Sexually Transmitted Diseases

syphilis is caused by what?

Treponema pallidum, a spirochete

Treatment of women before week __ of pregnancy prevents lesions of congenital syphilis, but not reliable after then

16

syphilis was first identified in 1905 and used to be treated with…?

arsenic and mercury (heavy metals!)

what are the stages of syphilis?

1. primary (localized)

2. Secondary (systemic)

3. Latent (asymptomatic)

4. Tertiary (long-term inflammation of the CNS, aorta, brain, skin, spine, eye...).

5. Congenital (systemic, chronic inflammation)

those with syphilis often have…?

HIV, or other STDs

what are the symptoms of primary syphilis?

• negative serological test

• chancres (sores/ulcers)

what are the symptoms of secondary syphilis?

• systemic disease (flu-like symptoms)

• macules and papules (palms, soles, face)

• high bacteremia, contagious

• positive serological tests

what are the sites of principal manifestation in secondary syphilis ?

skin and mucous membranes

what are the symptoms of latent (early, not primary or secondary) syphilis?

• clinically well, no signs of disease

• recovered from secondary disease

• serological tests are positive

what are the symptoms of tertiary syphilis?

• gummas, inflammation (CNS, aorta, brain, skin, spine, eye)

• positive serolgoical tests

t/f: Humans are only known hosts of syphilis.

true

syphilis transmission is virtually always by …?

direct contact with infectious lesions (highest incidence in 20-30 year old sexually active adults)

Syphilis Rates in US plummeted after…?

penicillin introduction in 1940/50s

One bump up with HIV; recent increase over last dozen years

in the general population, what group is at a higher risk of contracting syphilis? syphilis also has a strong linkage to…?

MSM; HIV status

what is a chancre?

hard and indurated ulcerated lesion, highly infectious, PAINLESS in primary syphilis

in primary syphilis, there may be regional adenopathy (swelling of lymph nodes). what are the symptoms?

painless, rubbery

Treponema pallidum on Darkfield Microscopy

• Light shines in from the side with a darkfield microscope. The light illuminates objects in the fluid sample.

• Scrape the suspected chancre and put the juices on a slide -> it is teeming with spirochetes

• Spirochetes twirl though the field of vision

papules vs macules?

(secondary syphilis)

what are gummas?

nodular granulomatous lesions (soft, tumor-like masses) affecting skin/bone/live/anywhere (tertiary syphilis)

can take years to develop after infection 15-45

tertiary syphilis can cause damage to what systems?

cardiovascular

• arteritis (vaculitis) results in thickening/hardening of vasa vasorum

neurosyphilis

• dementia, general paresis

Most (93%) of missed opportunities to identify congenital syphilis are due to a l

lack of testing, inadequate or no treatment, or lack of recognition of positive tests

what is congenital syphilis?

If mother infective, child will be stillborn or present with fulminant syphilis

what are symptoms of congenital syphilis I?

• rhinitis, sniffles followed by skin lesions

• positive serologic testing

• Osteochondritis (inflamed bone, cartilage).

• Hepatosplenomegaly and adenopathy.

• Immune-complex glomerulonephritis.

• Death in first 2 years with pulmonary hemorrhages, bacterial infections, hepatitis

what is a key symptom of congenital syphilis II?

• hutchinson’s teeth (notched, narrow edged incisors + mulberry molars)

• rhagades lines (fissures, cracks, fine linear dermal scars especially around the mouth, and areas subjected to frequent movement)

• saddle nose (deformed nasal cartilage)

which stages of syphilis can be cured with treatment?

primary or secondary

changes of tertiary syphilis (aortitis, neurological changes) are not reversible after treatment, except for gummas

how is secondary syphilis diagnosed?

1. T pallidum specific test

2. if positive → antibody titre test

how is primary syphilis diagnosed?

• presenting signs/symptoms/history

• darkfield exam of chancre exudate

• seronegative (no positive blood test)

what are treponemal tests?

• specific to syphilis

• appear early after acute infection

• detectable for life even after successful treatment

• indicate CURRENT OR PAST infection

what are non-treponemal tests?

• antibodies to a cardiolipin-cholesterol lecithin antigen (regain) that cross-react with syphilis antigens

• quantitative titer

• Falls in titer indicate a response (four-fold decrease)

are treponemal tests done first or non-treponemal?

treponemal test first to screen, then non-treponemal

what is the treatment for Primary, Secondary, early latent syphilis?

Penicillin

what is the regimen for Late latent, or tertiary, neurosyphilis without CSF changes?

IM penicillin

what is the regimen for syphilis during pregnancy?

Treat as appropriate for the stage of their disease. Treatment of women before16th week of pregnancy prevents lesions of congenital syphilis, but not reliable after then

what is the regimen for neurosyphilis/congenital syphilis?

IV penicillin

what treatments for syphilis are alternatives for penicillin allergies?

ceftriaxone, tetracyline, or doxycyline (but not well studied)

what is gonorrhea caused by?

Neisseria gonorrhoeae (Gram-negative diplococcus) which infects mucus-secreting epithelial vells

what are some complications that arise with gonorrhea?

• pelvic inflammatory disease (PID) with abscesses,

• subsequent ectopic pregnancies or sterility in women.

• Can be lethal.

• Gonorrheal pharyngitis;

• disseminated bacteremia occurs with rash and arthritis

t/f: > 95% of men with gonorrhea are symptomatic; however, often no symptoms in women

true

A patient has, on exam, a large circular lesion on the side of the tongue that they were unaware of. It has slightly rolled edges, and
despite the erosion of the mucosa is essentially painless. The patient
is sexually active. Which of the following is the most likely
explanation for this scenario?

A. Oropharyngeal gonorrhea
B. Oropharyngeal syphilis
C. Oropharyngeal papillomavirus ("warts")
D. Tongue abscess

B. Oropharyngeal syphilis

The following statements about gonorrhea are correct EXCEPT one.
Which is the EXCEPTION?

A. Gonorrhea can be transmitted at the same time as HIV.
B. Gonorrhea can cause pharyngitis, proctitis, urethritis, and cervicitis.
C. Gonorrhea is always clinically evident (i.e., symptomatic).
D. Gonorrhea is a major cause of female sterility

C. Gonorrhea is always clinically evident (i.e., symptomatic).

The following statements regarding Chlamydiae are correct EXCEPT
one. Which is the EXCEPTION?

A. Chlamydiae infection can lead to blindness.
B. Chlamydiae can survive within phagosomes.
C. Chlamydiae can grow only inside a host cell because their small
genomes do not encode some essential enzymes.
D. The reticulate body is the form that can transit from one host cell to
another

“Screwdriver” shaped incisors with notching (Hutchinson’s teeth)

congenital syphilis II

A “Mulberry” Molar (hutchinson’s teeth)

congenital syphilis II

what are symptoms of gonorrhea (men)?

epididymitis, urethritis

what are symptoms of gonorrhea (women)?

pelvic inflammatory disease with abscesses, subsequent ectopic pregnancies or sterility

both men and women with gonorrhea can have what symptom?

gonorrheal pharyngitis /tonsilitis/gingivitis

what is the 2nd most common cause after Group A Strep?

Gonorrheal pharyngitis

what is the most common cause of urethritis (men) and cervicitis (women)
in the US?

chlamydiae

chlamydiae can also cause what other complications?

trachoma, conjunctivitis, arthritis, pneumonia, and other respiratory tract infections

what are the 2 unique stages of chlamydiae?

1. reticulate body (active metabolism)

2. elementary body (transit form that goes from one cell to another)

anitbiotics are only effective against which stage of chlamydiae?

reticulate

what is a key genomic characterisitcs of chlamydiae?

• Strict intracellular bacteria with small genome

• cannot generate ATP;

• has no oxidative enzymes, flavoproteins or cytochromes;

• can make own proteins

symptoms of human papilloma virus?

• Cutaneous and anogenital warts, cervical cancer

• juvenile onset recurrent respiratory papillomatosis (JORRP)

• focal oral hyperplasia

what is the new recommended treatment for gonnorhea?

ceftriaxone 500 mg given IM

what are the 2 major STD syndromes of C. trachomatis in humans?

• lymphogranuloma venereum (LGV)

• urethritis

how is chalmydiae diagnosed?

direct fluorescent assays (nucleic acid amplification tests NAAT)

what are treatments for chlamydiae urethritis/cervicitis?

• 100 mg Doxycycline 2x daily (or azithromycin)

• erythromycin (children or pregnant women)

what is respiratory papillomatosis?

death by suffocation – during vaginal delivery, infant’s oropharynx infected

what causes the majority of cervical, penile, vulvar, vaginal, anal, and oropharyngeal cancers?

HPV 16 and 18 (preventable via subunit vaccine)