to the dx?
a. Anti-HSV antibodies
b. Dark ground microscopy of the ulcer
c. Treponema palladium antibody test
d. Rapid plasma regain test
e. VDRL
answer: A
HERPES SIMPLEX VIRUS OF VULVA
Etiology
• 90% are HSV-2, 10% are HSV-1
Clinical Features
• may be asymptomatic
• initial symptoms: present 2-21 d following contact
• prodromal symptoms: tingling, burning, pruritus
• multiple, painful, shallow ulcerations with small vesicles appear 7-10 d after initial infection
(absent in many infected persons); lesions are infectious
• inguinal lymphadenopathy, malaise, and fever often with first infection
• dysuria and urinary retention if urethral mucosa affected
• recurrent infections: less severe, less frequent and shorter in duration (especially with HSV-1)
Investigations
• viral culture preferred in patients with ulcer present, however decreased sensitivity as lesions heal
• cytologic smear (Tzanck smear)
multinucleated giant cells, acidophilic intranuclear inclusion bodies
• type specific serologic tests for antibodies to HSV-1 and HSV-2
• HSV DNA PCR
Treatment:
Acyclovir
SYPHILIS
• Treponema pallidum
Classifications
• primary syphilis
- 3-4 wk after exposure
- painless chancre(e.g. PAINLESS ULCER) on vulva, vagina, or cervix
- painless inguinal lymphadenopathy
- serological tests usually negative, local infection only
- 2-6 mo after initial infection
- nonspecific symptoms: malaise, anorexia, headache, diffuse lymphadenopathy
- generalized maculopapular rash: palms, soles, trunk, limbs
- condylomata lata: anogenital, broad-based fleshy gray lesions
- serological tests usually positive
- no clinical manifestations; detected by serology only
- may involve any organ system
- neurological: tabes dorsalis, general paresis
- cardiovascular: aortic aneurysm, dilated aortic root
- vulvar gumma: nodules that enlarge, ulcerate and become necrotic (rare)
- may cause fetal anomalies, stillbirths, or neonatal death
• aspiration of ulcer serum or node
• darkfield microscopy (most sensitive and specific diagnostic test for syphilis): spirochetes
• non-treponemal screening tests (VDRL, RPR); nonreactive after treatment, can be positive with other conditions
• specific anti-treponemal antibody tests (FTA-ABS, MHA-TP, TP-PA) remain reactive for life (even after adequate treatment)
Treatment
• treatment of primary, secondary, latent syphilis of <1 yr duration
benzathine penicillin G 2.4 million units IM single dose
treat partners, reportable disease
• treatment of latent syphilis >1 yr duration
benzathine penicillin G 2.4 million units IM q1wk x 3 wk
• treatment of neurosyphilis
IV aqueous penicillin G 3-4 million units IM q4h x 10-14 d
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