Jane Simplecks was a 20-year-old white female who came to the emergency room with a 4-day history of fever, chills, and myalgia. Two days prior to this, she had noted some genital lesions.
Question 1 - Single Best Answer
What are the major causes of genital lesions (in this country)? Bugs Database
Treponema pallidum and Chlamydia trachomatis Calymmatobacterium and Hemophilus ducreyi Papilloma virus and Neisseria gonorrhoea Herpes virus and Treponema pallidum Herpes virus and HIV
Question 2 - Single Best Answer
How are Herpes lesions described? Bugs Database
papular macular maculopapular vesicular
Question 3 - Single Best Answer
How can the primary lesion of syphilis be described? Bugs Database
painful ulcer painless ulcer wart blister maculopapular
Question 4 - Single Best Answer
Could any of the organisms that cause genital lesions be responsible for Jane's constitutional symptoms (fever, chills, myalgia)? Bugs Database
yes no
Two days ago Jane had developed a severe headache and a stiff neck. Loud noises and bright lights bothered her, but she could still go about most of her daily activities. Previously she had not been sick for several years. She said the genital lesions were very painful. She said she had a new boyfriend with whom she had a sexual relationship; they used condoms but maybe not all the time. She had no history of sexually transmitted diseases. She didn't think Dick did either because he was from one of the oldest families in town and his father was a lawyer. Pelvic examination revealed extensive vesicular lesions on the labia and marked edema. The cervix also had some necrotic ulcerations. There was no inguinal lymphadenopathy.
Question 5 - Single Best Answer
What ulcerative genital infections are most often associated with lymphadenopathy and therefore not likely a cause of Jane's problems? Bugs Database
chancroid granuloma inguinale lymphogranuloma venereum all of the above
Question 6 - Single Best Answer
What tests should you perform next? Bugs Database
analysis of CSF brain biopsy Wasserman test CAT scan serologic test for herpes antibody
The CSF had a leukocyte count of 41/cu mm with 23% PMN's and 77% mononuclear cells. The glucose level was 46 mg/dl and the protein was 68 mg/dl. A CSF VDRL was negative.Normal Lab Values
Question 7 - Single Best Answer
Considering all the information you have , what do you think is the most likely diagnosis? Bugs Database
primary syphilis secondary syphilis first-episode genital herpes caused by HHV2 bacterial meningitis caused by Neisseria meningitidis herpes encephalitis
Question 8 - Single Best Answer
What therapy is available for herpes meningitis? Bugs Database
hyperimmune serum globulin acyclovir alpha interferon ribivarin AZT
Question 9 - Single Best Answer
Herpes viruses that are resistant to acyclovir are missing which of the following? Bugs Database
DNA polymerase RNA polymerase ribosomes thymidine kinase acyclovir kinase
Question 10 - Single Best Answer
How could you confirm your diagnosis of herpes infection? Bugs Database
acid fast stain anti-nuclear antigen clue cells virus isolation VDRL
After three days viral cultures of both the CSF and the genital lesions confirmed that she was infected with HHV2. She was treated for ten days with intravenous acyclovir.Normal Lab Values
Question 11 - Single Best Answer
Where did Jane acquire the infection? Bugs Database
from a fever blister on her mouth via accidental innoculation from Dick via the respiratory route from Dick via saliva from Dick via white cells in the semen from Dick via sexual contact
Question 12 - Single Best Answer
The infection occured because? Bugs Database
Dick was asymptomatic at the time Dick didn't tell Jane he was infected Jane didn't insist on condoms any of the above are possible
Question 13 - Single Best Answer
What is her prognosis? Bugs Database
she will never be able to become pregnant because of scarring of her cervix her meningitis will become progressively worse and, although she may recover, she will be severely neurologically impaired she will recover from her meningitis and never have any more problems if she becomes pregnant her baby will be at high risk of neonatal encephalitis
Question 14 - Single Best Answer
What counseling should you give her? Bugs Database
she can infect her sex partners with herpes she should practice safer sex she could be HIV+ if she gets pregnant she should tell her doctor that she has herpes all of the above
This story has a happy ending. Jane got better. She married Dick. Both of them were tested for HIV as advised by Jane's doctor, but neither of them were HIV+. They had three children with no problems. Jane and Dick bought a condom store where they gave out lots of free advice, sold all kinds of condoms, and stocked a line of Dick and Jane tee shirts. Jane's favorite said "See Dick with no protection -- See Jane with an infection". They made lots of money but donated it all for AIDS research as they both felt extremely lucky that they had not contracted the HIV virus.