Syphillis

Question 1

What is syphillis?

Answer 1

It is an infection caused by a spirochete bacteria called Treponema pallidum

Question 2

What are the two mechanisms in which syphillis can be transmitted?

Answer 2

Sex

Vertical transmission

Question 3

How does syphillis tend to present?

Answer 3

Asymptomatically

Question 4

What are the four stages of syphillis?

Answer 4

Primary

Secondary

Latent

Tertiary

Question 5

What are the two clinical features of primary syphillis?

Answer 5

Chancre

Local lymphadenopathy

Question 6

What is a chancre?

Answer 6

It is is a painless genital ulcer

Question 7

How do we treat a chancre?

Answer 7

This tends to resolve over three to eight weeks

Question 8

When does secondary syphillis begin?

Answer 8

It starts after the chancre has healed

Question 9

When do the symptoms of secondary syphillis resolve?

Answer 9

They resolve after three to twelve weeks

Question 10

What are the six clinical features of secondary syphillis?

Answer 10

Maculopapular Rash

Condylomata Lata

Alopecia

Oral Lesions

Fever

Lymphadenopathy

Question 11

In what three locations does the maculopapular rash appear?

Answer 11

Trunk

Palms

Soles

Question 12

What is condylomata lata?

Answer 12

They are grey wart-like lesions around the genitals and anus

Question 13

What is latent syphillis?

Answer 13

It occurs after the secondary stage of syphilis and the patient becomes asymptomatic despite still being infected

Question 14

When does early latent syphillis occur?

Answer 14

Within 2 yrs of the initial infection

Question 15

When does late latent syphillis occur?

Answer 15

After 2 yrs of the initial infection

Question 16

When does tertiary syphillis occur?

Answer 16

Years after the initial infection

Question 17

What are the three clinical features of tertiary syphillis?

Answer 17

Gummatous Lesions

Cardiological Features, such as ascending aortic aneurysms

Neurosyphilis

Question 18

What cardiological feature is associated with tertiary syphillis?

Answer 18

Ascending aortic aneurysm

Question 19

What is neurosyphilis?

Answer 19

It occurs when the infection reaches the CNS

Question 20

What are the five clinical features of neurosyphilis?

Answer 20

Tabes Dorsalis

Argyll Robertson Pupil

Headache

Dementia

Paralysis

Question 21

What is tabes dorsalis?

Answer 21

This is demyelination affecting the spinal cord dorsal columns

Question 22

What is Argyll Robertson Pupil?

Answer 22

This is a constricted pupil that accommodates when focusing on a near object but does not react to light

Question 23

Are motor deficits associated with neurosyphilis?

Answer 23

No

Question 24

What are the three investigations used to diagnose syphillis?

Answer 24

Blood Tests

Polymerase Chain Reaction

Dark Field Microscopy

Question 25

How are blood tests generally used to diagnose syphilis?

Answer 25

They are used to check for the presence of antibodies that the body produces to fight infection

Question 26

What four blood tests are used to assess for active syphillis infection?

Answer 26

Rapid plasma regain (RPR) test Venereal disease research laboratory (VDRL) test Enzyme immunoassay test (EIA) Treponema pallidum particle agglutination assay (TPPA)

Question 27

What is a RPR test?

Answer 27

It assesses the quantity of antibodies being produced by the body to an infection with syphilis

Question 28

How do we interpret PRP test results?

Answer 28

It is written as the number of times a sample of containing syphilis needs to be diluted before it becomes undetectable Therefore, 1 in 2 means it needs to be diluted twice However, 1 in 32 means it needs to be diluted 32 times. This means the disease activity is greater in this sample

Question 29

What are the four causes of a false positive RPR/VDRL result?

Answer 29

Some Times Mistakes Happen SLE TB Malaria HIV

Question 30

What is an EIA test?

Answer 30

It detects an acute IgM antibody to syphillis

Question 31

What EIA test result indicates syphillis infection?

Answer 31

Positive

Question 32

What is a TPPA test?

Answer 32

It is used to detect the presence of treponema pallidum within a blood sample

Question 33

What TPPA test result indicates syphillis?

Answer 33

Positive

Question 34

How do we treat syphillis?

Answer 34

IM Benzathine Penicillin

Question 35

What is a common side effect after syphilis treatment?

Answer 35

Jarisch Herxheimer reaction

Question 36

What is the Jarisch Herxheimer reaction?

Answer 36

It is the rapid killing of Treponema pallidum and the release of endotoxins, which occurs 24 hours after starting syphilis treatment

Question 37

What are the four features of a Jarisch Herxheimer reaction?

Answer 37

Fever Rash Tachycardia Myalgia

Question 38

How do we manage Jarisch Herxheimer reaction?

Answer 38

It requires supportive management, with oral paracetamol, usually resolving within 24 hours

Question 39

How can we determine whether reinfection with syphillis has occurred?

Answer 39

The RPR level rises by 4 fold or more The TPPA result will be positive The EIA results may be negative

Question 40

How do we treat a reinfection with syphillis?

Answer 40

We administer another IM benzathine penicillin G dose

Question 41

What is the first line management option of syphillis during pregnancy?

Answer 41

IM Benzathine Penicillin

Question 42

What is the second line management option of syphillis during pregnancy?

Answer 42

Orał doxycycline

Question 43

What are the four features of congenital syphillis?

Answer 43

Hutchinson's teeth Saddle nose Mulberry molars Linear scars at the angle of the mouth