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TM: Syndromic Approach to STIs (iii) (HPV (warts (Tx (topical: e.g.…

- - - - painless chancre @ inoculation site 3 wks after exposure (female 1 may be int)
    - - systemic illness 3 months later
      - blood dissemination - multiple manifestations
      - adenopathy
      - malaise
      - rash (diffuse macular-papular over trunk + extremities)
      - mimics vasculitis
      - 1/3 resolve, 1/3 progress to latent, 1/3 progress to tertiary
    - - approx 3 yrs (2-4)
    - - CVS
        
        aortitis
        
        endarteritis
      - neurosyphilis
      - gummatous
        
        skin
        
        soft tissue
        
        bone
      - ocular
  - - - TPPA/TPHA
        
        treponemal
        
        T pallidum particle agglutination
        
        stays +ve
      - RPR/VDRL
        
        non-treponemal (tests for Abs)
        
        should decrease x4 in 3-6 months
        
        -ve @ 1-2 yrs
        
        non-specific
        
        quantitative
        
        used to measure response to tx
        
        rapid plasma regain / venereal disease research lab
  - - - 2.4 million units IM
      - in tertiary will require 3 doses (wkly)
      - if allergic consider densenitisation
      - patients with HIV may need longer
    - - doxycycline
      - amoxicillin
      - ceftriaxone
      - azithromycin
      - longer courses
    - - densentisation
      - Jarisch Herxheimer reaction
        
        fever
        
        headache
        
        myalgia
        
        HTN
        
        looks similar to anaphylaxis
        
        warn patient
        
        give antipyretics
        
        NOT A PENICILLIN ALLERGY
- - - - topical: e.g. podophyllotoxin 10-20%, imiquimod
      - cryotherapy
      - surgery (rare)