0071643192.pdf

INFECTIOUS DISEASE

■ Uncomplicated

■ Men: Urethritis, epididymitis, prostatitis

■ Women: Cervicitis, PID

■ Both: Pharyngitis, conjunctivitis

■ Disseminated (~2% of patients; usually women)

■ Primary (febrile) stage

■ Fever/chills

■ Rash

■ Tender pustules on red/hemorrhagic base

■ Peripherally located

■ Tenosynovitis (~66%)

■ Most often dorsum of wrist, hand, and ankle

■ Second stage

■ Monoarticular or oligoarticular septic arthritis

DIAGNOSIS

■ Uncomplicated

■ Cervical/urethral swab using nucleic acid amplification tests (NAAT;

sensitivity ~95%)

■ Urine test (less sensitive)

■ Disseminated

■ BCx, biopsy of skin lesions, or synovial fluid (positive in only 20–50%)

■ Cultures

■ Chocolate agar if sterile site (eg, CSF, synovial fluid)

■ Martin-Lewis agar if nonsterile site (eg, cervix, urethra, rectum,

oropharynx)

TREATMENT

■ All cases should also be empirically covered for chlamydia

■ Uncomplicated (not PID)

■ Ceftriaxone 125 mg IM ×1 or cefixime 400 mg PO

■ Avoid fluoroquinolones (increasing resistance)

■ PID

■ See Gynecology section.

■ Disseminated

■ Treat empirically if high suspicion as test sensitivity is low.

■ Ceftriaxone 1 g IV daily ×10 days

■ Or ceftriaxone ×3 days followed by cefixime PO for 7 days

■ Refractory tenosynovitis may require surgical washout.

Syphilis

■ The spirochete Treponema pallidum

SYMPTOMS/EXAM

■ Incubation period: ~3 weeks

■ 1° syphilis (see Figure 8.1)

■ Painless genital ulcer with indurated border (chancre)

■ Heals spontaneously over 2–6 weeks

■ 2° syphilis

■ 4–8 weeks after healing of chancre

Empirically treat all patients

with suspected gonorrhea for

chlamydia, because of the

high rates of coinfection.

Consider 2ºsyphilis in any

patient with a rash involving

the palms and/or soles.

FIGURE 8.1. Primary

syphilis.

(Reproduced, with permis-

sion, from Bondi EE et al.

Dermatology: Diagnosis

and Therapy. Stamford,

CT: Appleton & Lange,

1991:394.)