CONFIRMING DIAGNOSIS Identifying T. pallidum from a lesion on dark-field examination confirms the diagnosis of syphilis. This method is most effective when moist lesions are present, as in primary, secondary, and prenatal syphilis. (See Treponema pallidum.)
The fluorescent treponemal antibody-absorption test identifies antigens of T. pallidum in tissue, ocular fluid, cerebrospinal fluid (CSF), tracheobronchial secretions, and exudates from lesions. This is the most sensitive test available for detecting syphilis in all stages. Once reactive, it remains so permanently.
Other appropriate procedures include the following:
❑ Venereal Disease Research Laboratory (VDRL) slide test and rapid plasma reagin test (RPR) detect nonspecific antibodies. Both tests, if positive, become reactive within 1 to 2 weeks after the primary lesion appears or 4 to 5 weeks after the infection begins.
❑ CSF examination identifies neurosyphilis when the total protein level is above 40 mg/dl, the VDRL slide test is reactive, and the cell count exceeds five mononuclear cells/µl.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Genital lesions in the male:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, the number of sexual partners, and the pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Syphilis:
Diagnosis
(Handbook of Diseases)
Identifying T. pallidum from a lesion on a dark-field examination provides immediate diagnosis of syphilis. This method is most effective when moist lesions are present, as in primary, secondary, and prenatal syphilis.
The fluorescent treponemal antibody-absorption test identifies antigens of T. pallidum tissue, ocular fluid, cerebrospinal fluid (CSF), tracheobronchial secretions, and exudates from lesions. This is the most sensitive test available for detecting syphilis in all stages. After it becomes reactive, it remains so permanently.
Other appropriate procedures include the following:
❑ Venereal Disease Research Laboratory (VDRL) slide test and rapid plasma reagin test detect nonspecific antibodies. Both tests, if positive, become reactive within 1 to 2 weeks after the primary lesion appears or 4 to 5 weeks after the infection begins.
❑ CSF examination identifies neurosyphilis when the total protein level is above 40 mg/100 ml, VDRL slide test is reactive, and CSF cell count exceeds five mononuclear cells/µl.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Genital lesions in the male:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesions. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Genital lesions, male:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Congenital Infections:
Diagnosis
(Pediatric Infectious Disease)
The gold standard of diagnosis is isolation of the virus, usually from the
urine. Urine viral cultures are often positive within days because the kidney
is a principal site of viral replication. Proof of congenital infection is
based on obtaining appropriate specimens within 3 weeks of birth. After this
time, distinguishing between intrauterine infection and perinatal infection may
be difficult.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Infectious Disease, 2004
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