<prompt> 23 years old with painless penile ulcer and painless lymphadenopathy. What is the diagnosis?ChancroidDonovanosisSyphilisHerpes  <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 daysTreponemapallidum:General characteristicsCultural characteristicsSpirochete motile with endoflagellumLevaditi and Fontana stainingCork screw lashing , Flexion - extension rotatory motilityDoes not follow Kochs postulatesBiochemical reactionsClinical featuresHyaluronidsae veIncubation period: 9- 90 daysPrimary - painless punched out genital ulcer chancre Secondary - condylomata lata, palmar rashesTeiary - gummaNeurosyphilis - General paresis of insane, Tabes dorsalisCardiosyphilis - 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, 372-376 