STI: Ulcers

Question 1

What are these ulcers due to?

Answer 1

Chancroid

Question 2

What is the cause of chancroid?

Answer 2

The tropical disease haemophilus ducreyi.

Question 3

What are the symptoms and signs of chancroid?

Answer 3

• Painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement.
• Ulcers are typically sharply defined and ragged.

Question 4

What is this ulcer due to?

Answer 4

Syphilis

Question 5

What is syphilis due to and what kind of organism is it?

Answer 5

Treponema pallidum.

It is a bacteria - a spirochaete.

Question 6

Describe the natural progression of syphilis.

Answer 6

1. Primary syphilis
   
   • Chancre
     
     • Early - a chancre (genital ulcer) erodes
     • Late - the ulcer becomes clean, painless and indurated with smooth firm borders.
     • Ulcers unnoticed in 15-30% of population.
     • Resolves in 2-6 weeks and they are highly infectious in this stage.
   • Regional lymphadenopathy - non-tender, mobile, firm rubbery, discrete not matted.
2. Secondary syphilis - hematogenous dissemination of spirochetes. 2-8 weeks after chancre
   
   • Whole body rash, mucous patches, Moth-eaten alopecia, generalized lymphadenopathy, Constitional symptoms (fever, malaise etc)
   • These symptoms generally resolve in 2-10 weeks.
3. Tertiary/Latent Syphilis (33% will develop this if untreated)
   
   • Early latent = <1 year. Late latent= >1 year. Can last 2-20 years.
   • Can affect heart, lungs, brain, nerves, bones.

Question 7

What is this due to?

Answer 7

HSV

Question 8

Which herpes virus affects the genitals?

Answer 8

Herpes Simplex 2

Question 9

What is this due to?

Answer 9

HSV

Question 10

Describe the natural history of Genital Herpes

Answer 10

• Vesicles (filled with clear fluid) rupture forming pucnhed out erosions.
• Vesicles can sometimes form pustules (filled with yellow fluid) and then rupture.
• They can become grouped.
• The skin around is usually erythematous and crusted.

Question 11

What is this due to?

Answer 11

Genital Herpes

Question 12

What causes lyphmogranuloma venereum (LGV)?

Answer 12

Chlamydia trachomatis

Question 13

What are the 3 stages of LGV?

Answer 13

Stage 1 - Small painless pustule which later forms an ulcer

Stage 2 - painful inguinal lymphadenopathy

Stage 3 - proctocolitis

Question 14

What is the treatment for LGV/Chlamydia?

Answer 14

Doxycycline or erythromycin

Question 15

What is the treatment for syphilis?

Answer 15

Primary, secondary, early latent syphilis:

• First line: benzathine penicillin 2.4 mega units (intramuscular (IM), single dose) is first-line
• Second line: oral azithromycin single dose is second-line.[5]
• Other options: procaine penicillin 600,000 units (IM, once daily for 10 days)
• doxycycline 100 mg (twice daily for 14 days).

Late latent syphilis:

• First line - benzathine penicillin weekly for three weeks is first-line

Neurosyphilis: procaine penicillin 2.4 units once daily (IM, for 17 days) with oral probenecid 500 mg four times a day. Alternatively, doxycycline 200 mg twice daily for 28 days.

Question 16

What is the treatment for syphilis in pregnancy?

Answer 16

Treatment depends upon which trimester the presentation is in:

1. First and second trimesters: give single dose benzathine penicillin
2. Third trimester two doses of benzathine penicillin one week apart.
3. For late syphilis treat as for non-pregnancy (avoiding tetracyclines).
   
   • Alternatives include ceftriaxone 500 mg IM for 10 days.

Question 17

What is the supportive and drug treatment for genital herpes?

Answer 17

• Supportive - saline bathing, painkillers, topical lidocaine, vaseline, micturition in bath, increase fluid to dilute urine.
• Drug treatment first line - Aciclovir 200mg five times daily.

Question 18

What are the drug treatments for chancroid?

Answer 18

• Ciprofloxacin
• Erythromycin
• Azithromycin