Flashcards in CCDM: SYPHILIS Deck (11):
Identification—An acute and chronic treponemal disease characterized clinically by a primary lesion, a secondary eruption involving skin and mucous membranes, long periods of latency, and late lesions of skin, bone, viscera, the CNS and cardiovascular system.
The primary lesion
(chancre) usually appears about 3 weeks after exposure as an indurated, painless ulcer with a serous exudate at the site of initial invasion.
After 4–6 weeks, even without specific treatment, the chancre begins to involute and, in most cases, a generalized secondary eruption appears, often accompanied by mild constitutional symptoms.
A symmetrical maculopapular rash involving the palms and
soles, with associated lymphadenopathy, is classic.
CNS disease, manifested as acute syphilitic meningitis, may occur at any time in secondary or early latent syphilis, later as meningovascular syphilis,
and finally as paresis or tabes dorsalis.
Fetal infection results in congenital syphilis and occurs with high frequency in untreated early infections of pregnant women. It frequently causes abortion or stillbirth and may cause infant death through preterm delivery of low birthweight infants or from generalized systemic disease.
The laboratory diagnosis of syphilis is usually made through serological testing of blood (and CSF when indicated).
Reactive tests with nontrepo-
nemal antigens (e.g. RPR [rapid plasma reagin] or VDRL [Venereal Disease
Research Laboratory]) must be confirmed by tests using treponemal antigens (i.a., FTA-Abs [fluorescent treponemal antibody absorbed] or TPHA [T. pallidum hemagglutinating antibody])
For screening newborns,
serum is preferred over cord blood, which produces more false-positive reactions.
Primary and secondary syphilis can be confirmed through darkfield or phase-contrast examination or FA antibody staining of exudates from lesions or aspirates from lymph nodes if no antibiotic has been administered.
Serological tests are usually nonreactive during the early
primary stage while the chancre is still present; a darkfield examination of
all genital ulcerative lesions can be useful, particularly in suspected early seronegative primary syphilis.
Infection through contact with contaminated articles may be theoretically possible but is extraordinarily rare.
Incubation period—10 days to 3 months, usually 3 weeks.
Communicability exists when moist mucocutaneous lesions of primary and secondary syphilis are present.
Syphilis serology must be included in the workup of all cases of STD and should be a routine part of prenatal examination.
Specific treatment: Long-acting penicillin G (benzathine penicillin), 2.4 million units in a single IM dose on the day that primary, secondary or early latent syphilis is diagnosed.
Alternative treatment for nonpregnant patients allergic to penicillin: either doxycycline PO, 100 mg twice/day for 14
days, or tetracycline PO, 500 mg 4 times/day for 14 days.
Serological testing is important to ensure adequate treatment; tests are repeated at 3 and 6 months after treatment and later as needed.
Increased dosages and longer periods of treatment (benzathine penicillin G 7.2 million units total, as 3 doses of 2.4
million units IM at 1-week intervals) are indicated for late
stages of syphilis.
Success in treatment must be verified by following serological titres and appropriate CSF examinations every 6
months until CSF cell count is normal.