Syphilis

Question 1

What causes syphilis?

Answer 1

Treponema pallidum which is a spirochete (spiral shaped bacteria)

Question 2

How is syphilis transmitted?

Answer 2

Oral, vaginal or anal sex involving direct contact with an infected area
Vertical transmission
IV drug use
Blood transfusion

Question 3

What is primary syphilis?

Answer 3

A painless ulcer called a chancre at the original site of infection

Question 4

What is secondary syphilis?

Answer 4

Involves systemic symptoms, particularly of skin & mucus membranes
Symptoms resolve after 3-12 weeks and the pt can enter the latent stage

Question 5

What is latent syphilis?

Answer 5

Occurs after the secondary stage of syphilis, where symptoms disappear and the pt becomes asymptomatic despite still being infected
Early latent syphilis → occurs within 2 years
Late latent syphilis → occurs from 2 years after the initial infection

Question 6

What is tertiary syphilis?

Answer 6

Can occur many years after the initial infection and affect many organs of the body esp with the development of gummas and CVD and neurological complications

Question 7

What is neurosyphilis?

Answer 7

Occurs if the infection involves the CNS, presenting with neurological symptoms

Question 8

How does primary syphilis present?

Answer 8

Painless ulcer- chancre which resolves over 3-8 weeks
Local lymphadenopathy

Question 9

How does secondary syphilis present?

Answer 9

Maculopapular rash
Condylomata lata (grey wart like lesions around the genitals & anus)
Low grade fever
Lymphadenopathy
Alopecia
Oral lesions

Question 10

How does tertiary syphilis present?

Answer 10

Gummatour lesions
Aortic aneurysms
Neurosyphilis

Question 11

How does neurosyphilis present?

Answer 11

Headache
Altered behaviour
Dementia
Tabes dorsalis- demyelination affecting the spinal cord posterior columns
Ocular syphilis- affecting eyes
Paralysis
Sensory impairment

Question 12

Diagnosis?

Answer 12

Antibody testing for antibodies to the T. pallidum bacteria can be used as a screening test for syphilis
Samples from sites of infection can be tested to confirm the presence of T pallidum with dark field microscopy & PCR

Question 13

What is rapid plasma reagin and venereal disease research lab?

Answer 13

Two non specific but sensitive tests used to assess for active syphilis by assessing the quantity of antibodies being produced by the body to an infection with syphilis
The higher the antibodies- the greater chance of active disease

Question 14

General management?

Answer 14

Full screening for other STIs
Advice about avoiding sexual activity
Contact tracing
Prevention of future infections

Question 15

Treatment?

Answer 15

A single deep IM dose of benzathine benzylpenicillin