Genital Ulcers & Genital Lesions

Question 1

Epidemiology of Syphilis

Answer 1

Infection uncommon
Mostly M2M
Non-infectious syphilis has been over diagnosed in NZ

Question 2

What is the bacteria causing syphilis

Answer 2

Treponema Pallidum - A spirochaete (flexible spiral shaped bacterium)

Question 3

Pathology of Treponema Pallidum

Answer 3

Virulence factors of T. Pallidum allow it to avoid the immune system which maintains latency of syphilis.

It is in immune priveleged sites such as the brain and eye where immune response causes the disease (Vasculitis, fibrosis etc.)

Question 4

Early manifestations of syphilis

Answer 4

9-90 days post exposure

1) Anogenital ulcerations
2) Rash - palms and soles/CLASSIC sign
3) Ocular lesions
4) Neurological signs (cranial nerves)

Question 5

Primary syphillis

Answer 5

Onset 2-3 weeks
1 - Painless ulceration - NOT usually at genital sites
2 - Rubbery inguinal nodes - usually one
3 - Rash 
4 - Mucus membrane lesions (red)

Question 6

Early confirmation of diagnoses

Answer 6

Dark field microscopy:
- Not specific

Direct fluorescent antibody test:
- Specific

Question 7

Secondary syphilis

Answer 7

4-10 weeks after primary lesion