STD's

Question 1

Which STD’s ulcers are PAINFUL?

Answer 1

• HSV

* Chancroid (Hemophilus ducreyi)

Question 2

Which STD’s ulcers are PAINLESS?

Answer 2

• Syphilis
• LGV (but lymphadenopathy is PAINFUL)
• Granuloma Inguinale (Calymmatobacter / Klebsiella granulomatis)

Question 3

SYPHILIS: TAKE-HOME POINTS

Answer 3

• Neurological and ocular manifestations can occur at any stage
• Treponemal tests are almost always positive in late syphilis (once positive always positive) irrespective of treatment history
• Penicillin is the DOC treat all stages of syphilis. No alternate agents should be used in pregnant women

Question 4

Nontreponemal tests False+ :

Answer 4

old age, pregnancy, autoimmune
disease (APS), viral infections, PROZONE
effect

• Four-fold (i.e. 2-dilution) decline after
treatment = CURE (irrespective of the
end-titer)

Question 5

Treponemal tests (MHA-TP, TPPA, FTA-Abs, EIAs, CIA) False + :

Answer 5

endemic treponemal infections (e.g. yaws,

pinta, bejel) or with Lyme disease

Question 6

Syphilis Tx

Answer 6

• Early stages (primary, secondary, early latent) • 2.4 MU benzathine penicillin x1 or doxycycline X 14 days
• Late latent/unknown duration: 2.4 MU benzathine penicillin G q1w X3 or doxycycline X 4 weeks
• Neurosyphilis/Ocular syphilis:
• Aqueous penicillin 18 to 24 MU IV X 10-14 days
• Procaine penicillin 2.4 MU IM qd + probenecid 500 mg po QID X 10-14 days
• Ceftriaxone 1-2g IV/IM X 10-14 days

Question 7

LGV DIAGNOSIS & THERAPY

Answer 7

> Routine NAATs do not distinguish between serotypes D-K and L1-L3 (LGV). 
> Multiplex PCR can be performed for
specific serotypes. 
> Serology may support the clinical
diagnosis

• Therapy: doxycycline X 3 weeks or azithromycin 1g qwk X 3 weeks

Question 8

CHANCROID DIAGNOSIS & THERAPY

Answer 8

• Dx: culture (80% sensitive)
• Rx: Azithromycin 1g PO X1 OR CTX 250mg IM X1
• Treat all partners in preceding 60 days

Question 9

GRANULOMA INGUINALE OR
DONOVANOSIS DIAGNOSIS & THERAPY

Not endemic in US

Answer 9

Dx: tissue biopsy- Donovan
bodies, using Wright-Giemsa stain (NOT Gram’s stain)

• Rx: Doxycycline 100mg PO BID X 3 weeks (or until resolution) OR
azithromycin 1g PO q week X3