Syphilis

Question 1

What is syphilis?

Answer 1

Treponema pallidum

Question 2

Transmitted by?

Answer 2

Sex

Trans-placental/during birth

Question 3

Staging of syphilis?

Answer 3

Early infectious

• Primary
• Secondary
• Early latent

Late non-infectious:

• Late latent
• Tertiary

Question 4

Presentation of primary syphilis?

Answer 4

Lesion is traditionally known as primary chancre (painless)
Lesions appear at site of inoculation
Non-tender local lymphadenopathy

Question 5

Secondary syphilis presentation?

Answer 5

Skin: macular, follicular or pustular rash on palms and soles
Lesions of mucous membranes
Generalized lymphadenopathy, fever, sore throat
Malaise
Anterior uveitis
Cranial nerve lesions
Condylomata lata

Question 6

Testing for syphilis if symptomatic?

Answer 6

Symptomatic: 
Cervical microscopy (gram stain)
Vaginal microscopy (gram stain)
Urethral microscopy (gram stain)

Question 7

Why would you do Amies swab?

Answer 7

Recurrent/persistent discharge 
-Vaginitis of unknown cause 
-Pregnant 
-Post partum 
Post gynae surgery/instrumentation or signs of PID

Question 8

Investigation for signs of treponoma pallidum?

Answer 8

Dark field microscopy

PCR

Question 9

What is condylomata lata?

Answer 9

Highly infectious lesion in syphilis

Exudes serum teeming with treponemes

Question 10

Treating early syphilis?

Answer 10

2.4 MU benzathine (penicillin stat)

Question 11

Late syphilis treatment?

Answer 11

2.4 MU benzathine penicillin weekly x3 weeks

Question 12

Following up syphilis treatment?

Answer 12

Until RPR is negative or serofast
Titres should decrease fourfold by 3-6 months in early
-Concern re serological relapse/reinfection if titres increases by 4 fold

Question 13

Serologcal testing of non-treponmeal?

Answer 13

VDRL: Venereal disease research lab
RPR: Rapid plasma reagin

Question 14

Serological testing for treponemal?

Answer 14

ELISA/EIA
TPPA
INNO-LIA
FTA abs

Question 15

Syphilis organism

Answer 15

Spirochete bacteria treponema pallidum

Doesn’t gram stain: diagnosis relies on PCR or serological tests
Dark field microscopy

Question 16

Test to monitor syphilis?

Answer 16

RPR

Question 17

4 stages of syphilis?

Answer 17

Primary
Secondary
Latent
Tertiary

Question 18

Primary stage?

Answer 18

10-90 days
Primary chancre
Appears at site of inoculation
Heal within 2-6 weeks

Question 19

Secondary stage?

Answer 19

Between 6-10 weeks after primary chancre get snail track ulcers 
Red maculopapular rash on palsm and soles of feet 
Typically not itchy
Malaise 
Generalized lymphadenopathy 
Anterior uveitis 
Fever 
Sore throar

Question 20

Latent stage?

Answer 20

Early latent:<2 years after acquiring

Late latent >2 years after infection

Question 21

Tertiary stage?

Answer 21

-2-30 years
Gummatous growths
CVS syphilis causes aortitis, aortic regurg, aneurysms if ascending aorta and coronary artery
Stenosis
Neurosyphilis: meningovascular damage and endarteritis of small vessels of brain and SC causing general paralysis of insane