Ulcer ddx:
primary syphillis
chachroid
herpes
lymphogranuloma venreum
others: granuloma inguinale, trauma, behcet disease, abscess (draining)
primary syphillis classic presedntation
painless papule (ulcerates) chancre
is well demarcated and measured 1-2cm ; may have non tender LAN takes 3-6 weeks to resolve and no tx. Anywhere in contact with an open ulcer.
syphillis diagnosis:
VDRL
treponemal specific
titres
tx of syphillis
2.4 million units of penicllin; doxy or tetracycline x 14 days, others (less recommended) azithromycin and ceftriaxone
if neuro: aqueous pen G 3-4 million units q4h for 10-14 days
Jarisch-Herxmeiher reaction
presents within 24 h of abx tx dt lysis of the spirochetes. tx is supportive.
give good education around symptamology and supportive mgmt at home.
Epithelial cell lesions ddx
2ndary syphillis, moloscum contagiosum, neoplasm,
presentation of 2ndary syph
develops in ~25% of those with 1ary syph; rash in palms and soles of feet, generalized rubbery mobile and nontender LAN, get condylomalatta; moth-eaten alopecia
rates of asymptomatic chlamydia
men 50% ; women 70%
abn vag differential
chlamydia, gonorrhea, BV, trich, yeast, allergic; FB, candida, PID nongonoccocal ureteritis
tx of gonorrhea and chlamydia
test: NAAT
gon: CTX 500mg IM single dose
chlamydia: doxy 100mg PO BID x 7 days OR azithro 1g PO once
