01b: Syphilis Flashcards
T. pallidum stains as gram (pos/neg).
Neither (though may stain as weak gram-neg)
List the modes of transmission of T. pallidum.
- Sex contact
- Transplacental
- Blood contact
Primary syphilis emerges within (X) days of acquisition and the classic finding is (Y).
X = 10-90 Y = chancre (painless, indurated, usually solitary lesion at site of inoculation)
T/F: Syphilis is almost always sexually transmitted.
True
Spirochetes have unique ability to penetrate (X).
X = blood vessels
T/F: There has been a recent rapid decline in syphilis cases.
False - increase
Key clinical picture of primary syphilis.
- Painless ulcer/chancre at inoculation site (heaped borders, clean base)
- Painless bilateral lymphadenopathy
T/F: Primary syphilis symptoms resolve within few weeks, even without treatment.
True - but spirochetes disseminate
Key clinical picture of secondary syphilis.
- Low-grade fever, malaise, sore throat, lymphadenopathy
- RASH (including palms/soles)
- Condyloma lata (wart-like lesions in moist areas)
T/F: Secondary syphilis symptoms resolve within few weeks, even without treatment.
True
Rash in (primary/secondary/tertiary) syphilis is (macular/pustular/plaque/scaling) and often confused with:
Secondary;
Can be any of those;
Drug eruption
Symptoms of early neurosyphilis occurs in about (X) time after infection. It presents as (Y) disease.
X = within 1 year Y = meningitis (headache, photophobia, CN abnormalities)
Symptoms of late neurosyphilis usually occurs in about (X) time after infection. They fall into which two categories?
X = 10 years
- Meningovascular
- Parenchymatous
T/F: Both secondary and tertiary stages of syphilis represent reactivation of latent syphilis.
False - tertiary stage
Typical clinical manifestations of meningovascular symptoms of late neurosyphilis.
STROKES and seizures
Typical clinical manifestations of parenchymatous symptoms of late neurosyphilis.
- Tabes Dorsalis (shooting pains, ataxia)
- General paresis (dementia, psychosis, slurry speech)
- Argyll Robertson pupil
Argyll Robertson pupil is symptom of (X). Describe it.
X = late neurosyphilis
Bilateral small pupils that constrict to accommodation, but not light
List the three general presentations of tertiary syphilis.
- Late neurosyphilis
- CV syphilis
- Late benign syphilis
Symptoms of CV syphilis, which occurs more often in (M/F).
M (3x)
AAA, aortic insufficiency, coronary artery stenosis, myocarditis
“Gummas” are seen in which infectious disease? Briefly describe these.
Late stage of syphilis;
Granulomatous process (involving skin, cartilage, bone)
T/F: Syphilis in pregnancy increases risk for many adverse effects on child.
True - miscarriage/stillbirth, premature delivery, low weight, hydrops fetalis, congenital infection
Incidence of congenital syphilis is clearly related to:
Socioeconomic factors and availability/use of pre-natal care
T/F: Most syphilitic infants lack manifestations at birth.
True - typically takes 3 weeks to 3 months
Classic findings of congenital syphilis.
- Rhinitis
- Skin eruptions
- Hepatomegaly, anemia, lymphadenopathy
Failure to treat congenital syphilis can lead to which malformations?
- Dental abnormalities
- Eye damage
- Saddle-nose deformity
- Neurosyphilis
T/F: T. pallidum is large enough to be seen in light microscope.
False - too thin
(X) microscopy used to see T. pallidum. Best to isolate from (primary/secondary/tertiary) lesion.
X = dark-field or phase-contrast
Primary or secondary
In most cases, how is syphilis diagnosed?
- Hx and physical exams
2. Serological tests
Non-treponemal tests are used to diagnose (X). What do they detect?
X = syphilis
Ab against host antigens (cardiolipin), released from cells damaged during spirochete dissemination
(Non-treponemal/Treponemal) tests used as screening test for (X). What are some risks for false positive?
Non-treponemal
X = syphilis
Advanced age, pregnancy, autoimmune diseases, viral infections
Prozone effect can produce false (pos/neg) on (Non-treponemal/Treponemal) test. Describe this phenomenon.
False neg;
Non-treponemal
Too many Ab interferes with proper formation of antigen-antibody lattice
Which value of (non-treponemal/treponemal) test is used to indicate of cure from (X) infection?
Non-treponemal;
X = syphilis
4-fold decline after treatment (independent of end titer)
Treponemal tests are used to diagnose (X). What do they detect?
X = syphilis
IgG (and maybe IgM) against treponemal agents
T/F: A positive treponemal test usually means it’ll be positive for life.
True
It takes (X) days/weeks/months after infection for VDRL/RPR, aka (treponemal/non-treponemal) tests to come back positive if (Y) infection present.
X = 4-6 weeks
Non-treponemal
Y = syphilis
T/F: In late syphilis, most untreated patients have negative non-treponemal tests.
False - 25%
The gold standard for neurosyphilis diagnosis is:
None
T/F: All treatment regimens for syphilis involve penicillin.
True
When should pregnant women be screened for syphilis?
First prenatal visit
And if high risk, twice more in 3rd trimester (one at time of delivery)
The Jarisch-Herxheimer reaction occurs after (X) treatment in some patients. What are the symptoms?
X = syphilis (with penicillin)
Similar to allergic reaction, but endotoxin-related (fever, chills, headaches, joint pain
T/F: All patients with syphilis should be evaluated for other sexually transmitted
infections.
True
What’s the etiologic agent in Chancroid? It’s a gram (pos/neg) (aerobe/anaerobe).
Haemophilus ducreyi;
Gram-negative;
Facultative anaerobe
“School of fish” pattern in gram staining should make you think of which infective organism? What’s responsible for this pattern?
Haemophilus ducreyi (Chancroids);
agglutination properties that lead to clumping of organisms
Describe the classic hallmark of Chancroid.
PAINFUL, ragged, NON-INDURATED, sharply demarcated ulcer which often has a necrotic, friable (crumbly) base
Diagnosis of chancroid is almost always via (X).
X = history and physical exam
Top two preferable treatments for Chancroid are:
- Azithromycin
2. Ceftriaxone
