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Genital Ulcers (See the Ulcer (1. # of ulcers, w/ or w/o px 2. Pain or…

- - - - Pt: 1º
        
        Singular (@ site of inoculation)
        
        no Px
        
        non-tender LAD
        
        2º
        
        Fever :fire:
        
        rash: targetoid
        
        on palms :hand::skin-tone-5: and soles :footprints:
        
        :pencil2:rash on palms/soles could only be syphilis or erythema multiforme
        
        3º (decades later)
        
        Neurosyphilis
        
        any neuro sx
        
        Tabes Dorsalis
        
        loss of DCMLS
        
        foot flopping
        
        the old "rake" :older_man::skin-tone-4:
        
        Argyll-Robertson Pupil :eye:
        
        accommodation impaired
        
        Dx: 1º
        
        Chancre w/o immunologic reaction
        
        dx: Dark Field Microscopy :night_with_stars::microscope:
        
        there won't be (+) Ab's
        
        2º
        
        dx: Serologic testing
        
        non-treptonemal: RPR (better)
        
        VDRL
        
        Treptonemal Ab (confirmatory test)
        
        3º
        
        CSF evidence
        
        dx: LP w/ RPR
        
        Treptonemal Ab (confirmatory) on CSF
        
        Tx: 1º :pencil2: Penicillin IM 1x
        2º :pencil2: Penicillin IM 1x
        Early Latent (Asx)
        < 1yr inoculation range
        :pencil2: Penicillin IM 1x
        Late Latent (Asx)
        unk? inoculation or ≥ 1yr inoculation range
        :pencil2: Penicillin IM weekly for 3 weeks
        3º :pencil2: Penicillin IV q4h 10-14days
        
        f/u: HIV test
        
        :pencil2:RPR reported as a number : number
        
        bigger number after the ":", more (+) the RPR
        
        Number of dilutions that RPR is still (+)!
        
        1:2
        
        1:1028 <-- syphilis
        
        on repeat testing, we want decr. in this number
        
        # will always be (+), but ok if small
    - - Pt:
        
        Singular
        
        no Px
        
        Tender LAD
        
        ± suppurative & drain :volcano:
        
        Immunocompromised pt w/ pus in lymph nodes
        
        Dx:
        
        NAAT on drainage (pus) :volcano:
        
        Tx: :pill:Abx :bicyclist: Doxycycline
    - - Pt: Painful
        
        Singular
        
        Tender LAD
        
        Dx: Gram stain/Cx
        
        generally dx of exclusion
        
        Tx: :pill:Abx - Azithromycin or Cipro
    - - Pt: "gift that keeps on giving"
        
        Painful burning :fire: prodrome
        
        then…painful ulcer (actually vesicles on erythematous base)
        
        coalescence of vesicles forms ulcer
        
        clue is that ulcer has vesicles around it
        
        Dx: ~~Tzank prep~~ (perinuclear halos…)
        
        PCR
        
        tells us if HSV1/2
        
        viral Cx
        
        Tx: Acyclovir or Valacyclovir :pill:
        if someone has an outbreak, the dose and freq. is different from a recurrence
        
        if ≥6 infections in a year, another dose & freq