2025 – PAGE 96 – OB/GYN AND SOME STDs
(DOUBLE TAKE) SYPHILIS
Syphilis is caused by TREPONEMA PALLIDUM. Non-treponemal tests (RPR or VDRL) can be FALSE positives, so you need to do a confirmatory treponemal test (FTA). While the FTA does not correlate with disease activity, the non-treponemal tests do. Also, the non-treponemal tests may eventually disappear with decreased disease activity. So once disease presence is confirmed with FTA, look at disease activity with non-treponemal titers to help guide management. Neonates born to a mother with a reactive non-treponemal (RPR or VDRL) test result should have a quantitative non-treponemal serologic test (RPR or VDRL) performed on the infant’s serum. Treponemal serologic tests (FTA) on a baby are difficult to interpret so are not recommended. An immunoglobulin (IgM) test is also not currently available. If the mom was treated and the baby’s titers are lower than hers, it’s safe to assume that those are just the mom’s IgGs that crossed the placenta and that there is NO NEED TO TREAT (just follow the titers). If the mom was treated < 1 month ago, TREAT. If the mom was given Erythromycin, TREAT because it doesn’t cross the placenta.
- CONGENITAL SYPHILIS: The baby can be born with a maculopapular rash, HSM, generalized lymphadenopathy and PEELING SKIN. If left untreated, the baby may later develop a PERFORATED PALATE, a PERFORATED NASAL SEPTUM, hearing loss, HUTCHINSON TEETH or a host of other complications. Hutchinson teeth are peg-shaped (cone-like) but also have a central notch that is extremely specific for congenital syphilis. Treat with PENICILLIN (PCN).
- CONDYLOMA LATA refers to SECONDARY SYPHILIS, in which white-gray coalescing papules are seen.
- PEARL: If the FTA is positive but VDRL is negative, also consider LYME DISEASE (BORRELIA BURGDORFERI).
- NAME ALERT/MNEMONIC: Condyloma LATA (AKA “condyloma FLATa,” are much more FLAT than Condyloma ACUMINATA (which is found with HPV infections).
- NAME ALERT/MNEMONIC: Peg teeth are also found in patients with Incontinentia Pigmenti (AKA “incontinentia PEGmentia”).
- IMAGE: (PEG-SHAPED TEETH) – www.pbrlinks.com/PEGTEETH1
- IMAGE: (HUTCHINSON TEETH) – www.pbrlinks.com/HUTCHTEETH1
BACTERIAL VAGINOSIS (AKA GARDNERELLA)
Bacterial vaginosis (AKA Gardnerella vaginalis) has a homogenous, smelly/fishy odor. Discharge can be white, yellow, or gray. It is associated with anything that changes the usual flora, including IUDs and antibiotic use. Look for CLUE CELLS. The vaginal fluid is relatively alkaline with a pH > 4.5. FYI… While Gardnerella is the most common organism associated with Bacterial vaginosis, it is not the only causative organism. Also, while it is associated with sexual intercourse, concerns for sexual abuse should be taken on a case-by-case basis.
MNEMONIC: “the GARDNER found a missing CLUE in the GARDEN. It was a dead and smelly FISH!”
(DOUBLE TAKE) TRICHOMONAS VAGINALIS
Trichomonas vaginalis is a protozoa. Look for yellow-green discharge, bubbly, frothy, motile flagella, and a pH > 4.5. This can be intensely pruritic. A classic sign is a strawberry cervix. Treat with metronidazole. It can also cause nongonococcal urethritis.
MNEMONIC: Imagine two girls having this conversation: “Can you believe that dirty old man TRICKED MONA, our favorite BUBBLY stripper, into putting a STRAWBERRY into her va-jay-jay?!? Gross! I heard it still had a long green STEM on it!” Sorry for the gross mnemonic, but hopefully it helps you associate the stem with the motile TAIL/FLAGELLA of Trichomonas.