Operational Obstetrics & Gynecology |
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Primary Syphilis |
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The distinguishing symptom is a painless ulcer on the vulva, vagina or cervix. The ulcer is non-tender, has a well-defined border and smooth base. It starts as a macular lesion, forms a central papule, then erodes to form an ulcer crater. Regional lymph nodes are enlarged, firm, mobile, and painless. The diagnosis is confirmed by darkfield examination of serous fluid from crater (looking for spirochetes), a VDRL or RPR test. Watch for the Herxheimer reaction beginning within a few hours of treatment, with fever, chills, malaise, headache and myalgia. It is treated with bedrest and aspirin and will disappear within 24 hours. Continue treatment. Optimal treatment is:
but for those allergic to penicillin, you may substitute:
If the patient is pregnant, tetracyclines should not be used. Should the pregnant patient also be allergic to penicillin, desensitization is recommended by many, but operational circumstances may not allow for that. In such cases erythromycin or Azithromycin can be effective, although the optimal dosage is unknown. The main concern here is that if insufficient antibiotic gets across the placenta and to the fetus, fetal syphilis will be insufficiently treated.
Contents - Introduction - Medical Support of Women in Field Environments - The Prisoner of War Experience - Routine Care - Pap Smears - Human Papilloma Virus - Contraception - Birth Control Pills - Vulvar Disease - Vaginal Discharge - Abnormal Bleeding - Menstrual Problems - Abdominal Pain - Urination Problems - Menopause - Breast Problems - Sexual Assault - Normal Pregnancy - Abnormal Pregnancy - Normal Labor and Delivery - Problems During Labor and Delivery - Care of the Newborn
This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates. It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified. This formatting C. 2006
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