes granuloma inguinale?
Kelbsiella granulomatis (gram negative bacillus)
What is the clinical presentation of granuloma inguinale?
Enlarging chronic ulcer with beefy red friable hypertrophic granulation tissue
- Get pseudobuboes which are nodules in the genital area
What are the most common sites of granuloma inguinale?
prepuce/glans/frenulum/coronal sulcus in men; vulvar area in women
Treatment for granuloma inguinale?
Azithro 1gm PO once weekly or 500mg daily for at least 3 weeks and until all lesions have resolved
What are seen in a stain of exudate from granuloma inguinale?
Safety pin Donovan bodies (wright or Giemsa stain)
