177 - Syphilis Flashcards
Treponema pallidum is transmitted mainly through __ contact, but also through __, __, or __.
sexual
intrauterine
blood transfusion
transplanted organ
After incubation period of __ days, primary disease with a __ appear on site of infection.
21
chancre
Chancre is usually __ and has a cartilage like texture
unpainful
Local __, mostly __ and bilateral, appear __ after the chancre.
lymphadenopathy
inguinal
a week
The chancre will disappear after - weeks, but the lymphadenopathy stays for __.
4-6
months
Secondary syphilis appear - weeks after primary and includes a combination of __/__/__/__ lesions.
6-12
macular/papular/papulosquamous/pustular
The secondary disease lesions involve mostly the __ and __. They do not cause __ and later may involve the __.
back
limbs
pruritus
palms
Mucous patches are __ erosions with red borders, unpainful, mostly on oral/genital mucosa
silver
Lues maligna are __ lesions, and are more common in __ patients.
necrotic
HIV
On skin folds the papules can cause __- which are __ and very __ lesions with pink-grey appearance.
condylomata lata
moist
infective
Which systemic symptoms may appear in secondary syphilis? 5
pharyngitis fever weigh loss malaise headache
Acute __ is a possible CNS symptom in secondary syphilis
meningitis
Secondary syphilis may cause ocular symptoms: 3. If untreated they may cause permanent __
pupil anomalies
optic neuritis
iritis/uveitis
blindness
__ involvement is common in secondary syphilis, but ___.
hepatic
asymptomatic
Latent syphilis is defined with positive __, normal __, and no __ in an ___ patient.
serology
CSF
symptoms
treated
Symptomatic neurosyphilis is more common in __ patients with low __ count.
HIV
CD4
Neurosyphilis will present differently accordingly to the years passed and affected areas:
meningeal-
one year
10 years
20
25-30
What does general paresis include?
Personality Affect Reflexes Eyes Sensorium Intellect Speech
Tabes dorsalis is caused by de-___ of the __ column. __ roots, and __ of the spinal cord
myelination
posterior
dorsal
DRG (dorsal root ganglion)
Late syphilis may affect the __ system (__). Late benign syphilis may result in __ of the nasal/buccal cavity
cardio-vascular
endarteritis obliterans
perforation
Congenital disease can be prevented by treatment before the __ week
16th
Early symptoms of congenital syphilis include __, __/__ lesions, __ disorder, ___, ___, and others…
rhinitis mucosal/cutaneous bone hepatosplenomegaly lymphadenopathy
Congenital syphilis leads to interstitial ___, damage to the 8th cranial nerve->__, destruction of __/__ barrier due to periostitis.
keratitis
deafness
mouth/nasal
What is the classic stigmata of congenital syphilis? 4
Hutchinson’s teeth
mulberry molars
saddle nose
saber shins
What is the DDx for congenital syphilis?
rubella CMV HSV toxoplasma erythroblastosis fetalis
Syphilis cannot be cultured, so diagnosis is done with the following:
VDRL and RPR
TPPA and FTA-ABS
Lymphoid examination (VDRL/RPR) measure the levels of __ and __ for ___.
IgG
IgM
cardiolipin-licitin-cholesterol
RPR is a more __ exam, but VDRL is the gold standard for __
convenient
CSF
The lymphoid examinations are both good for follow up. When treating- the levels should decrease in __ folds.
4
Treponemal tests (TPPA and FTA-ABS) are used for __ the diagnosis.
confirm
Patients with RPR titer >: or HIV patients with CD4
1:32
350
neurosyphilis
Screening for neurosyphilis is based on __: 3
LP
pleocytosis mononuclear (>5, >20 in HIV)
elevated protein (>45)
reactive VDRL
Treatment for primary/secondary/early latent/prevention post exposure + abnormal CSF:
single dose of penicillin IM
if allergic-
tetracycline/doxycycline for 2 weeks
Treatment for late latent syphilis:
1 a week X 3 of penicillin IM
if allergic-
HIV (-): tetracycline/doxycycline for 4 weeks
HIV (+): desensitization for penicillin
Treatment for neurosyphilis:
penicillin IV for 10-14 days or penicillin IM + probenecid if allergic- desensitization for penicillin
Jarisch Herxheimer reaction=___, self-__ reaction that appear after we start __. Appears in __% of primary syphilis and __% of secondary. Most likely caused by particles released from dead bacteria.
dramatic limiting treatment 50 90
Jarisch Herxheimer reaction is characterized by: 5
fever+ chills myalgia headache tachycardia + elevated RR leukocytosis
What is the management of Jarisch Herxheimer reaction?
warn the patient and treat symptomatically
