A young man presents with asymptomatic macules and erythematous painless lesion over glans with generalized lymphadenopathy. Treatment of choice in this condition:
Ans. b. Benzathine penicillin (Ref: Fitzpatrick's 6/e p2164-2212; Rooks Textbook of Dermatology 7/e p30.1-35, 25.20-39)Asymptomatic macules and papule over the trunk and reddish patch over the palate with a flat, moist lesion on glans penis in a young man with generalized lymphadenopathy is suggestive of syphilis.Benzathine penicillin first line of treatment for syphilis.Clinical Presentation of SyphilisEarly Congenital Syphilis:Snuffles (rhinitis)Q is the earliest feature.Lesions are vesiculobullous and snail track ulcers on the mucosaLate Congenital Syphilis:Characterized by Hutchinson's triad (interstitial keratitis + 8th nerve deafness + Hutchinson's teeth i.e. pegged central upper incisors)QSaddle nose, saber tibia, mulberry molarsBull dog's jaw (protrusion of jaw)RhagadesQ (linear fissure at the mouth, nares)Frontal bossing, hot cross bun deformity of the skullClutton's joints (painless swelling of joints, most commonly both knee)Palatal perforationsHigaumenakis sign (periostitis leads to unilateral enlargement of sternal end of clavicle)Primary Syphilis:Painless, indurated, non-bleeding, usually single punched out ulcer (hard chancre)QPainless, rubbery shotty lymphadenopathySecondary Syphilis:Bilateral symmetrical asymptomatic localized or diffuse mucocutaneous lesions (macule, papule, papulosquamous and rarely pustule)Non-tender generalized lymphadenopathyHighly infectious condylomata IataQ, in warm moist intertriginous areasMoth ate alopecia, arthritis, proteinuriaQTertiary Syphilis:Gumma, neurosyphilis/tabes dorsalisQOstitis, periostitisAortitis, aortic insufficiencyQ coronary stenosis and nocturnal anginaQSyphilisCaused by Treponema pallidumQDiagnosed by dark field microscopyFTA-ABS (most sensitive test, earliest test to become positive)QVDRL or RPR titer (determine response to treatment as they become negative)QTPI (most specific test)QTPH (2nd most sensitive test)Treatment of Sexually transmitted DiseasesDiseaseDrug of choice* Gonorrhea- Non-penicillinase producing- Penicillinase-producing or disseminated gonorrhea- Amoxy/ampicillin, Procaine penicillin G - Ceftriaxone, cefuroximeQ* Syphilis- Early (Primary, secondary and latent) and Late- Neurosyphilis- Benzathine Penicillin GQ/Procaine penicillin G- Aqueous penicillin G/Aqueous Pen. G procaineQ* LGV (Chlamydia trachomatis)- AzithromycinQ- DoxycyclineQ* Donovanosis/Granuloma inguinale (Calymmobacterium granulomatis)- Doxycycline/tetracyclineQ* Chancroid (H. ducreyi)- CeftriaxoneQ- Azithro/ErytrhromycinQ- CotrimoxazoleQ
Ceftriaxone
Benzathine penicillin
Acyclovir
Fluconazole