Chancroid is a bacterial sexually transmitted infection caused by Haemophilus ducreyi that causes painful genital ulcers. It has an incubation period of 3 to 10 days and symptoms include tender inguinal lymphadenopathy. Diagnosis is made through identification of characteristic microscopic findings on smears from ulcer exudates or cultures.

1. PREPARED BY:
Kabita Shrestha
Roll No. 22
B. Sc. Nursing Student
3rdYear, 10th batch
KMCTH

2. STIS
 Reasons for increasing
incidence of STIS
Syphilis
Introduction
Mode of transmission
Activities that do not
transmit syphilis
Stages and Clinical
Features
Diagnosis
Treatment
Lymphogranuloma
venereum
Introduction
Stages and symptoms
Diagnosis
Treatment

3.  Sexually transmitted infections are
infections that are predominantly
transmitted through sexual contact from
an infected partner.
 Other modes of transmission include:
• Placental
• Blood transfusion
• Needle prick
• Organ or tissue transplant

4. Rising prevalence of
viral infections like HIV,
Hepatitis B and C.
Increased use of Pill and
IUCD which cannot
treat STI.
Increased rate of
overseas travel.

5. Lack of sex education
and inadequate
practice of safer sex.
Increased detection
due to heightened
awareness.

6. Types of
Infections
Infections Causative
Organism
Bacterial Syphilis
Lymphogranuloma venereum
Chancroid
Granuloma inguinale
Gonorrhoea
Non gonococcal urethritis
Non specific vaginitis
Mycoplasma Infecton
Treponema pallidum
Chlamydia trachomatis
Haemophilus ducreyi
Donovania
granulomatis
Neisseriae gonorrheae
Chlamydia trachomatis
Haemophilus vaginalis
Mycoplasma hominis
Fungal Monoliassis vaginitis Candida albicans

7. Types of
Infections
Infections Causative
organisms
Viral AIDS
Genital herpes
Condyloma acuminate
Molluscum contagiosum
Viral hepatitis
CIN
HIV 1 or HIV2
HSV 2
HPV
Pox virus
HBV and HCV
HPV 16, 18 or 31
Protozoal BacterialVaginosis
Trichomonas vaginitis
Gardnerella vaginalis
Trichomonas vaginalis
Ectoparasites Scabies
Pediculosis
Sarcoptes scabiei
Crab louse

8.  Syphilis is a sexually transmitted infection
caused by motile anaerobic Spirocheta
Treponema palllidum.
 Host: Humans

9.  Syphilitic Lesion of genital tract is acquired
by direct contact with another person who
has open primary or secondary lesion.
 Transmission occurs through the abraded
skin or mucosal surface during vaginal, anal
or oral sex. (sexual contact)
 Transplacental route

10. o Contact with toilet seats, door knobs,
swimming pools, bath tubs etc.
o Sharing clothings, eating utensils etc.

11.  Incubation period: 9-90 days

12. A. Primary Syphilis:
 The classic lesion designated as chancre
may be single or multiple and is usually
located in labia, fourchette, anus, cervix
and nipples.
 The macular lesion becomes papular and
then ulcerates.

13.  The ulcer is painless without any
surrounding inflammatory reaction.
 The inguinal glands are enlarged, discrete
and painless.
 The tubes are not affected and infertility
does not occur.
 The primary chancre heals spontaneously
in 1-8 weeks leaving behind a scar.

14. B. Secondary syphilis:
 Within 6 weeks to 6 months from the onset
of primary chancre, secondary syphilis may
be evidenced in the vulva in the form of
condylomata lata (coarse, flat-topped,
moist, necrotic lesions and teeming with
treponemas.

15.  The characteristic rash of secondary syphilis
may appear as rough, red, or reddish brown
spots both on the palms and feet.
 Patient may present with systemic symptoms
like fever, head ache, sore throat etc.
 Other symptoms include muscle ulcers,
weight loss, alopecia, generalized
lymphadenopathy.

16. C. Latent Syphilis:
 It is the quiescence phase after the stage of
secondary syphilis has resolved.
 Infection remains in the body of sufferer
though there are no sign and symptoms.
 It varies in duration from 2 to 20 years.

17. D.Tertiary Syphilis:
 About one-third of untreated patients
progress from late latent stage to tertiary
syphilis.
 Tertiary syphilis is characterized by
gumma.
* A gummatous ulcer is a deep punched
painless ulcer with rolled out margins and
moist leather base.

18.  It damages the central nervous,
cardiovascular and musculoskeletal
systems. (cranial nerve palsies, hemiplegia,
tabes dorsalis, aortic aneurysm etc)

20.  Congenital Syphilis:
 Untreated babies
born of syphilitic
mother may become
developmentally
delayed, have
seizures or die.

22. 1. History of exposure
2. Identification of the organism:
Motile, bluish white cork-screw shaped
organisms appear on exudates smear of
primary chancre when examined under
dark ground illumination through a
microscope.

24. 3. Serological tests:
Non-Treponemal
Tests
• VDRL
• RPR
Treponemal tests
• MHA-TP
• FTA-ABS

25. Non-TreponemalTests:
• These tests detect the body’s response to
the infection, but not to the actual
Treponema organism that causes infection.
• They can also produce a positive result
when no infection is actually present so
called false-positive results for syphilis.

26. TreponemalTests: (Confirmatory)
• These tests directly detect the body’s
response toTreponema pallidum.

28.  Early Syphilis:
o Benzathine Penicillin
G 2.4 million units IM
single dose, half to
each buttock
o In penicillin allergic
cases
• Tetracycline 500 mg
PO* 14 days
• Doxycycline 100 mg
BD PO*14 days

29. Late Syphilis:
o Benzathine Penicillin G 2.4 million units IM
weekly*3 weeks (Total 7.2 million units)
o Alternative Regimen
• Doxycycline 100mg PO BD * 4 weeks
• Tetracycline 500mg PO QID * 4 weeks

30. Syphilitic pregnant woman:
o Penicillin is the drug of choice as other
antibiotics do not effectively cross the
placenta to treat the infected fetus.

35.  LGV is sexually transmitted chronic
infection of the lymphatic system caused
by one of the aggressive L serotypes of
Chlamydia trachomatis, which is an
obligatory intracellular and Gram-
intermediate organism.

36.  Incubation period: 3-30 days
Initial lesion:
 Painless papules, papules or ulcers in the
vulvas, urethra, rectum or cervix.
 Inguinal nodes are involved and feel
rubbery.
 Acute lymphangitis and lymphadenitis

37.  The glands become necrosis and abscess
(bubo) forms.
 Within 7-15 days, the bubo ruptures and
results in multiple draining sinuses and
fistulas.
 The healing occurs with intense fibrosis
with lymphatic obstruction.

38. Secondary Phase:
 Painful adenopathy
 Groove sign- depression between groups of
inflamed nodes. (classical clinical sign of
LGV)

39.  Lymphatic obstruction leads to vulval
swelling.
 Lymphatic extension to vulva, vagina, or
rectum leads to ulceration, fibrosis and
stricture of vagina or rectum.

40.  History taking
 Physical examination- ulcer, fistula,
lymphadenopathy
 Culture and isolation: lymph node
aspiration
 Detection of LGV antigen:
• Immunofluorescence method
• ELISA method
 LGV compliment fixation test: positive
when rising titer >1:64

41. Definite treatment
 Doxycycline 100mg BD *21 days
 Azithromycin 1 g PO weekly * 3 weeks
 Erythromycin 500mg PO QID * 21 days
~Sexual partner should also be treated.

42. Surgical treatment
 Abscess should be aspirated but not
excised
 Manual dilatation of stricture weekly

44. 1. Which of the following is the most specific
test for syphilis?
a. FluorescentTreponemalAntibody
AbsorptionTest (FTA-ABS)
b. Gram stain of Lesion exudates
c. Rapid Plasma ReaginTest (RPR)
d. Veneral Disease Research LaboratoryTest
(VDRL)

45. 2. Which of the following is the best treatment
for syphilis in more than 1 year duration?
a. PenicillinV 250 mg QICD810 days
b. Benzathine Penicillin G 2.4 million units IM
single dose
c. Benzathine Penicillin G 2.4 million units IM
weekly*3 doses
d. Aqueous Penicillin G 4 million units every 4
hours*10 days

46. 3. Lymphogranuloma venereum is most
difficult to differentiate from which of the
following?
a. Granuloma inguinale
b. Chancroid
c. Herpes simplex vulvitis
d. syphilis

47. 4. What is the classical clinical sign of
Lymphogranuloma?
a. Hodgkin’s sign
b. Shrink sign
c. Deep sign
d. Groove sign

48.  Dutta DC, “Textbook of Gynaecology”. 6th
Edition 2013. Jaypee Brothers and Medical
Publishers. Page no. 148-150, 151
 Howkins and Bourne “Shaw’s Textbook of
Gynaecology”. 14th Edition. Page no. 127-
130
 Tamrakar Anupama, “ A Textbook of
Gynaecological Nursing”. 2069. Vidhyarthi
Pustak Bhandar Publishers. Page no. 260-
266

49.  http://en.wiki.org/syphilis (pictures)
 http://en.wiki.org/lymphogranuloma_vener
eum (pictures)

50. Q: Prepare note on Chancroid.