2. Primary syphilis: Painless genital sore (chancre) on labia, vulva, vagina, cervix, anus, lips, or nipples. Painless, rubbery, regional lymphadenopathy followed by generalized lymphadenopathy in the third to sixth weeks. Darkfield microscopic findings. Positive serologic test in 70% of cases. Secondary syphilis: Bilaterally symmetric extragenitalpapulosquamous eruption. Condylomalatum, mucous patches. Darkfield findings positive in moist lesions. Positive serologic test for syphilis. Lymphadenopathy. Syphilis
3. Tertiary syphilis: Cardiac, neurologic, ophthalmic, and auditory lesions. Gummas. Congenital syphilis: History of maternal syphilis. Positive serologic test for syphilis. Stigmata of congenital syphilis (eg, x-ray changes of bone, hepatosplenomegaly, jaundice, anemia). Normal examination or signs of intrauterine infection. Often stillborn or premature. Enlarged, waxy placenta. Latent syphilis: History or serologic evidence of previous infection. Absence of lesions. Serologic test usually reactive; titer may be low. Syphilis
4. Chancre of perianal area Syphilis Edema of labia majora due to primary syphilis
5. Syphilis during pregnancy—The course of syphilis is unaltered by pregnancy, but misdiagnoses are common. The chancre is often unnoticed or internal and not brought to medical attention. Chancres, mucous patches, and condylomalata are often thought to be herpes genitalis. The dermatoses can resolve prior to diagnosis, or they may be misdiagnosed. Syphilis
6. Treatment A. EARLY SYPHILIS AND CONTACTS Primary, secondary, and early latent syphilis (less than 1 year duration). (1) Benzathine penicillin G, 2.4 million units intramuscularly once. (2) Tetracycline hydrochloride, 500 mg orally 4 times daily or 100 mg doxycycline twice daily for 14 days, for nonpregnant penicillin-allergic patients. Erythromycin estolate should not be administered to pregnant women because of potential drug-related hepatotoxicity. Ceftriaxone 1 gm daily IM or IV for 8–10 days may be effective but data with this regimen are limited. Syphilis
7. B. LATE SYPHILIS Includes latent syphilis of indeterminate duration or more than 1 year duration, except neurosyphilis. (1) Benzathine penicillin G, 2.4 million units intramuscularly weekly for 3 successive weeks (7.2 million units total). (2) Tetracycline hydrochloride, 500 mg orally 4 times daily, or 100 mg doxycycline twice daily for 14 days, for penicillin-allergic patients. Syphilis
8. ESSENTIALS OF DIAGNOSIS Mucopurulentcervicitis. Salpingitis. Urethral syndrome. Nongonococcalurethritis in males. Neonatal infections. Lymphogranulomavenereum. Chlamydial Infections
9. ESSENTIALS OF DIAGNOSIS Most affected women are asymptomatic carriers. Purulent vaginal discharge. Frequency and dysuria. Recovery of organism in selective media. May progress to pelvic infection or disseminated infection. Gonorrhea
10. Recommended regimens of treatment: (a) ceftriaxone, 125 mg intramuscularly once, plus doxycycline, 100 mg orally twice daily for 7 days (for nonpregnant patients) and azithromycin 1 g orally in a single dose if chlamydial infection is not ruled out; cefixime 0.4 g orally once, plus doxycycline or azithromycin as above; (c) ofloxacin 0.4 g, levofloxacin .25 g, or ciprofloxacin 0.5 g, orally once Gonorrhea
11. Intra-abdominal spread of gonorrea Spread of pelvic infections Lymphatic spread of bacterial infection
12. Spread of pelvic infections Hematogenous spread of bacterial infection (eg, tuberculosis)
13. TrichomonasVaginitis Trichomonasvaginalis is a unicellular flagellate protozoan. T vaginalis infects the lower urinary tract in both women and men. A persistent vaginal discharge is the principal symptom with or without secondary vulvarpruritus. The discharge is profuse, extremely frothy, greenish, and at times foul-smelling. The pH of the vagina usually exceeds 5.0.
14. Metronidazole is the only FDA-approved treatment (in the United States), with cure rates of approximately 90–95%. A single-dose regimen of 2 g may assure compliance. Other regimens include a 500 mg tablet orally 2 times per day for 7 days. TrichomonasVaginitis
