STS Flashcards
Incubation for primary sts and percentage that go on to secondary when untreated
21 days (9-90) chancre 25% usually 4-10 weeks post chancre
Secondary sts Sx
3/12 post initial infection
Widespread macularpapular rash
Mucous patches mouth
Condylomata lata
Can get hepatitis, glomerulonephrtisi and splenomegaly
1-2% neuro complications - acute meningitis, cranial nerve palsies (8) eye involvement (uveitis, optic neuropathy)
Definition of latent sts
Secondary sts resolves spont in 3-12 weeks
Early in 2 years
25% recurrence of secondary during latent
Late tertiary
1/3 untreated
Cv/ neuro/ gummatous
Late neurosyphilis - types and symptoms
Meningovascular - 2-7 years - focal infective arteritis inducing infarction (ischameic stroke usually MCA). Occasional prodrome - headache, insomnia
Parenchymous
1) general paresis 10-20 years cortical neuronal loss. Dementia, cognitive decline, emotional labile, psychosis
2) tabes dorsalis- inflam of dorsal column - lightening pains, areflexia, sensory ataxia, parastjeisa, optic neuropathy, Argyll Robertson pupil
Loss of dorsal column Sx
Absent reflexes
Loss of joint position and vibrational sense
Pupil changes found with STS
Argyll Robertson pupil
Small bilat pupils- no constriction with light but accommodation reflex with near object
Late sts CV Sx (10-30 years)
Aortitis (ascending) Substernal pain Aortic regurg Coronary Ostial stenosis Angina Aneurysm
Other treponemes and where originate
Yaws- pertenue humid equatorial countries
Pinta- carateum Mexico , s and c America
Bejel - endemicum- hot dry regions of eastern med and Western Africa
Dark ground for chancres and when most sensitive
Can’t use for oral
Less reliable for rectal or non penile genital
Positive sts screening test ( TPPA or EIA)
Confirm with second test
If this is neg then do IgG immunoblot
Window when need to repeat sts screen after single high risk exposure
6 and 12 weeks post
2 weeks after those with neg dark ground or PCR and ulcer
When might get false neg sts?
Before chancre and for 2 weeks after
Secondary or early latent or late sts
When might get a false Positive STS test?
Old Autoimmune PWID Febrile illnesses Pregnancy Hep C Tb
When to do LP?
Neuro Sx and RPR >1:32
Late sts and suspicion of neuro sts or Rx failure
Hiv neg CSF criteria for STS
WCC > 5
Protein > 0.45
RPR positive
TPPA >1:320
HIV positive and CSF interpretation of sts
WCC >20 or 6-20 and undetectable VL or CD4 <200
Protein >0.45
RPR pos
TPPA >1:320
Diagnosis congenital sts
Four fold greater RPR or TPPA than morther
Four fold greater increase in RPR or TPPA within 3/12 of birth
Child >18months and positive treponemal test
General Mx sts - when can have sex?
Leaflet
No sex until chancre healed and two weeks from completing Rx
Mx of sts in pregnancy - from screening test if old infection
If pos and RPR excludes new infection and prev Rx ok - NFA
Retreat if concerns re Rx, country, not sero cure evidence didn’t have four fold drop
When to refer to FMU sts in pregnancy
26weeks
Adverse outcomes of sts in pregnancy
Poly
Preterm del
Still birth
Hydrops 2 or more cavities ascites pericardial etc
Mx of infants with CS and criteria for probability
Major Rhinitis Condylomata lata Osteochondritis Periostitis
Minor Jaundice Low weight Anaemia Lymphadenopathy Large spleen and liver Pyrexia Can’t move and extremity
Definite CS - PCR or dark ground neg
Probable - rising RPR over 3/12 or pos RPR which isn’t neg within 4/12. One major and one minor. One major plus pos RPR of IgM
Possible CS - pos RPR or IgM with no clinical signs
Unlikely - pos IgM or RPR but mother adequately Rx
When should passively transferred maternal antibodies decline in neonate?
By 3/12
And be neg by 6/12
Treponemal antibodies should be neg by 18months
