A 20-year-old young female presented with a relatively painless ulcer of 3 cm on the labia majora with raised margins. Which of the following organisms would have most likely caused this ulcer?
Herpes simplex
Treponema palladium
Chlamydia trachomatis
Candidal cervicitis
Ans. b. Treponema palladium (Ref: Rooks 7/e p17.37-17, 39.58-39.59)In a female with 3x4 cm painless ulcer with raised margin on labia majora is suggestive of syphilis, caused by Treponema pallidum.Sexually Transmitted DiseasesDonovanosisSyphilisLGVChancroid* Painless indurated and bleeding ulcerQ* Mostly involving genitalia (90%)* No lymphadenopathy/ pseudobuboQ* May lead to pseudoelephantiasis of labiaQ* Caused by calymmobacterium granulomatosis* Diagnosis made by microscopy by demonstration of Donovan bodiesQ or safety pin appearanceQ within large mononuclear cells in smears or biopsy sample* DOC is doxy/ tetracyclineQ* DOC in pregnancy is Azithromycin/ erythromycinQ* Painless indurated, non bleeding usually single punched out ulcerQ* Lymph nodes are rubbery* Caused by Treponema pallidumQ* Diagnosed by dark field microscopy, FTA-ABS (most sensitive test, earliest test to become positiveQ VDRL or RPR titer (determine response to treatment as they become negativeQ TPI (most specific test)Q TPH (2nd most sensitive test)* Penicillin G is drug of choiceQ for all stages of syphilis* Lymph nodes are matted (bubo)Q may suppurate and are painfulQ* Asymptomatic, single, painless (mostly) and non-bleeding macule / ulcerQ* Caused by Chlamydia trachomatis - L1L2 (MC)Q, L3 strains* Diagnosis by microscopic examination of Giemsa stained cell scrapings for inclusion/elementary bodiesQ* Esthiomine (vaginal and rectal stricture elephantiasis of vulva)Q* Frei's test is done for diagnosisQ* Groove sign is seenQ* DOC is doxy / tetracyclineQ* Lymph nodes are fluctuant and spontaneously rupture and suppurateQ* Ulcers develop within 7 daysQ, are multiple, painful, non indurated and bleeding (soft chancre)Q* Caused by Hemophilus ducreyiQ* Diagnosis by gram staining (gram negative cocco-bacilli, school of fish and rail road appearance)Q and culture of organism* DOC is Ceftriaxone. Azithromycin / erythromycin.
Specific Infections