This patient came with this complaint one month after an extramarital sexual contact. He has no pain. Which one of the following statements is true?
Genito-urinary ulcer disease:Genital ulcerPainless, InduratedPainful/ Non-induratedSyphilisLGVGranuloma inguinale/ DonovanosisHerpesChancroidTreponema pallidumChlamydia trachomatis (L1, L2, L3 strains)Klebsiella (Calymmatobacterium)granulomatisHerpes simplex virus type 2Hemophilus ducreyiNon-bleeding, usually single punched out ulcer (Hard chancre)Rubbery Lymph NodesAsymptomatic, single, non-bleeding ulcerMatted Lymph Nodes (BUBO)Vaginal & rectal strictures & elephantiasis (Esthiomine)Groove sign ++Single/ multiple, bleeding ulcersMostly involves genitalia & inguinal region, no lymphadenopathy (Pseudo Bubo)Genital swelling (Pseudo elephantiasis)Multiple, painful, non-indurated, bleeding, mostly presents as vesicular lesionsMultiple, bleeding on touch (vascular base)L.Ns- Painful, Fluctuant, spontaneously rupture &suppurateIncubation period: 9-90 days3 days- 6 weeks1-4 weeks2-7 days1-14 daysTreponema pallidum:General characteristicsCultural characteristics*Spirochete motile with endoflagellum*Levaditi and Fontana staining*Cork screw & lashing, Flexion-extension & rotatory motilityDoes not follow Koch's postulatesBiochemical reactionsClinical featuresHyaluronidase +ve*Incubation period: 9- 90 days*Primary - painless punched out genital ulcer (chancre) *Secondary - condylomata lata, palmar rashes*Teiary - gumma*Neurosyphilis - General paresis of insane, Tabes dorsalis*Cardiosyphilis - a syphilitic aneurysm Congenital syphilis Diagnosis*Early - Snuffles , rhinitis *Late - Interstitial keratitis , 8th nerve deafness , clutton's joints*Residual stigmata - Hutchinson's teeth , Mulberry molars, Saddle nose, Saber shins*Hutchinson triad- Hutchinson's teeth (pegged/notched teeth)+ interstitial keratitis+ sensorineural deafness*Dark ground microscopy - Detection limit - 104 /ml*Specific test - FTA - ABS, TPHA, TPI*Nonspecific test - VDRL, RPR*For monitoring treatment - VDRL and RPR*For CSF testing: VDRL> RPR in sensitivity *VDRL not done for plasma samples*Microscope required for interpretation for VDRL but not for RPRTreatment*Primary, secondary or early latent: Benzathine Penicillin single dose of 2.4 mU I.M*Late latent, cardiovascular or bening teiary: Benzathine Penicillin 2.4 mU I.M weekly for 3 weeks*Neurosyphilis: Aqueous Procaine Penicillin G 2.4 mU/d I.M + oral Probenecid 500mg qid both for 10- 14 daysSecondary syphilis:Cutaneous` lesions*Roseolar syphilide*Papular syphilide*Psoriasiform lesion *Condylomalata*Malignant syphilide*Palm & sole lesion ( Coppery red lesion )Mucosal lesions *Mucous patches *Snail track ulcers Lymphadenopathy *Generalized symmetrical rubbery lymphadenopathy Systemic involvement *Periosteitis, Ahritis *Iridocyclitis, Uveitis, Chorioretinitis*Nephritic syndrome Ref: Ananthanarayan 9th edition, p373-376
A single dose of 2.4 million units of benzathine penicillin IM is the treatment
Examination of the groin will reveal a characteristic Groove Sign
It is caused by Hemophilus ducreyi
He is likely to develop ahritis of the knee
Bacteriology