Ulcer STDs

Question 1

What are some important things to know about Treponema Pallidum (aka bacteria that causes syphilis)

Answer 1

It’s a Spirochete

Cork-screw motility

Question 2

What are the screening tests for T. Pallidum (syphilis)

Answer 2

Nontreponemal tests:

• VDRL (Venereal Disease Research Laboratory test)
• RPR (rapid plasma reagin)

USR (unheated serum reagin test)
TRUST (toluidine red unheated serum test)

Doesn’t test specifically for T. Pallidum, just Treponema antigen. Can get false positive tests

Question 3

What is the dx test for T. Pallidum (syphilis)

Answer 3

Treponemal tests: test specifically for T. Pallidum
*FTA-ABS
fluorescent treponemal antibody absorption
*Dark field microscopy

TP-PA (Treponema pallidum particle agglutination)
EIA (enzyme immunoassay)

Question 4

There is primary, secondary and tertiary T. Pallidum (syphilis) . What characterizes the primary form?

Answer 4

Primary: PAINLESS genital ulcer (known as a chancre) (may heal in 2-6 weeks but you’re still infected).

Question 5

You don’t treat the primary form in time so now you’ve got secondary T. Pallidum (syphilis) which means you’ve got….

Answer 5

1. Rash (esp. palm and soles of feet)
2. Condyloma LATUM (not acuminatum) on mucous membranes

Can heal spontaneously but you’re still infected.

Question 6

You still don’t get treatment or it’s not working and now you’ve got tertiary T. Pallidum (syphilis) which means you’ve got

Answer 6

1. Gumma formation: soft growths with firm necrotic center,
2. ascending aorta aneurysm with “tree-barking” appearance.
3. Tabes dorsalis–posterior column of spinal cord is damaged (damaged proprioception)
4. Argyll Robertson pupils (accommodate but do not react to light)

Question 7

What does Haemophilus ducreyi cause?

Answer 7

Chancroid which is one or more painful genital ulcers with swelling and tenderness. Includes regional lymph node enlargement

Question 8

What kind of bacteria is Haemophilus?

Answer 8

Gram neg rod

Grows on enriched agar like chocolate with X and V factors, amino acids, vitamins and 10% CO2

Question 9

What is the mode of transmission of syphilis

Answer 9

Sex

Congenital transmission from mom to fetus

Question 10

What do genital ulcers put you at risk for getting?

Answer 10

HIV

Having HIV and then getting syphilis makes syphilis more aggressive

Question 11

Talk about the disease course of syphilis

Answer 11

I told you about primary, sedentary and tertiary forms already. But at any point you can get a latent (asymptomatic) infection, or spontaneously be cured of the disease. You regress from secondary to primary or go all the way through. There is a VARIABLE disease course, is what I’m trying to say.

Question 12

How do you treat syphilis

Answer 12

Penicillin