Sexually Transmitted Infections

Question 1

What are the two common syndromes caused by Disseminated Gonorrhoeae infection
and how do you diagnose

Answer 1

Arthritis ( monoarthritis or oligoarthritis knees, hips wrists) Plus Dermatitis (necrotic papules) and tendon sheath inflammation
OR
Purulent Arthritis Alone

Diagnosed by + Blood Cx

Question 2

How do you treat disseminated gonorrhea?

Answer 2

7-14 days of Ceftriaxone will treat this disseminated disease

Question 3

What is Fitz Hugh Curtis Syndrome?

Answer 3

PID in patient with RUQ pain and elevated LFTS consider perihepititis

Question 4

How do you treat PID

Answer 4

Ceftriaxone and doxy +/- Flagyl

Question 5

How does Primary Syphilis Present?

How is it treated

Answer 5

Painless, clean based ulcer which resolves spontaneously and tender lymphadenopathy

RPR might be negative

Treat with one dose of IM benzathine PCN

Question 6

How does Secondary Syphilis present

How is it treated

Answer 6

Develops 2-8 weeks after the appearance of the primary chancre and is characterized by widespread hematogenous dissemination involving most often the skin, liver and lymph nodes, resolves spontaneously

To diagnose: look for fever, rash of any kind (except veiscles) involving palmar or plantar surgaces
Non Tender generalized lymphadenopathy
Headache, cranial nerve abnormalities AMS or stiff neck
Mucous patches in mouth, condyloma lata

Will have high titers

Treatment- One dose of IM PCN

Question 7

How do you treat early latent syphilis

Answer 7

this is diagnosis within one year

give one dose of IM PCN

Question 8

How do you treat late latent or ASX syphilis of unknown duration?

Answer 8

3 weekly doses of PCN ( late latent is > 1 yr from exposure)

Question 9

Treat Late tertiary NONneurosyphilis?

Answer 9

3 weekly doses of PCN

Question 10

Treat Neurosyphillis with:

Answer 10

Continuous PCN infusion for 10-14 days

Question 11

True or False: Failure of Non Treponemal Serologic test ( RPR or VDRL) results to decrease four fold in 6-12 months after treatment indicates failure or reacquisition

Answer 11

True

Question 12

How does tertiary syphilis present

Answer 12

Meningitis and Subarachnoid arteritis (cause of a stroke in young person)
Aortitis
General Paresis and Tabes Dorsalis
Gumma in any organ

will see lower titers

Question 13

What should you confirm a RPR or VDRL with

Answer 13

Fluorescent Treponomal Ab absorption test ( FTA ABS) or Treponema Pallidium particle agglutination assay

Question 14

True or False: FTA ABS and Microhemagglutination assay for T pallidium will be positive indefinitely

Answer 14

true

may be negative after treatment and will rise again if reinfection

Question 15

Multiple 1-2mm tender vesicles or erosions and tender lymphadenopathy

Answer 15

Herpes ( HSV type 1 or 2)

Question 16

Ragged, purulent, painful ulcer with tender lymphadenopathy

Answer 16

Chancroid ( Haemophilus Ducreyi)

Question 17

Single 0.2-1.0 ulcer, sometimes painful with tender unilateral lymphadenopathy which may suppurate

Answer 17

Lymphogranuloma venereum ( Chlamydia trachomatis)

Question 18

Single or multiple blisters or erosions 1-3 cm, frequently on glans penis

Answer 18

Fixed Drug eruptions ( NSAIDs, Phenobarbital, Antibiotics)

Question 19

What is the Jarisch Herxheimer reaction

Answer 19

acute febrile illness occurring within 24 hours of treatment for any stage, this is not an allergic reaction to PCN