Syphilis (Lues, Venereal Syphilis) | Figure 4.16
A: Secondary syphilis*
B: Secondary syphilis*
C: Secondary syphilis,
mucous patches*
*Courtesy of Dr. Paul Getz |
| Figure 4.15 Primary syphilis
(Courtesy of Dr. Paul Getz) |
(Figure 4.15 and 4.16A–C) | | | | | | | Table 4-10 Venereal Bacterial Infections (Figure 4.17A–F) | | | Disease | | Organism | | Clinical Findings | | Treatment | | | Chancroid
(Soft chancre) | | Haemophilus ducreyi | | Soft, painful non-indurated ulcer with purulent base, raised and ragged borders, painful inguinal adenitis (buboes) with suppuration often present, does not heal without treatment
Gram stain: “school of fish” pattern | | Azithromycin 1 g × 1 or Ceftriaxone IM × 1 or Cipro 500 mg bid × 3 days | | | Granuloma inguinale
(Donovanosis) | | Calymmatobacterium granulomatis
(related to Klebsiella spp.) | | Painless subcutaneous papule or nodule → ulcerates with painful, beefy red granulation tissue and serpiginous borders, rare lymphadenopathy; does not heal without treatment
Histo: Donovan bodies | | For 3 weeks: Azithromycin 1 g qweek or Bactrim DS bid or Cipro 750 mg bid or Doxy 100 mg bid | | | Lymphogranuloma
venereum
(Tropical bubo) | | Chlamydia trachomatis (L1–3 serotypes)Doxycycline | | Stage I: papule → painless, flast, small ulcer with gray base and serous discharge
Stage II: enlarged unilateral inguinal lymph node (bubo) which often ruptures with suppuration, ± groove sign (if bubo above and below Poupart ligament) Giemsa stain: Gamma-Favre bodies | | For 3 weeks: Azithromycin 1 g qweek or Erythromycin qid or Levo 500 mg qd or 100 mg bid | | | Gonorrhea | | Neisseria gonorrhoeae | | Broad spectrum of disease patterns
Men: gonococcal urethritis with dysuria and extensive urethral discharge of pus
Women: urethritis and purulent cervicitis
Ascending gonorrhea: acute salpingitis or pelvic inflammatory disease (PID)
Disseminated gonococcal infection: episodic fever, arthralgias, tenosynovitis, swollen joints (wrists, ankles, knees commonly) and pustular hemorrhagic skin lesions | | Azithromycin 1 g × 1 or Ceftriaxone IM × 1 or Cipro 500 mg × 1 or Doxycycline 100 mg bid × 1 week | | | | | | | | | |
| | | | | |
|
 | Figure 4.17
A: Granuloma inguinale*
B: Granuloma inguinale*
C: Gonococcal urethritis*
D: Gonococcal urethritis*
E: Chancroid*
F: Lymphogranuloma venereum*
*Courtesy of Dr. Paul Getz |
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