<prompt> 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?A single dose of 2.4 million units of benzathine penicillin IM is the treatmentExamination of the groin will reveal a characteristic Groove SignIt is caused by Hemophilus ducreyiHe is likely to develop ahritis of the knee  <response>: Genito-urinary ulcer disease:Genital ulcerPainless, InduratedPainful Non-induratedSyphilisLGVGranuloma inguinale DonovanosisHerpesChancroidTreponema pallidumChlamydia trachomatis L1, L2, L3 strainsKlebsiella CalymmatobacteriumgranulomatisHerpes simplex virus type 2Hemophilus ducreyiNon-bleeding, usually single punched out ulcer Hard chancreRubbery Lymph NodesAsymptomatic, single, non-bleeding ulcerMatted Lymph Nodes BUBOVaginal rectal strictures elephantiasis EsthiomineGroove sign Single multiple, bleeding ulcersMostly involves genitalia inguinal region, no lymphadenopathy Pseudo BuboGenital swelling Pseudo elephantiasisMultiple, painful, non-indurated, bleeding, mostly presents as vesicular lesionsMultiple, bleeding on touch vascular baseL.Ns- Painful, Fluctuant, spontaneously rupture suppurateIncubation period: 9-90 days3 days- 6 weeks1-4 weeks2-7 days1-14 daysTreponema pallidum:General characteristicsCultural characteristicsSpirochete motile with endoflagellumLevaditi and Fontana stainingCork screw lashing, Flexion-extension rotatory motilityDoes not follow Kochs postulatesBiochemical reactionsClinical featuresHyaluronidase veIncubation period: 9- 90 daysPrimary - painless punched out genital ulcer chancre Secondary - condylomata lata, palmar rashesTeiary - gummaNeurosyphilis - General paresis of insane, Tabes dorsalisCardiosyphilis - a syphilitic aneurysm Congenital syphilis DiagnosisEarly - Snuffles , rhinitis Late - Interstitial keratitis , 8th nerve deafness , cluttons jointsResidual stigmata - Hutchinsons teeth , Mulberry molars, Saddle nose, Saber shinsHutchinson triad- Hutchinsons teeth peggednotched teeth interstitial keratitis sensorineural deafnessDark ground microscopy - Detection limit - 104 mlSpecific test - FTA - ABS, TPHA, TPINonspecific test - VDRL, RPRFor monitoring treatment - VDRL and RPRFor CSF testing: VDRL RPR in sensitivity VDRL not done for plasma samplesMicroscope required for interpretation for VDRL but not for RPRTreatmentPrimary, secondary or early latent: Benzathine Penicillin single dose of 2.4 mU I.MLate latent, cardiovascular or bening teiary: Benzathine Penicillin 2.4 mU I.M weekly for 3 weeksNeurosyphilis: Aqueous Procaine Penicillin G 2.4 mUd I.M oral Probenecid 500mg qid both for 10- 14 daysSecondary syphilis:Cutaneous lesionsRoseolar syphilidePapular syphilidePsoriasiform lesion CondylomalataMalignant syphilidePalm sole lesion Coppery red lesion Mucosal lesions Mucous patches Snail track ulcers Lymphadenopathy Generalized symmetrical rubbery lymphadenopathy Systemic involvement Periosteitis, Ahritis Iridocyclitis, Uveitis, ChorioretinitisNephritic syndrome Ref: Ananthanarayan 9th edition, p373-376 