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What is 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? and explain in detail?
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