Exam #6: STD II

Question 1

What causes syphilis?

Answer 1

Treponema pallidum (spirochete)

Question 2

List the characteristics of Treponema pallidum.

Answer 2

Thin Gram (-) spirochete
Motile
Microaerophilic

*Does NOT grow in cell free culture, very difficult to grow

Question 3

Describe the structure of Treponema pallidum.

Answer 3

Gram (-) cytology, but DOES NOT gram stain
Flexible
Peptidoglycan surrounds axial fibrils
Wound endoflagella
Cell wall & axial fibrils are covered by an outer bilayered membrane

Question 4

How is syphilis diagnosed?

Answer 4

Dark-field micrscopy
Direct fluorescence
Antibody/ serology is most common

Question 5

How is primary syphilis characterized?

Answer 5

1+ skin lesions (chancres)
Hard
Indurated
Painless

Question 6

What causes the lesion & how long does it last?

Answer 6

Inflammation causes the lesion
Onset is 10-90 days post initial infection
Lasts 2 weeks–>2 months

Question 7

How is secondary syphilis charactertized?

Answer 7

Disseminated disease

• Flu-like syndrome
• Prominent skin lesions on plams & soles
• “Condylomata lata”

Question 8

What are Condylomata lata?

Answer 8

Raised lesions in skin folds associated with secondary syphilis

Question 9

How is latent syphilis characterized?

Answer 9

Asymptomatic period

• Lasts years to decades
• Can relapse into secondary syphilis
• Transmission possible esp. from mother to child

Question 10

How is tertiary syphilis characterized?

Answer 10

Diffuse, chronic inflammation
Can cause devastating destruction of virtually any organ/ tissue
Gumma

Question 11

What is a gumma?

Answer 11

Granulomatous lesions that may be found in bone, skin, & other tissues i.e. brain & heart associated with tertiary syphilis

Question 12

What were the outcomes of the Tuskegee syphilis experiment?

Answer 12

IRB

Informed consent

Question 13

What is congenital syphilis?

Answer 13

Mother-to-child transmitted syphilis

• Often terminates pregnancy, but when it doesn’t:
• Chronic rhinitis–>saddle nose
• “Condylomata lata”
• Teeth & bone malformation, blindness, deafness, & cardiovascular syphilis

Question 14

What is Hutchinson’s triad?

Answer 14

Small
Malformed
Widely spaced teeth

Question 15

What are the serologic tests for syphilis? What are their targets?

Answer 15

Treponemal test= detects antibody specific to T. pallidum

Nontreponemal= measures antibody directed against cardiolipin

Question 16

When will a person start to exhibit a positive response to serologic tests through the infectious process?

Answer 16

Four weeks

Question 17

How is syphilis treated?

Answer 17

PCN

Question 18

What is NGU?

Answer 18

Non-gonococcal urethritis

i.e. when Gonorrhea & Chlamydia don’t cause urethritis

Question 19

What are the most common causes of NGU?

Answer 19

Mcoyplasma genitalium & Ureaplasma urealyticum

Question 20

List the characteristics of Mcoyplasma genitalium & Ureaplasma urealyticum.

Answer 20

DO NOT have a cell wall
Not stained
Pleomorphic

Plasma membrane contains sterols

Question 21

What is the characteristics morphology of Mycoplasma genitalium?

Answer 21

“Fried-egg” appearance

Question 22

What is Mycoplasma genitalium resistant to?

Answer 22

Doxycycline

Question 23

What is Mycoplasma genitalium susceptible to?

Answer 23

Azithromycin

Question 24

How is Ureaplasma treated?

Answer 24

Doxycycline

Question 25

What is Chancroid caused by?

Answer 25

Haemophilus ducreyi

Question 26

List the characteristics of Haemophilus ducreyi.

Answer 26

Gram (-) pleomorphic coccobacillus

Question 27

What is required for the growth of Haemophilus ducreyi ?

Answer 27

X & V factor

Question 28

What are the symptoms of Chancroid?

Answer 28

Genital ulcers - Painful chancre (vs. painless) - Soft (vs. hard) - Multiple vs. 1 lesion - Lymphadenopathy "You do cry with ducreyi" *Note that diagnosis is challenging because labs are NOT set up to detect b/c of low prevalence

Question 29

How is Haemophilus ducreyi i.e. Chancroid treated?

Answer 29

Macrolides

Question 30

What causes Donovanosis or Granuloma inguinale?

Answer 30

Klebsiella granulomatis

Question 31

What are the symptoms of Donovanosis?

Answer 31

- Primary lesion is ulcerated - Lesions are painless & bleed easily - Significant genital damage can occur - Hard

Question 32

How is Donovanosis diagnosed?

Answer 32

Donovan bodies

Question 33

Describe the medical decision making process when a patient presents with a genital ulcer.

Answer 33

1) Syphilis vs. Genital Herpes? | 2) IF NOT, then chancroid or donovanosis

Question 34

M. genitalium vs. Ureaplasma & doxycycline?

Answer 34

M. genitalium is resistant! | Ureaplasma is susceptible