Ulcerative lesions Flashcards
What are the 2 groups STD are divided into?
- Mucopurulent discharge (gono/chlamydia)
- ulcerative lesions (for these travel history is a good diagnostic tool because many of the signs and symptoms are similar)
LGV characteritics
rare in US
- common in developing countries (africa, asia, south america)
- person is often infected with another STD (co-infection)
swollen lymph nodes of groin area
- painless ulcer (primary stage)
- painful bubo forms (secondary stage)
- genital ulcers (tertiary stage - rare)
Diagnosing LGV
(since its a chlamydia bacterium) its obligate intracellular and won’t appear on gram stain
*use nucleic acid amplification assay
causative agent of klebsiella granulomatis
gram negative rod
virulence/pathogenic factor klebsiella granulomatis
Donovan bodies
vacuole within PMN or plasma cell (where the organism multiplies)
what is the ulcer like in klebsiella granulomatis
- painless
- bleeds on contact
- beefy red, granulomatous heaped ulcer
(would not be like herpes ulcers - bc those are painful)
complications of klebsiella granulomatis
if lesions are advanced - carcinoma can develop
4 progressive phase of presentation - klebsiella granulomatis?
- ulcerogranulomatous
- hypertrophic
- necrotic foul smelling ulcer
- sclerotic – formation of fibrous and scar tissue
What organism can cause a Chancroid infection?
Haemophilus ducreyi
predominantly a male disease - MSM
characteristics of Haemophilus ducreyi?
- gram (-) rod
- oxidase positive (like Neiserria)
- humans are the reservoir
Describe the Ulcers seen in someone with Chancroid
- VERY PAINFUL! after 3-5 weeks (not initially though)
- ragged boarder
- could be covered in yellow or gray necrotic exudate - it’s highly contagious)
- if it spreads to the inguinal lymphnodies, they can become so swollen that they can rupture upon touch
Diagnosing Chancroid
unless you can isolate the H. ducreyi from lesion,
use negative deduction: rule everything else out and determine that they were not traveling
Chancroid epidemiology
Probably underreported Minority populations African-American Hispanics Heterosexuals Female prostitutes and clients -on the decline (high when aids was prevalent)
Describe the syphilis ulcer?
- PAINLESS (so silent transmission is an issue)
- chancre (sore/ulcer at site of entry of pathogen)
- indurated (hardened)
- well circumscribed
What organism causes syphilis and what are its characteristics?
Treponema pallidum
-spirochete (thin, can’t see on gram stain, need to use silver stain)
-cannot culture (needs host to survive)
-
How is syphilis transmitted?
- CONTACT (through sexual contact)
- CONGENITAL (during birth)
Can you discuss the epidemiology of syphilis?
- trending up, more males affected than females
- highest incidence in 20-24 year old males/females
- blacks have the highest incidence
- Spike in secondary syphilis in men sexing men
Are there different stages of syphilis?
YES.
Primary, Secondary, Latent, and Tertiary
Primary syphilis
- ulcers develop at the site where the organism landed
- incubation is 3 weeks
- regional lymphadenopathy (swollen glands)
- heals in 1-6 weeks after incubation
Secondary syphilis
- infection has entered the blood stream
- flu like symptoms
- highly infectious at this point (but it can resolve spontaneously in a few weeks so they may never seek any treatment
what are symptoms associated with secondary syphilis?
- characteristic rash (not raised) found on soles of feet and palms of hands (DON’T SHAKE THEIR HAND!) - rash could even cover entire body
- usually the rash resolves on its own in a few weeks and this indicates the patient has entered the latent (recovery phase)
- alopecia (hair falls out in chunks)
- condylomas: soft, fleshy papules (elevations of the skin), these are infectious, found in genital region
- lymphadenopathy
How long could the latent stage last?
-recovery phase could last from 3 years to 30 years
the phase usually begins anytime from 3 weeks to 3 months *after the *secondary phase
Tertiary syphilis
- it’s a delayed hypersensitivity reaction?
- one third of people not treated progress to this phase 3 to 15 years later
- Not infectious at this point (its the body’s reaction causing the symptoms), so no congential transmission (very rare)
Tertiary syphilis complications
Neurological symptoms:
- destruction of parenchyma (demenia
- meningitis
- optic atrophy (going blind)
- meningovascular damage (spinal column damage)
Cardiovascular symptoms:
- *-thoracic aortic aneurysm
- aortitis
- aortic endocarditis
- can see the aortic calcification on an x-ray!
Gummas:
- soft tumor-like balls of inflammation in bones, skin and other tissue
- granulomatous lesions
