Genitourinary Tract Infections
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Diseases in this Handout:



Genital Herpes

IV. Syphilis
Syphilis is a sexually transmitted infectious disease caused by the bacterium Treponema pallidum.

A. T. pallidum has a number of characteristics which are important for diagnosis. 

B. Epidemiology of syphilis 

C. The manifestations of syphilis depend on the stage of disease the patient is in.

1. Manifestations of primary syphilis: a) hard chancre (lesion on female); and b) regional lymphadenitis.

2. Manifestations of secondary syphilis 3. Latent syphilis is by definition the stage in which there is a positive serological test for syphilis in the absence of any clinical disease symptoms.

4. Tertiary or late syphilis is a noncontagious but highly destructive phase of syphilis which may take many years to develop; it may manifest itself in several forms:


5. Congenital syphilis results when maternal syphilis spreads in utero to the fetus after the 4th month of gestation.

D. Pathology and Pathogenesis of Syphilis 
  1. The organisms enter the body via minute abrasions of epithelial cell linings, by penetrating mucous membranes or via hair follicles, and then there is a rapid systemic spread via the blood and lymphatics.
  2. The most prominent histologic features are vascular changes caused by endarteritis and periarteritis (perivascular cuffing).

E. Diagnosis of syphilis is accomplished via: 

  1. Evaluation of presenting signs and symptoms as well as contact history
  2. Darkfield examination of exudative material in syphilitic lesions
  1. Serological approaches using treponemal or nontreponemal tests

False + serological reactions in non-treponemal antigen tests are quite common and may occur in patients with:

    1. hepatitis
    2. infectious mononucleosis
    3. viral infections
    4. malaria
    5. pregnancy
    6. connective tissue disease like SLE
    7. disease with Ig abnormalities
    8. in some healthy people
False positives in direct treponemal tests are more rare because they are more specific; they are associated with:
    1. diseases with Ig abnormalities
    2. multiple myeloma
    3. SLE
F. Prognosis of Syphilis G. Therapy of syphilis
  1. Patients who have primary or secondary syphilis should be treated with the following regimen: Benzathine penicillin G 2.4 million units IM in a single dose.
  2. Early Latent Syphilis: Benzathine penicillin G 2.4 million units IM in a single dose.
  3. Late Latent Syphilis or Latent Syphilis of Unknown Duration: Benzathine penicillin G 7.2 million units total, administered as three doses of 2.4 million units IM each at 1-week ntervals.
  4. Tertiary Syphilis: Benzathine penicillin G 7.2 million units total, administered as three doses of 2.4 million units IM at 1-week intervals.
  5. Recommended Regimen for Children: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose.
  6. Congenital Syphilis: Aqueous crystalline penicillin G 100,000-150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life, and every 8 hours thereafter for a total of 10 days; OR Procaine penicillin G 50,000 units/kg/dose IM a day in a single dose for 10 days.
  7. Identify source contact, examine and treat.
  8. Treatment of congenital syphilis.
  9. POST TREATMENT FOLLOW-UP IS IMPORTANT. Jarisch-Herxheimer Reaction: Intensification of existing syphilitic lesions and/or exacerbation of old ones following administration of penicillin; the reaction subsides in 24 hours and you should simply warn the patient to expect it. 
H. Prevention of Syphilis V. Chancroid or soft chancre disease is an acute sexually transmitted disease characterized by genital ulceration and suppuration caused by the organism Haemophilus ducreyi. VI. Genital herpes (= herpes genitalis) is an acute inflammatory disease of the male and female genital tract due to infection with Herpes simplex virus (HSV). D. Pathology E. Diagnosis F. Therapy Counseling of these patients should include the following:

Patients who have genital herpes should be told about the natural history of the disease, with emphasis on the potential for recurrent episodes, asymptomatic viral shedding, and sexual transmission.

Patients should be advised to abstain from sexual activity when lesions or prodromal symptoms are present and encouraged to inform their sex partners that they have genital herpes. The use of condoms during all sexual exposures with new or uninfected sex partners should be encouraged.

Sexual transmission of HSV can occur during asymptomatic periods. Asymptomatic viral shedding occurs more frequently in patients who have genital HSV-2 infection than HSV-1 infection and in patients who have had genital herpes for less than 12 months. Such patients should be counseled to prevent spread of the infection.

The risk for neonatal infection should be explained to all patients, including men. Childbearing-aged women who have genital herpes should be advised to inform health-care providers who care for them during pregnancy about the HSV infection.

Patients having a first episode of genital herpes should be advised that

Recurrent Episodes of HSV Disease:

  1. When treatment is started during the prodrome or within 1 day after onset of lesions, many patients who have recurrent disease benefit from episodic therapy.
  2. Daily suppressive therapy reduces the frequency of genital herpes recurrences by greater than or equal to 75% among patients who have frequent recurrences (i.e., six or more recurrences per year). Suppressive treatment with acyclovir reduces but does not eliminate asymptomatic viral shedding.

These antiviral compounds have NO effect on establishment of latency and subsequent recurrences can and do occur. However, the recurrences maybe less numerous and less severe.

Severe Disease
IV therapy should be provided for patients who have severe disease or complications necessitating hospitalization, such as disseminated infection, pneumonitis, hepatitis, or complications of the central nervous system (e.g., meningitis or encephalitis). Acyclovir 5-10 mg/kg body weight IV every 8 hours for 5-7 days or until clinical resolution is attained.

G. Prognosis

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Revised 8/7/02
©2002 Neal R. Chamberlain, Ph.D., All rights reserved.