CHAPTER 18: SHYPHILIS

Question 1

Most widely used non treponemal tests

Answer 1

RPR (rapid plasma reagin)

VDRL (venereal disease research lab)

Question 2

Nontreponemal tests can be positive within how much time after infection?

Answer 2

5-6 weeks

Question 3

Tests used to confirm syphilis

Answer 3

Treponemal tests:
MHA-TP
FTA-ABS

Positive earlier than nontreponemal and remain positive for life

Question 4

What to do?

(+) Initial screening treponemal test
(-) nontreponemal

Answer 4

Ask for history of prior syphilis and treatment

Serofast- if with no evidence of syphilis after tx

Question 5

What to do?

(-) nontreponemal
(+) 2nd treponemal test

Answer 5

No prior history and tx

Patient is considered to have late latent syphilis

Question 6

has an incubation period of 3 weeks;
painless erosion, not an ulcer;

no surrounding inflammatory zone; and is round or oval.
surface is smooth, dark, velvety red, lacquered appearance

bilateral, nontender, non-suppurative Lymphadenopathy

Answer 6

primary syphilis (chancre)

Question 7

has a short incubation period of 4–7 days; the ulcer is acutely inflamed, is extremely painful, and has a surrounding inflammatory zone.

ulcer edge is undermined and extends into the dermis.

unilateral, tender, suppurative lymphadenopathy

Answer 7

Chancroid

caused by H. ducreyi

Question 8

Macular eruptions: Exanthematous erythema 6-8 weeks after chancre development

Papular eruptions: round, raw ham or coppery color
Characteristic palmar and plantar indurated yellow red spots

Annular eruptions: common in blacks; cheeks angle of mouth

Answer 8

Secondary syphilis

Question 9

Broad and flat Papular lesions located on folds of moist skin, around genitalia and anus, toe webs, angle of mouth

May become hypertrophic-mushroom like mass with smooth weeping gray surface

Answer 9

Condyloma lata

Question 10

Most common mucosal lesion in the early phase of secondary syphilis

Answer 10

Syphilitic sore throat

Question 11

Most characteristic mucous membrane lesions of secondary syphilis

Answer 11

Mucous patches

Question 12

Degeneration of dorsal rootss of the spinal nerves and posterior columns of the spinal cord

Gastric crisis with severe pain and vomiting
Paresthesia, ataxia, diplopia, reduced reflexes

Answer 12

Tabes dorsalis

Question 13

Basic lesion of cardiovascular syphilis

Answer 13

Aortitis

Question 14

if mother has early syphilis and prenatal infection, fetal death can occur when?

Answer 14

After 4th month

Question 15

Most frequent and often first finding in early congenital syphilis (before 2y)

Answer 15

Snuffles: a form of rhinitis;
nose blocked with blood stained mucus

Question 16

Hutchinson triad (late congenital syphilis)

Answer 16

Hutchinson’s teeth
opacities of the cornea, and
eighth cranial nerve deafness,

Question 17

malformation of the central upper incisors that appear in the secondary or permanent teeth.

Occurs in late congenital syphilis

Answer 17

Hutchinson’s teeth

Question 18

The destructive effects of syphilis in young children often leave scars or developmental defects called _________, which persist throughout life and confirm a diagnosis of congenital syphili

Answer 18

stigmata

Question 19

The unilateral thickening of the inner third of one clavicle called ________, is a hyperostosis resulting from syphilitic osteitis in indi- viduals who have had late congenital syphilis.

The lesion appears typically on the right side in right-handed persons and on the left side in left-handed persons.

Answer 19

Higouménaki’s sign

Question 20

Drug of choice for syphilis

Answer 20

primary, secondary, or early latent syphilis known to be of less than 1 year:
benzathine penicillin G 2.4 million units IM SD

In nonpregnant, penicillin-allergic, HIV-negative:
tetracycline, 500 mg 4x daily or doxycycline, 100 mg BID for 2 weeks

alternative:
Ceftriaxone, 1 g IM or IV x 8–10 days,

Question 21

Treatment for late syphilis

Answer 21

treatment of late or late latent syphilis of more than 1-year duration in an HIV-negative patient:
benzathine penicillin G, 2.4 MU IM SD weekly for 3 weeks

In a penicillin-allergic, nonpregnant, HIV-negative patient:
tetracycline, 500 mg orally four times daily, or
doxy- cycline, 100 mg BID x 30 days

Question 22

Treatment of neurosyphilis

Answer 22

penicillin G crystalline, 3–4 MU IV every 4 h x 10–14 days, or
procaine penicillin, 2.4 MU/day IM + probenecid, 500 mg orally four times daily x 10–14 days.

followed by benzathine penicillin G, 2.4 MU intramuscularly, once weekly for 3 weeks.

Question 23

Febrile reaction that occurs after initial dose of syphilitic tx

6-8h after tx- shaking chills, fever, malaise, sore throat, myalgia, exacerbated inflammatory reaction ar sites of infection

Answer 23

Jarisch-Herxheimer or Herxheimer reaction

Question 24

Sex partners in syphilis should be identified and persons within ______ of diagnosis should be treated presumptively

Answer 24

90 days

Question 25

Firm reddish brown or copper colored papules or nodules covered with crusts or scales (serpiginous pattern)

Extensor surfaces of arms and back
Lesions in different stages

Answer 25

Nodular syphilid

Late stage ( tertiary cutaneous syphilis)

Question 26

Unilateral, isolated single or disseminated lesions or serpiginous patterns

Extensive central necrosis, deep punched out ulcers with gelatinous necrotic base

Lower legs

Answer 26

Gummas
( late/ tertiary syphilis)