Sexually Transmitted Diseases - Syphilis

Question 1

Pathology : Syphilis (4).

Answer 1

1. Bacteria : Treponema pallidum (Spirochete - Spiral-Shaped).
2. Gets in through skin/mucous membranes - replicates - disseminates.
3. Incubation Period : 21 Days.
4. Transmission : Direct Contact (Sex); Vertical Transmission; IV Drug use; Blood Transfusions and Other Transplants (Rare - Screening).

Question 2

Primary Syphilis (3).

Answer 2

1. Painless Ulcer = Chancre at Original Site of Infection.
2. 3-8 Weeks.
3. Local Lymphadenopathy.

Question 3

Secondary Syphilis (4).

Answer 3

1. Chancre has healed.
2. Systemic Symptoms - affecting skin and Mucous Membranes.
3. 3-12 Weeks.
4. Maculopapular Rash; Condylomata lata (grey wart-like lesions around genitals and anus); fever; lymphadenopathy; alopecia; oral lesions.

Question 4

Latent Syphilis (3).

Answer 4

1. Symptoms disappear - patient becomes asymptomatic despite still being infected.
2. Early Latent - Within 2 years of initial infection.
3. Late Latent - After 2 years of initial infection.

Question 5

Tertiary Syphilis (5).

Answer 5

1. Many years after initial infection.
2. Affect multiple organs - development of gummas, cardiovascular and neurological complications.
3. Gummatous (granulomatous lesions that affect skin, organs and bones);
4. Aortic Aneurysms.
5. Neurosyphilis.

Question 6

Neurosyphilis (6).

Answer 6

1. Infection has reached CNS.
2. Headache, Altered Behaviour, Dementia.
3. Tabes Dorsalis (demyyelination affects spinal cord posterior columns).
4. Ocular Syphilis : Argyll-Roberton Pupil (Prostitute Pupil - accommodates but does not react to light).
5. Paralysis.
6. Sensory Impairment.

Question 7

Investigations of Syphilis (4).

Answer 7

1. Screening : Antibodies to T. pallidum.
2. Refer to Specialist GUM Centre.
3. Confirm T. pallidum with Dark Field Microscopy or PCR.
4. RRR (Rapid Plasma Reagin) and VDRL (Venereal Disease Research Laboratory) Tests : Non-Specific but Sensitive Tests for Active Syphilis (Quantity of Antibodies).

Question 8

Additional Management of Syphilis (5).

Answer 8

1. Management and Follow-Up at GUM.
2. Full Screening for Other STIs.
3. Advice.
4. Contact Tracing.
5. Prevention of Future Infection.

Question 9

Additional Management of Syphilis (5).

Answer 9

1. Management and Follow-Up at GUM.
2. Full Screening for Other STIs.
3. Advice.
4. Contact Tracing.
5. Prevention of Future Infection.

Question 10

Medical Management of Syphilis (2).

Answer 10

1. Single Deep IM Dose of Benzathine Benzylpenicillin.
2. Alternatives : Ceftriaxone, Amoxicillin, Doxycycline.