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GYNECOLOGICAL INFECTIONS . . . CONT.

Notes

S y p h i l i s T r e p o n e m a p a l l i d u m p r i m a r y s y p h i l i s p a i n l e s s c h a n c r e o n v u l v a , v a g i n a o r c e r v i x p a i n l e s s i n g u i n a l l y m p h a d e n o p a t h y 3 - 4 w e e k s a f t e r e x p o s u r e s e r o l o g i c a l t e s t s u s u a l l y n e g a t i v e s e c o n d a r y s y p h i l i s ( s e e C o l o u r A t l a s F 1 3 ) 2 - 6 m o n t h s a f t e r i n i t i a l i n f e c t i o n n o n s p e c i f i c s y m p t o m s m a l a i s e , a n o r e x i a , h e a d a c h e , d i f f u s e a d e n o p a t h y g e n e r a l i z e d m a c u l o p a p u l a r r a s h p a l m s , s o l e s , t r u n k , l i m b s c o n d y l o m a t a l a t a ( a n o g e n i t a l , b r o a d - b a s e d f l e s h y g r e y l e s i o n s ) s e r o l o g i c a l t e s t s u s u a l l y p o s i t i v e t e r t i a r y s y p h i l i s m a y i n v o l v e a n y o r g a n s y s t e m g u m m a o f v u l v a n e u r o l o g i c a l : t a b e s d o r s a l i s , g e n e r a l p a r e s i s c a r d i o v a s c u l a r : a o r t i c a n e u r y s m , d i l a t e d a o r t i c r o o t c o n g e n i t a l s y p h i l i s m a y c a u s e f e t a l a n o m a l i e s , s t i l l b i r t h s o r n e o n a t a l d e a t h l a t e n t s y p h i l i s n o s y m p t o m s , p o s i t i v e s e r o l o g y n a t u r a l h i s t o r y i f u n t r e a t e d , 1 / 3 w i l l e x p e r i e n c e l a t e c o m p l i c a t i o n s d i a g n o s i s a s p i r a t e o f u l c e r s e r u m o r n o d e s p i r o c h e t e s o n d a r k f i e l d m i c r o s c o p y s e r o l o g y V D R L i s n o n - s p e c i f i c M H A - T P i s t h e c o n f i r m a t o r y t e s t F T A - A B S i s s p e c i f i c T P I i s t h e m o s t s p e c i f i c t e s t , m o s t e x p e n s i v e t r e a t m e n t o f p r i m a r y , s e c o n d a r y , l a t e n t s y p h i l i s o f < 1 y e a r d u r a t i o n b e n z a t h i n e p e n i c i l l i n G 2 . 4 m i l l i o n u n i t s I M t r e a t p a r t n e r s r e p o r t a b l e d i s e a s e t r e a t m e n t o f l a t e n t s y p h i l i s > 1 y e a r d u r a t i o n b e n z a t h i n e p e n i c i l l i n G 2 . 4 m i l l i o n u n i t s I M o n c e p e r w e e k x 3 w e e k s s c r e e n i n g h i g h r i s k g r o u p s i n p r e g n a n c y

Chancroid Hemophilus ducreyi symptoms • painful soft ulcer with or without pus • tender regional lymphadenopathy = buboe diagnosis • culture • Gram stain • Gram-negative bacilli in rows treatment • erythromycin 500 mg qid for 7 days • ceftriaxone 250 mg IM once

Granuloma Inguinale (Donovanosis) Calymmatobacterium granulomatis symptoms • painless nodule —> ulcer —> intact pseudobuboes diagnosis • Donovan bodies with Giemsa stain treatment • tetracycline 500 mg qid for 14 days • erythromycin 500 mg qid for 14 days if pregnant

Lymphogranuloma Venereum Chlamydia trachomatis serotypes L-1, L-2, L-3

Gynecology 28

MCCQE 2000 Review Notes and Lecture Series

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