Syphilis and HIV

Question 1

What family is syphilis part of?

Answer 1

spirochaetaceae

Question 2

What are the sub species of treponema pallidum that cause disease?

Answer 2

pallidum; endemicum; pertenue ; T.carateum

Question 3

What disease does endemicum cause?

Answer 3

Bejel

Question 4

What disease does pertenue cause?

Answer 4

Yaws

Question 5

What disease does T.carateum cause?

Answer 5

pinta

Question 6

What makes diagnosis between the subspecies of treponema pallidum difficult?

Answer 6

pallidum; endemicum; pertenue are all morphologically and serologically indistinguishable

Question 7

Where is Bejel found?

Answer 7

hot and dry climates

Question 8

Where is Yaws foudn?

Answer 8

hot wet countries

Question 9

Where is Pinta found?

Answer 9

Central and South America

Question 10

What is the shape of syphilis?

Answer 10

helically-shaped

Question 11

What is found on the outer membrane of syphilis?

Answer 11

limited OM proteins and no LPS

Question 12

How does syphilis move?

Answer 12

spins

Question 13

When is the infectious capacity of syphilis lost after harvesting?

Answer 13

within 2 days

Question 14

What makes research with syphilis difficult?

Answer 14

cannot be cultivated for sustained periods on artificial media; slow doubling time (30-33hours)

Question 15

What is the metabolic capacity of syphilis?

Answer 15

glycolysis only- no TCA or electron transport

Question 16

What makes syphilis such a fussy organism?

Answer 16

small genome; limited metabolic capacity; no oxidase/catalase; no heat shock proteins

Question 17

What are the oxygen/temp requirements of syphilis?

Answer 17

micro-aerophilic; doesn’t do well above 37 degress

Question 18

What are the modes of transmission of syphilis?

Answer 18

direct contact with infectious lesions; vertical transmsiion or during pregnancy

Question 19

What is the transmission rate of syphilis?

Answer 19

1/3rd of sexual contacts of syphilis will develop the disease

Question 20

What is the incidence rate of syphilis in Europe in 2016?

Answer 20

6.1/100,000

Question 21

What is the european syphilis gender ratio?

Answer 21

8:1

Question 22

How many cases of syphilis were in HIV postiive individuals?

Answer 22

27% but HIV status unknown in 20%

Question 23

Why are rates of syphilis increasing?

Answer 23

reduced condom use- HIV treatable; Prep; more risky sexual practicies

Question 24

What drugs make up prep?

Answer 24

tenofovir/emtricitabine

Question 25

What is the efficacy of prep?

Answer 25

86%

Question 26

What is the effect of HIV on syphilis?

Answer 26

T.pallidum load is higher in patients with HIV

Question 27

What is the ID50 for treponema pallidum?

Answer 27

57

Question 28

What age is there a peak in MSM syphilis cases?

Answer 28

35-39 peak

Question 29

Why is there a spike in syphilis cases in heterosexual females at 25-29?

Answer 29

first pregnancy syphilis testing

Question 30

What is the time after contact with pallidum for primary disease?

Answer 30

9-90days

Question 31

What is the time after pallidum contact for secondary disease?

Answer 31

6 weeks-6 months

Question 32

How many chancres are found in the genitals?

Answer 32

90%

Question 33

What can be a feature of secondary syphilis in the mouth?

Answer 33

snail-track ulcers

Question 34

Aside from the classical whole body rash in secondary syphilis what other skin manifestation is seen?

Answer 34

condylomata in warm moist areas

Question 35

What are the neurological complications of secondary syphilis?

Answer 35

acute meningitis and CN palsy

Question 36

What can be seen in the eyes with secondary syphilis?

Answer 36

anterior, posterior involvement; keratouveitis

Question 37

How long after initial innoculation does CVS syphilis happen?

Answer 37

15-30 years

Question 38

What is seen with CVS syphilis?

Answer 38

affects any blood vessel, usually the ascending aorta- aneurysm. get associatied aortic regurgitation

Question 39

When does gummatous syphilis occur after initial innoculation?

Answer 39

1-46years

Question 40

What organs does gummatous syphilis commonly affect?

Answer 40

skin and bone

Question 41

Waht are the 2 categories of neurosyphilis?

Answer 41

meningo-vascular and parenchymal

Question 42

What are the symptoms of meningovascular syphilis?

Answer 42

HA; optic neuritis; tinnitus- infectious arteritis may result in stroke

Question 43

What are the 2 main forms of parenchymal neurosyphilis?

Answer 43

general paresis; tabes dorsalis

Question 44

What structure is affected in general paresis?

Answer 44

cortical white matter loss

Question 45

What are the symptoms of general paresis?

Answer 45

cognitive function; personality- dementia like; hemiparesis

Question 46

What are the symtpoms of tabes dorsalis?

Answer 46

lightening pains; patchy sensory lsoss; pupil changes(Argyll-Robertson); sensory ataxia; neuropathic ulcers and joints

Question 47

What is the difference between early and late congenital syphilis?

Answer 47

early is within 2 years of life; late is presenting after 2 years

Question 48

What are the features of early CS?

Answer 48

rash; haemorrhagic rhinitis; lymphadenopathy; hepatosplenomegaly; skeletal abnormalities

Question 49

What are hte features of late CS?

Answer 49

interstitial keratitis; Clutton's joints; hutchison's incisors; high palatal arch; SN deafness; frontal bossing; saddlenose deformity; neuro involvement

Question 50

What is the difference in primary syphilis presentation in HIV?

Answer 50

more likely to present with >1 chancer and may have larger and deeper lesions

Question 51

How many HIV infected patients present with concomitant lesiosn of primary and secondary syphilis at diagnosis?

Answer 51

25%

Question 52

How does HIV change the incidence of neurosyphilis?

Answer 52

increases incidence generally; and neuro complications (eye and ear; and meningitis) during early syphilis

Question 53

What Cd4 and RPR titre is associated with a risk of neurosyphilis?

Answer 53

RPR >=1:32 and CD4<350

Question 54

Why are CSF results hard to diagnose in HIV patietns?

Answer 54

HIV causes a CSF pleocytosis and raised protein

Question 55

What is the effect of HIV on ocular invovlement of syphilis?

Answer 55

more severe uveitis in pateitn with HIV- panuveitis more common than isolate anterior uveitis; worse papillitis; optic neuritis and retrobulbar optic neuritis

Question 56

What are the methods of direct detection of T.pallidum?

Answer 56

dark ground microscopy and PCR

Question 57

What is the beneffit of PCR over dark ground microscopy?

Answer 57

higher sensitivty and specificity; can be used for both gential and oral lesiosn

Question 58

What are the specific trepnoemal tests | ?

Answer 58

EIA (treponemal enzyme immunoassay); TPPA (T.pallidum particle agglutination assay); TPHA (T.pallidum haemoagglutination assay); FTA-abs (fluoresent treponemal antibody absorption test) ; T. pallidum immunoblot

Question 59

What are hte non-specififc serological tests for syphilis?

Answer 59

VDRL (venereal diseases research lab test) and RPR (rapid plasma reagin test)

Question 60

What is the primary screening test for syphilis?

Answer 60

EIA- if primary suspected do IgM

Question 61

What is the confirmatory test for syphilis?

Answer 61

different treponemal test; TPPA

Question 62

What test should be done if positive test isn't confirmed by standard confirmatory test?

Answer 62

immunoblot

Question 63

What is RPR/VDRL used for?

Answer 63

to stage the infection and monitor treatment

Question 64

What are the routine screening recommendatiosn for HIV positive patients?

Answer 64

at least annually; in outbreaks 6 monthly and high risk MSM screened every 3 months for STIs

Question 65

What is the prozone phenomenon?

Answer 65

high antibody titres interferes with formation of antigen-antibody lattice network necessary to visualise a positive test

Question 66

Why is direct groun microscopy; PCR and tissue biopsy important in HIV patients?

Answer 66

increased rate of negative serological test s

Question 67

What is serofasting?

Answer 67

non treponemal antibodies persist for a long period of time rather than become completely non reactive with time

Question 68

How much should RPR drop by 3 months after treatment?

Answer 68

2-fold

Question 69

How long should patients be advised to refrain from sexual contact after syphilis treatment?

Answer 69

until lesions fully healed and 2 weeks following treatment completion

Question 70

What is the JArish-Herxheimer reaction?

Answer 70

as bacteria die they release toxin and pt gets fever and flu symtpoms

Question 71

What is the origin of macrolide resistnace in syphilis?

Answer 71

single mutant strain introduced into a specific sexual network and becomes endemic-- simialr types in populations /geographical regions