82 STD's Flashcards
(36 cards)
syphilis, manifestations (general)
mucocutaneous: genital ulcers to widespread papulosquamous eruptions to granulomatous nodules
what % of untreated syphilis progress to 3° disease
33%, with 17% presenting with benign gummas, 8% CVD, and 8% neurosyphilis
unethical study with infected black men
Tuskegee study
5 diseases caused by treponemal species
venereal syphilis (pallidum), yaws (pallidum pertenue), endermic syphilis (pallidum endemicum), pinta (carateum), and periodontal disease (deticola, socraskii)
what % of 2° syphilis relapses (i.e. happens again within a 1-2 year period) ?
25%
latency, def
positive serologic test without clinical signs or sxs; infectivity may occur intermittently w presence of treponemes in the bloodstream; response to treatment is indicated by decline in RPR or VDRL titer; if treatment failure, most examine CSF
3° syphilis, immunological features
small number of organisms and high cellular immune reactivity against the organism; organisms in tissues (CNS, CV system, etc) lead to damage related to host delayed-type hypersensitivity reaction –> local inflammation and gummas
syphilis increases risk of
HIV infection
chancre
1° syphilis; single, indolent, round/oval, indurated ulcer with regional LAD usually 3 week after sexual contact, heal spontaneously w/in a few weeks; in women they may go unnoticed esp when located intravaginally
lab dx of syphilis
treponemes on darkfield microscopy of chancre fluid (most sensitive and specific), ab’s to cardiolipin (80%, i.e. non-tremonemal tests, measured by RPR or VDRL; correlate w disease activity and response to tx), ab’s to T pallidum surface proteins (treponemal tests: T pallidum hemagglutination test, TPHA; FTA-ABS) - ab’s positive for life so cannot differentiate stage of syphilis
2° syphilis
hematogenous and lymphatic spread, 3-10 mo after sex contact; usually generalized, non-pruritic papulosquamous eruption (pink to violaceous to red-brown), mucosal aphthae, condyloma data in moist regions, LAD
condyloma lata
manifestation of 2° syphilis
necklace of Venus
manifestation of 2° syphilis, hypopigmented macule on the neck
collarette of Biett
manifestation of 2° syphilis , symmetric papules and plaques with collarette of scale on palms and soles
moth eaten alopecia
manifestation of 2° syphilis
gummas
locally destructive lesions in skin, bone, liver, and other organs; nodular or noduloulcerative, arciform pattern; involute with scarring; disappear with tx
neurosyphilis occurs …
at any stage, though classically late
tabes dorsalis, manifestations
diplopia, painful paresthesias, loss of vibratory and position sense, reduced reflexes in the legs, ataxia, sphincter dysfunction, visceral pain (crisis), Argyll Robertson pupils
stigmata of congenital syphilis
rhagades (radial scars at sites of previous periorificial fissures), hutchinson teeth, saddle nose, saber shins, deafness
non-treponemal tests and response to tx
must see a 4-fold decline in titers 1 year after appropriate tx, otherwise, tx failure
false-positive non-treponemal tests in:
pregnancy, autoimmune diseases, drug abuse, lymphoma, infectious disease (e.g. malaria), vaccinations, hepatic cirrhosis, APL syndrome, idiopathic/familial
tx of syphilis
1°: penicillin G (benzathine penicillin 2.4 million units IM as a single dose); azithromycin 2g PO as a single dose
latent/2°: penicillin G IM weekly for 3 doses
neurosyphilis/ocular: aqueous penicillin G, 3-4 million units IV a4h for 10-14 days
acute onset of fever, headache, and myalgias upon tx of early syphilis
Jarisch-Herxheimer reaction
N gonorrheae pathogenesis
invades human cells, adhesion through pili, need iron and high CO2 to grow
