Infection - Syphillis

Question 1

What microorganism causes syphilis?

Answer 1

Bacteria - Treponeme pallidum - spirochete type

Question 2

How many stages does syphillis have?

Answer 2

3 distinct stages

spread primarily through direct contact with sores

Question 3

What is the initial ulcerative lesion called?

Answer 3

Chanchre:

contans the bacteria, polymorph leukocytes

Question 4

Describe the 3 stages?

Answer 4

Primary: painless ulcer

Secondary: systemic symptoms resolve 3-12 weeks

Latent: asymptomatic but infection can be further split into early and late latent*

Tertiary: affecting organs years later

early: within 2 years of infection, late is after

Question 5

What features occur in the tertiary stage?

Answer 5

Gummas development (soft tissue tumor like growth)

Cardiovasculaer comps

Neurovascular comps (neurosyphillis)

Question 6

Presentation of primary stage?

Answer 6

Chanchre + local lymphodenopathy

very infectious chanchre

Question 7

Presentation of secondary syphillis?

Answer 7

Maculopapular rash, constitutional symptoms, tonsilitis,** condylomata lata, oral snail track ulcer **

Question 8

How to investigate for syphillis?

Answer 8

Serological testing:
treponemal test - bacteria specific but wont tell you if current or past infection

Non-treponemal tests: disease progession

Question 9

What is a specific test for neurosyphillis?

Answer 9

CSF VDRL (venereal disease research lab test)

Question 10

EIA?

TPPA?

RPR?

Answer 10

EIA : detecs acute IgM - this may still be negative if a reinfection

TPPA : specific, remains +ve in previous infected AND treated

RPR: disease monitoring, presented in dilutions

Question 11

RPR result of 1/2 vs 1/32?

Answer 11

This is used for disease monitoring or reinfection and presented as dilution

1/32 means higher disease activity

Question 12

What change in RPR is suggestive of a re-infection in need of new treatment?

Answer 12

If RPR is repeated and ther eis a 4 fold or more rise

Question 13

How to treat primary, secondary and early latent?

Answer 13

IM penicillin G (benzathine benzylpenicillin)

Question 14

How to treat tertiary and late latent ?

Answer 14

Longer course of IM penicillin

Question 15

How to treat neurosyphillis?

Answer 15

IV pencillin G for 1-14 days

Question 16

What is the jarisch - herxheimer reaction?

Answer 16

Following syphillis treatment - fever

treat with antipyretic

Question 17

What is argyll robertson pupil?

Answer 17

Associated with tertiary syphillis:

constricted pupil unreactive to light but reactive for accomodation reflex

Question 18

Would you do a non trep or a trep investigative method if a person is pregnant?

Answer 18

Trep (TPPA / EIA)

due to false positives in non trep

Question 19

If you get a positive trep test, what is usually the next step?

Answer 19

Do a non-trep test (RDR, VDRL) to confiem