Genital Ulcer.pptx

Slide show for MRCP part-1 student

1. Half An Hour With MRCP Topic : S y philis Dr. Sharif Raihan MRCP (PACES Candidate) FCPS (Final part)

2. Syphilis Spirochaete - Treponema pallidum Primary, secondary and tertiary stages Incubation period= 9-90 days.

3. Primary Stage: Primary lesion or chancre in the genital area. Dull red macule develops, becomes papular and then erodes to indurated ulcer (chancre). Inguinal lymph nodes may become moderately enlarged, mobile, discrete and rubbery. Chancre and the lymph nodes are both painless and non-tender

4. Secondary features: occurs 1-6 months after primary infection: Systemic symptoms: fevers , painless generalized lymphadenopathy Generalized symmetrical rash on trunk, palms and soles Buccal 'snail track' ulcers Condylomata lata .

5. Snail track ulcer

6. Condylomata lata

7. Tertiary features: (cardio-syphilis & Neuro -syphilis) Occurs up to 10-25 years following the original inoculation. Gummas Cardiovascular syphilis: AA Aortic aneurysms, Aortic regurgitation and Aortitis . Neurosyphilis : GPI ( General paralysis of the insane ): Gradual onset confusion, Hallucinations, Tremors, Fits, Cognitive impairment, Hyperreflexia , and Argyll-Robertson pupils. TD ( Tabes dorsalis ) – Ankle reflex absent & extensor plantar

8. Gumma

9. Features of congenital syphilis: 1) Blunted upper incisor teeth 2) Saddle nose 3) deafness 4) Keratitis 5) Sabre shins

10. Hutchinson teeth & sabre shin

11. Investigation: Serological tests can be divided into: Cardiolipin tests (not treponeme specific): VDRL (Becomes negative after treatment) and RPR. Treponemal specific antibody tests: TPHA (Remains positive all the life even after treatment) TPHA is positive for both syphilis and Yaws

12. False positive cardiolipin tests (VDRL): Pregnancy SLE, anti- phospholipid syndrome Tb Leprosy Malaria Hiv

13. Management: Benzyl-penicillin long-acting 2.4 million units single IM injection. Alternatives: doxycycline

14. Chancre Treponema pallidum Painless Hard indurated edge Non exudative Heal spontaneously within 3-6 wks. even if no ttt . Chancroid Haemophilus ducreyi Painful Soft , ragged edge Grey or yellow purulent exudate Need Treatment

15. Chancre Chancroid

16. 1. A 34-year-old man presents with a widespread maculopapular rash and mouth ulcers. Two months ago he presented to the local GUM clinic after developing a painless penile ulcer . At the time he was noted to have inguinal lymphadenopathy . Which one of the following organisms is most likely to be responsible? a) Lymphogranuloma venereum b) Herpes simplex virus type 2 c) Mycoplasma genitalium d) Haemophilus ducreyi e) Treponema pallidum