Syphilis

Question 1

What is the drug of choice for treating syphilis? How did they used to treat it?

Answer 1

Penicillin is the gold standard. Old days they used to use heavy metals like arsenic (idiots)

Question 2

What causes syphilis? specifically the organism.

Answer 2

spirochete, T. pallidum

Question 3

Is syphilis cultivatable with consistency in artifical lab medias?

Answer 3

nope, cant grow that sh’t

Question 4

True or False: Outside of the host, syphilis is extremely susceptible to physical and chemical agents

Answer 4

true

Question 5

T. Pallidum causes?

Answer 5

Syphilis, worldwide location

Question 6

T. pallidum (varient) causes? name a few locations associated with it

Answer 6

Causes Bejel, located in mediterranean, balkans and north africa

Question 7

T. pertenue causes? name a few locations associated with it

Answer 7

Causes Yaws, located in the caribbean, latin america, central africa and far east

Question 8

T carateum causes? location?

Answer 8

Pinta in latin America

Question 9

What are the three reportable diseases by the CDC?

Answer 9

Chlamydia, gonorrhea and Syphilis

Question 10

True or False: Syphilis is higher in men than women

Answer 10

true (long live carlos)

Question 11

Syphilis is considered what type of diease?

Answer 11

primary venereal disease and is the most common STD in the U.S

Question 12

What are the two basic transmission routes of the pathogenic treponemes?

Answer 12

transmission via direct contact or infections of the skin/oral regions that contain spirochetes that may be transmitted by personal, not necessarily venereal contact

Question 13

true or false: syphilis can be aquired by kissing a person with active lesions/bed sharing

Answer 13

yes true duh

Question 14

what is the risk of acquiring syphilis through blood transfusions?

Answer 14

In the US transmission is low since we dont do donor-to-donor and syphilis has a short survivial in blood <72 hrs, risk in countries that do d-t-d

Question 15

Untreated syphilis leads to what chronic disease?

Answer 15

subacute chronic disease w/ symptomatic and asymptomatic periods

Question 16

What are the progressional stages to syphilis? (there are 4)

Answer 16

primary, secondary, latent (hidden) and tertiary

Question 17

How does T. pallidum infect the host?

Answer 17

via penetration of intact mucus membranes or enters the body through defects in the epithelium

Question 18

How long is the incubation period for syphilis?

Answer 18

usually about 3wks but can range from 10-19 days

Question 19

Primary Syphilis: what is the defining characteristic and other characteristics?

Answer 19

Chancres in primary inflammation developed at the end of the incubation period, relatively painless and single. Typically around genitalia but can be other places. 50-70% will develop inguinal adenopathy

Question 20

How long does the primary chanchre presist?

Answer 20

1-5wks then heals completely within 4-6 weeks without treatment

Question 21

Secondary Syphilis characteristics

Answer 21

signs and symptoms usualy devlp 2-8 wks after chancre (as long as 6mos). can overlap with primary and never notice the chancre. Has a generalized illness-begins like a viral infection

Question 22

Secondary syphilis disease progression

Answer 22

lymphadenopathy (75%) lesions of skin and MM (80%). lesions contain high spirochete numbers. CNS asymp in 1/3 of pt. Usually resolves within 2-6wk even without treatment

Question 23

Latent syphilis

Answer 23

after untreated secondary syphilis, pt enters the non infectious stage (diag. only through serology). during the first 2-4yr after infefction, can relapse into secondary. relapses rare after 4yrs, 1/3 pt spontaneously cured. 1/3 will never have more manifestations or they will develope late syphilis

Question 24

Tertiary (late) syphilis

Answer 24

3-10yrs after primary infection, 15% untreated indiv. develope late benign syphilis - destructive granulomas. cardiovascular manifestations and CNS is possible. Spirochetes may infect brain and cause personality changes…etc

Question 25

Meningovascular syphilis usually manifests as what?

Answer 25

seizures or strokes

Question 26

Congenital syphilis characteristics

Answer 26

major problem in Africa and Far east, can be reduced by treating syph in preggo women. Caused maternal spirochetemia and transplacental transmission. Untreated can cause stillbirtht

Question 27

true or false: congenital syphilis can be prevented if already transmitted with penicillin at least 30 days before delivery

Answer 27

true

Question 28

How do you classify congenital syphilis?

Answer 28

according to age at diagnosis, early stages seen in 2yrs or younger and late stages in older than 2yrs (hutchinson triad)

Question 29

Neurosyphilis characteristics

Answer 29

may be asympt. symptomatic form includes: menigeal syph (1 yr after infection) and meningovascular syph. 5-10yrs after infection or parenchymatous syphilis

Question 30

Characteristics of meningeal syphilis

Answer 30

involves brain or spinal cord, headaches and stiff neck

Question 31

meningovascular syphilis characteristic

Answer 31

inflammation of the pia mater and arachnoid space w/ focal arteritis

Question 32

parenchymatous syphilis characteristic

Answer 32

general paresis, joint degeneration and demyelination of columns

Question 33

what are the two classes of Ag recongnized in treponemes?

Answer 33

ag restricted to one or a few species and Ag shared by many different spirochetes

Question 34

what are the specific antitreponemal Ab’s produced in early syphilis?

Answer 34

IgM and rapidly followed by IgG

Question 35

True or false: delayed hypersensitivity immune mech are also involved in syphilis

Answer 35

ture, ab-ag complexes have been detected in secondary syphilis and can cause glomerunlonephritis

Question 36

Diagnostic evaluations: what are the two types of ab used to measure classical methods?

Answer 36

nontreponemal and treponemal/traditional and “reverse” algorithms

Question 37

why are direct observations of spirochetes often unavailabe?

Answer 37

uses a darkfield microscope and can miss up to 30% of primary cases, needs a pt with active syphilitic lesions

Question 38

What do nontreponemal methods do?

Answer 38

determine the presence of reagin, use rapid plasma reagin (RPR), measures IgM and IgG ab, if present they agglutinate to charcoal particles. More sensitive than VDRL test for syphilis

Question 39

does reactive RPR test confirm T. pallidum infections?

Answer 39

no

Question 40

Nontreponemal methods

Answer 40

VDRL tests, also focculation (qual/quanitative) serum must be heated to 56 degrees celcius for 30 min. measures IgG and IgM, doesnt confirm T. pallidum

Question 41

what is the preferred test for CSF in suspected teritary syphilis?

Answer 41

VDRL with reflex to titer

Question 42

Chemiluminescene immunoassay (CIA/EIA)

Answer 42

treponemal method low cost automated equipment becoming more popular

Question 43

Positive ELISA means what with a T.pallidum infection?

Answer 43

suggest current or past infection, can also distinguish between IgG ab and neonatal IgM

Question 44

TP-PA Test

Answer 44

treponemal, semiquan, not for CSF cant distinguish between IgM and IgG, good to resolve inconclusive FTA result

Question 45

FTA-ABS Test

Answer 45

confirms positive non treponemal test, determins titers, may be helpful in late neurosyph when RPR is negative

Question 46

sensitivity procedures in primary, secondary, latent and late stages

Answer 46

Primary: serology active 30% after 1wk, 90% after 3wk, reagin titer increase rapidly during first 4wk
Secondary: sero positve
Latent: grad. return of nonreactive manifestation
Late: trep test generally reacitve, nontrep non reactive

Question 47

true or false: CDC suggests the use of TP-PA to rule out false positives?

Answer 47

true