Syphilis

Question 1

What is the etiologic agent of syphilis?

Answer 1

A spirochete, Treponema pallidum

Question 2

Can T. pallidum be grown in the lab?

Answer 2

No, but it can be propagated in rabbit testes

Question 3

Does syphilis have distinct sequential phases?

Answer 3

Yes, including latent phases

Question 4

Can T. pallidum cross the placenta?

Answer 4

Yes, resulting in congenital syphilis

Question 5

What is the pathology of syphilis largely due to?

Answer 5

Host’s cellular inflammatory response, it resembles and AI response

Question 6

What is the hallmark feature of primary syphilis?

Answer 6

Non-painful ulcer called a chancre, developing at site of entry of treponeme

Question 7

Secondary syphilis is what kind of infection?

Answer 7

Systemic, characterized by fever, swollen LNs, mucous membrane lesions, and sometimes a skin rash that eventually includes soles and palms and/or wart-resembling lesions (condylomata kata)

Question 8

What is Lab Dx of syphilis done by?

Answer 8

Serology, and by microscopic examination of scrapings

Question 9

What are all forms of syphilis treated with?

Answer 9

Penicillins, most commonly Pen G; prevention with abstinence and use of condoms

Question 10

What type of bacterium is T. Pallidum?

Answer 10

Helical/spiral-shaped bacterium

Question 11

T. pallidum is very thin, what does this mean?

Answer 11

Too thin to be seen by standard direct light transmission microscopy (gram stain useless)

Question 12

What method is T. pallidum seen by?

Answer 12

Indirect light microscopy method called darkfield microscopy

Question 13

What is dark field useful for?

Answer 13

Useful Dx method early in disease process, before antibodies develo

Question 14

What do spirochetes resemble?

Answer 14

gram negative bacteria

Question 15

What membranes to spirochetes have?

Answer 15

An inner membrane, a periplasm with peptidoglycan and an outer sheath/membrane

Question 16

What is different about the outer sheath in spirochetes?

Answer 16

It’s proteins are mainly lipoproteins and lipids (not LPS) that probably contribute to the pathogenic inflammatory process

Question 17

What is the immune response to spirochetes?

Answer 17

Rigorous humoral and cellular response that does not eliminate the infection; Host’s cellular immune response probably controls the infection but also responsible for pathology (tert sylph)

Question 18

Does T. pallidum have a latent phase?

Answer 18

Yes, unknown mechanism and if untreated infection and continue for life/can progress to tertiary stage

Question 19

What is the incubation time and symptom resolution time of primary syphilis?

Answer 19

2-3 week incubation w/ resolution in 3-6 weeks

Question 20

What is the manifestation and resolution time of 2ndary syphilis?

Answer 20

1-2 months after infection; resolve in a month or so w/o tx

Question 21

What is early latent syphilis?

Answer 21

The 1-2 yr period after resolution of 2ndary syphilis

Question 22

What is late latent syphilis?

Answer 22

Begins 1-2 years post infection, may last lifetime, may progress to tertiary or resolve spontaneously

Question 23

What can be affected in tertiary syphilis?

Answer 23

Almost any organ system can be affected

Question 24

Will symptoms be present at birth with congenital syphilis?

Answer 24

Sometimes, stigmata may develop 2 yrs or more after birth

Question 25

What are the signs/sx of primary syphilis?

Answer 25

Painless ulcer (chancre) at sight of entry, nontender inguinal LAD

Question 26

What are the signs/sx of secondary syphilis?

Answer 26

Disseminated infection, hyperpigmented maculopapular rash over entire body that with time extends to palms and soles; mucous membrane patches in mouth and genitals a.k.a. snail track lesionsl condylomata lata; and the patient is sick (fever, headache, diffuse LAD); may also have mild meningitis

Question 27

What 4 diseases have a rash on palms and soles?

Answer 27

Secondary syphilis, RMSF, hand foot mouth dz, and rarely meningococcemia

Question 28

What are the signs/sx of early latent Syphilis?

Answer 28

No symptoms, positive serology, may relapse to secondary (can spread in utero)

Question 29

What are the signs/sx of late latent syphilis?

Answer 29

No symptoms, positive serology, no relapse to secondary (not infectious even to fetus)

Question 30

What are the signs/sx of tertiary syphilis?

Answer 30

Progressive, inflammatory disease that may take years to develop; Tertiary S in endarteritis, few spirochetes can be detected in lesions, Gummas, CV and CNS S can take years to develop (Any organ system can be involved here... LOTS of symptoms)

Question 31

What are the signs/sx of Congenital S?

Answer 31

May or may not be symptoms at birth, can cause spontaneous abortion; disseminated infection transmitted transplacentally after first trimester via blood, no chancre

Question 32

In late congenital syphilis what develops?

Answer 32

Stigmata over years, generally starting around age 2

Question 33

Syphilis is an STD, but how else can it be transmitted?

Answer 33

Biting or through a crack in skin by touching a chancre or snail track lesion or handling contaminated catheter (doesn't remain viable outside the body very long)

Question 34

How is lab diagnosis of syphilis done?

Answer 34

Serology and occasionally microscopic examination of scrapings from chancre

Question 35

What types of serology are done for syphilis?

Answer 35

Non-treponemal serologic tests and treponemal tests

Question 36

What are the non-treponemal serologic tests for syphilis?

Answer 36

Non-specific tests; the Ag is NOT T. pallidum but rather is beef heart mitochondria cardiolipin. KNOW THESE TWO NAMES: Rapid Plasma Reagin (RGR) test and Venereal disease research laboratory (VDRL); they are cheap and sensitive, there are false positives; Titers drop after patient is cured (good test for antibiotic efficacy)

Question 37

What are the Treponemal tests?

Answer 37

Antigen is pathogenic T. Pallidum. KNOW THIS ONE: Fluorescent Treponemal Antigen-Absorbed (FTA-ABS); Titers tend to remain for months to years after patient is cured

Question 38

What is in the Ddx for syphilis?

Answer 38

Any ulcer forming STD; herpes, LGV, haemophilis ducreyi, warts, etc.

Question 39

How is syphilis prevented/treated?

Answer 39

Large, single IM dose of PenG