Genital ulcer diseases

Question 1

Syphilis:
Causative organism

Answer 1

Treponema palladium

Question 2

Classification of syphilis

Answer 2

1. Early syphilis(infectious):
   Primary
   Secondary
   Early latent
2. Late syphilis(non infectious):
   Late latent
   Tertiary
3. Congenital:
   Early
   Late
   Stigmata

Question 3

Mode of transmission of syphilis

Answer 3

Sexual
Transplacental
Blood transfusion
Direct contact with the primary chancre

Question 4

Primary syphilis:
Definition, Period of infectivity, Clinical features

Answer 4

Stage from infection to healing of chancre
Period of infectivity : 9-90 days
Clinical features:
1. Genital lesion:
Hard chancre/Hunterian chancre:
Single
Clean base
Indurated
Non tender
Does not bleed on touch
2. Inguinal lymph nodes: Bilateral enlarged, non tender rubbery lymph nodes
3. Extra genital lesions : lips

Question 5

Hard chancre definition and other name

Answer 5

Heals with scar even without treatment
Hunterian chancre

Question 6

Secondary syphilis: definition, clinical features

Answer 6

6-8 weeks after the appearance of primary chancre

Clinical features:
1. Constitutional symptoms (Fever)
2. Generalized lymphadenopathy(Characteristic: epitrochlear node)
3. Skin lesions: Symmetrical, non pruritic, polymorphic seen on palms and soles
Buschke ollendroff sign is positive
4. Mucosal lesions:
a. Condyloma lata : Flat topped moist lesions
b. Mucosal patch
c. Snail track ulcers: Colleasing mucosal patches -> Serpigenous ulcer
5. Non scarring alopecia : Moth eaten alopecia

Question 7

Buschke ollendroff sign

Answer 7

Blunt end of pin when pressed on skin lesion, it causes deep dermal tenderness

Question 8

Symphilis d’emblee

Answer 8

Secondary syphilis bypassing primary syphilis stage
Chancre is absent
Route : blood transfusion and needle puncture wounds

Question 9

Latent syphilis

Answer 9

Persistent seropositivity with clinical latency

<1 year : Early latency
>1 year : Late latency

Question 10

Tertiary syphilis

Answer 10

1. Cutaneous (characteristic lesion : gumma, rubbery nodule -> ulcer, punched out edges wash leather slough)
2. Cardiovascular (Aortic aneurysm, aortic regurgitation)
   3, Neurosyphilis(General paresis of insane, Tabes dorsalis)

Question 11

Neurosyphilis

Answer 11

General paresis of insane:
Paralytic dementia
Personality changes
Psychiatric changes

Tabes dorsalis:
Gait abnormalities
Lancinating pain
Argyl robertson pupil

Question 12

Early cogenital syphilis :
definition, clinical features

Answer 12

Occurs in first 2 years of life

Clinical features:
1. Skin lesions:
Syphilitic pemphigus
Erythematous maculopapular rash
Radiating fissures from angle of mouth leaving linear scars (rhagades)
Syphilitic paronychia and alopecia

2. Mucous membrane lesions:
   Mucosal patches (greyish white) - palate, tongue, buccal mucosa, genital mucosa, pharynx and larynx
   Condyloma lata
   Snuffles
   Complication : saddle nose deformity
3. Bone lesions:
   Osteochondritis(Parrot’s pseudoparalysis)
   Wimberger’s sign
4. Systemic associattions:
   Hepatomegaly
   Glomerulonephritis
   Generalized lymphadenopathy(hard, non tender nodes)

Question 13

Late congenital syphilis:
definition, clinical features

Answer 13

occurs after 2 years of age

Hutchinsons triad:
1. Interstitial keratitis
2. Peg shaped upper incisors
3. eighth cranial nerve deafness
Saddle nose deformity
Periosteitis:
1. Olympian brow : frontal bossing
2. Higomenaki sign : sternal end of clavicle(unilateral)
3. Sabre tibia : Anterior aspect of tibia

Question 14

Stigmata :
definition, clinical features

Answer 14

Scars and deformities

Frontal bossing
Short maxilla
Protruding mandible
High arched palate
Saddle nose
Rhagades
Sabre tibia
Mental retradation
Hydrocephalus