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infectious disease > Syphilis > Flashcards

Syphilis Flashcards

1
Q

Stages of syphilis

A

Exposure
Primary
Secondary
Latent
Tertiary

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1
Q

How long after exposure does primary syphilis occur

A

3-4 weeks after exposure

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2
Q

Classical symptom of primary syphilis

A

Chancre at site of infection - firm, round, painless
May go unnoticed if not visible, disappears in 2-8 weeks

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3
Q

When does secondary syphilis occur

A

2-6 weeks after primary infection

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4
Q

What is the rash in secondary sypphilis

A

Gneralised incl palms and soles
Maculopapular, non itchy
Condylomata lata - moist warty lesions in genital area

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5
Q

Systemic secondary syphilis symptoms

A

Fevers, fatigue, lymphadenopathy, splenomegaly, hepatitis, alopecia

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6
Q

How long does the latent phase of syphilis last

A

Early - <2 yeras
late - >2 years after initial infection

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7
Q

Features of early latent syphilis

A

Sexual and vertical transmission
25% have repeat secondary syphilis
Treated with single dose penicillin

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8
Q

Features of late latent syphilis

A

> 2 years after original
Only vertical transmission
Longer treatment required

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9
Q

When does tertiary syphilis occur

A

2-20 years after latency
1/3 develop

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10
Q

Features of tertiary syphilis

A

Gummatous
Cardiovascular
General paresis - progressive dementia
Tabes dorsalis
Ocular syphilis
Neuro syphilis

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11
Q

What is tabes dorsalis

A

neuropahty(loss of proprio and vibrioception), ataxia, pupillary changes (argyl robertson pupil)
Incontinence

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12
Q

CV syphilis causes

A
  • aortitis -> aneurysm, aortic regurg
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13
Q

What see in gummatous syphilis

A

granulomatoous lesion with central necrosis

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14
Q

Ocular syphilis features

A

Painful red eye
Visual distubrance - floaters, flashing lights
May cause blindness

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15
Q

Neurosyphilis features

A

Asymptomatic but abnormal CNS findings
Menningitis
Altered behaviour
Stroke - secondary vasculitis
Tertiary neruosyphilis

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16
Q

When can ocular and neurosyphilis occur

A

Any stage of syphilis infection

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17
Q

What is congneital syphilis

A

Syphilis contracted in pregnancy or prior to

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18
Q

What can congenital syphilis cause

A

Adverse pregnancy outcomes incl miscarraige, stillbirth, prematurity
Early or late congenital syphilis

19
Q

What is earyl congenital syphilis presentation

A

Hepatosplenomegaly, lymphadenopathy, desquemating rash
Severe anaemia, jaundice
Significant mortality

20
Q

Late congenital syphilis presentation

A

Hutchinsons triad - pegged teeth, keratitis, deafness
Saddle nose, bone and joint deformities, developmental delay

21
Q

What is hitchinsons triad and what is it seen in

A

Keratitis, pegged teeth, deafness
Late congenital syphilis

22
Q

Preventing congenital syphilis

A

Routine antenatal screening

23
Q

Direct diagnosis of syphilis what do and when used

A

Primary syphilis
Dark field miscrocopy - spirochetes
PCR

24
Q

Options to detect syphilis

A

Direct detection - primary syphilis
Serological tests:
Treponemal tests
Non-treponemal tests

25
Q

What are treponemal tests

A

eg EIA, TPPA, IgM
Determine exposure to syphilis but remain positive life long

26
Q

What are non treponemal tests for syphilis

A

eg RPR, VDRI
Determine disease activity
Measure response to treatmnet
Serial dilutions - measure amount of antibody til disappears

27
Q

What is the treatment for all stages of syphilis

A

Penicillin by injection

28
Q

Early syphilis treatmnet

A

Primary, secondary, early latnet
Single dose of benzathine benzylpenicillin IM

29
Q

Treatment for late syphilis

A

Late latent, unknown, tertiary
3 x weekly doses IM enicillin

30
Q

Coular and neurospyhilis treatment

A

Daily doses for 10-14 dyas

31
Q

How do you monitor efficacy of syphilis treatment

A

4 fold decrease in non treponemal test titre

32
Q

What is the risk of ssyphilis treatment

A

Jarisch Herxheimer reaction

33
Q

What happens in a Jarishc-Herxheimer reaction

A

Triggered by penicillin treatment
Acute onset fever, muscle aches, flush, rash and palpitations

34
Q

How manage Jarish-Herxheimmer

A

Manage conservatively w paracetamol
Steroids used preventatively if treating neurosyphilis

35
Q

What is syphilis

A

Spirchaete treponema pallidum bacteria
Sexually transmitted through micro-abrasions

36
Q

Epidemiology of syphilis

A

300% increase in early syphilis since 2010
MSM
30% HIV + MSM cases in 2019
Indicator disease for other STIs

37
Q

Sexual transmission of syphilis

A

Only in early syhilis
30-50% contacts infected
Vaginal, oral and anal sex

38
Q

Blood borne spread of syphilis

A

Needle sharing
Blood transusion - v rare
dies 24-48 hrs fridge,

39
Q

Transplacental route of transmission of syphilis

A

More common in early syphilis due to high bacteruial load
Routine antenatal screening
Mostly after infections happen

40
Q

How to reduce transmission of sylhilis

A

Contact racing/partner notification
Decrease transmission - trace, test and treating partners of infected patients
Voluntary
Patient or provider referral
Performed by health advisors
Limitations - dating/hook up apps

41
Q

How far back do you notify partners of peole with syphilis early vs late

A

Primary - partners in last 3 months
Secondary/early latent - past 2 years or 3 months before last neg test
Late - time when patient last had infections

42
Q

Management of syphilis contacts

A

Testing and empirical treatmentn
Test every 12 months

43
Q

Sexual history tups

A

Taken last
Introduce reason
Closed questions
Details for all artners last 3 months

44
Q

Questions to ask in sexual history

A

Gender of partners
Last sex
Regular or casual
Condom?
Vaginal, anal, oral
Nationality

45
Q

What antibiotic offer if penicllin allergic

A

Doxycycline 100mg/12h - early 14 dyas
late 21 dyas

46
Q

Treatment of syphilis in pregnancy

A

ERYTHROmycin 500mg/6hrs PO

infectious disease (37 decks)

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