Syphilis, Yaws, and Pinta

Question 1

What’s the scientific name for Syphilis?

Answer 1

Treponema pallidum (T. pallidum)

Question 2

Can Syphilis be cultured?

Answer 2

No

Question 3

Can syphilis be viewed using simple light microscopy? Describe the motion of syphilis.

Answer 3

Yes, specifically dark field microscopy. Flagellar “corkscrew” motion

Question 4

How is syphilis transmitted?

Answer 4

sexual contact (acquired) and transplacentally (congenital)

Question 5

Primary treatment for syphilis? Secondary?

Answer 5

Prim.: Penicillin G (long release), treat preggos by 5 mos

Sec.: tetra/doxycycline, erythromycin, ceftriaxone (MUCH less effective)

Question 6

Describe the initial syphilis infection.

Answer 6

Penetrate mucous membranes (sex!), grow in vascular endothelium, enter lymphatic and bloodstream. Unique: systematic infection occurs immediately. CNS invaded early.

Question 7

Host immune response to syphilis?

Answer 7

Very non-immunogenic.
No strong inflammatory response.
Useless antibodies produced: non-specific anti-treponemal antibodies used for diagnoses.

Question 8

Describe primary syphilis.

Answer 8

3-6 weeks post-infect., painless chancre @ site of transmission. Highly infectious. Heals/goes away in 3-12 weeks.
Easiest to treat at this stage. One shot of penicillin.

Question 9

Describe secondary syphilis.

Answer 9

4-10 weeks post-infect., systemic symptoms.
Flu-like: Fever, malaise, myalgias, arthralgias, lymphadenopathy.
Musculocutaneous lesions, patchy alopecia, condylomata lata (gun metal gray skin plaques)
High antibody titers - very diagnosable.

Question 10

Two possible endpoints for syphilis infection?

Answer 10

Latent syphilis (2/3) and Tertiary syphillis (1/3)

Question 11

Describe latent syphilis.

Answer 11

Recurrence and resolution of secondary symptoms intermittently over lifetime

Question 12

Describe tertiary syphilis.

Answer 12

Fatalities possible.
A. Gummatous syphilis: granulomatous necrotic lesions in skin, liver, testes and bone (classic presentation: “deep, boring pain in a long bone at night.”)
B. Cardiovascular syphilis (>10 yrs): aneurysm of asc. aorta). Look for diastolic murmur with a tambour quality.
C. Neurosyphilis (another card)
D. Jaundice

Question 13

Describe neurosyphilis.

Answer 13

A. Syphilitic meningitis (within 6 mos): Low grade
B. Meningovascular syphilis
C. Parenchymal neurosyphilis: spinal cord damage (impaired sensation, wide based gait), disruption of dorsal roots (loss of nociception, areflexia), general paresis, dementia

Question 14

Describe the link between syphilis and HIV.

Answer 14

Syphilitic ulcerations facilitates HIV entry.

HIV immunosuppression accelerates syphilis course.

Question 15

Which exam is diagnostic of neurosyphilis (tertiary) syphilis?

Answer 15

Argyll-Robertson pupil.
One/both pupils fails to constrict in response to light.
Constriction in response to accommodation is intact.

Question 16

What are some imaging diagnostic tests for syphilis?

Answer 16

CT imaging: for gummas
Angiographs: for CV syphilis
Lumbar puncture: for neurosyphilis; specific, but not sensitive
Microscopy: swab skin lesions, use dark field microscopy. Doesn’t culture/stain.

Question 17

What are some serological diagnostic tests for syphilis?

Answer 17

Serology (non-treponemal specific): VDRL, RPR, or ICE syphilis antigen test
Serology (trep. specific antibodies): See presentation. Not very useful. Tells you exposure, not current disease state.

Question 18

Best diagnostic during primary chancre phase (10-90 days)?

Answer 18

Dark field

Question 19

Best diagnostic during secondary eruptions (6 mos)?

Answer 19

RPR or VDLR

Question 20

Best diagnostic during tertiary disease (10-30 years)?

Answer 20

Specific treponemal antibody tests: TP-PA, AIA, FTA

Question 21

Histological presentation of syphilis?

Answer 21

Endarteritis, plasma cell rich infiltrate in gummatous ulcerations

Question 22

What is the Jarisch-Herxheimer rxn?

Answer 22

8-24 hrs post treatment, flu-like symptoms develop

Question 23

How do you protect against syphilis?

Answer 23

CONDOMS, CONDOMS, CONDOMS!

Question 24

A pt with no syphilis risk factors presents with cutaneous skin lesions and a very high RPR or VDLR test. What is the most likely explanation?

Answer 24

Pt most likely has Yaws (T. pertunue) or Pinta

Question 25

What are Yaws? Treatment?

Answer 25

Treponemal infection found in Africa, Asia, S. America, and Oceania.
Transmitted by direct contact with skin lesion. No repro issues. Only skin disease.
Multiple stages like syphilis, but no neuro/cv involvement.
Treat with Penicillin G

Question 26

What are Pinta? Treatment?

Answer 26

Treponemal infection. Skin lesions. No repro issues.
Similar to Yaws, except for hyper pigmentation. No systemic symptoms.
Treat with Penicillin G