18-Syphilis Flashcards
Most widely used non treponemal tests
RPR (rapid plasma reagin)
VDRL (venereal disease research lab)
Nontreponemal tests can be positive within how much time after infection?
5-6 weeks
Tests used to confirm syphilis
Treponemal tests:
MHA-TP
FTA-ABS
Positive earlier than nontreponemal and remain positive for life
What to do?
(+) Initial screening treponemal test
(-) nontreponemal
Ask for history of prior syphilis and treatment
Serofast- if with no evidence of syphilis after tx
What to do?
(-) nontreponemal
(+) 2nd treponemal test
No prior history and tx
Patient is considered to have late latent syphilis
Exanthematous erythema 6-8 weeks after chancre development
Papular- round, raw ham or coppery color
Characteristic palmar and plantar indurated yellow red spots
Annular- common in blacks; cheeks angle of mouth
Secondary syphilis
Broad and flat Papular lesions located on folds of moist skin, around genitalia and anus, toe webs, angle of mouth
May become hypertrophic-mushroom like mass with smooth weeping gray surface
Condyloma lata
Most common mucosal lesion in the early phase of secondary syphilis
Syphilitic sore throat
Most characteristic mucous membrane lesions of secondary syphilis
Mucous patches
Firm reddish brown or copper colored papules or nodules covered with crusts or scales (serpiginous pattern)
Extensor surfaces of arms and back
Lesions in different stages
Nodular syphilid
Late stage
Unilateral, isolated single or disseminated lesions or serpiginous patterns
Extensive central necrosis, deep punched out ulcers with gelatinous necrotic base
Lower legs
Gummas
Degeneration of dorsal rootss of the spinal nerves and posterior columns of the spinal cord
Gastric crisis with severe pain and vomiting
Paresthesia, ataxia, diplopia, reduced reflexes
Tabes dorsalis
Basic lesion of cardiovascular syphilis
Aortitis
Fetal death can occur if mother has early syphilis and prenatal infection occurs when?
After 4th month
Most frequent and often first finding in early congenital syphilis (before 2y)
Snuffles- nose blocked with blood stained mucus
Hutchinson triad (late congenital syphilis)
Hutchinson teeth
Corneal opacity
CN 8 deafness
Malformation of central upper incisors that appear in permanent teeth
Occurs in late congenital syphilis
Hutchinson teeth
Drug of choice for syphilis
Penicillin
Less than 1 year duration- 2.4 million units IM benzathine Pen G single dose
Allergy- tetracycline 500mg QID or doxy 100mg BID X 2 weeks
Ceftriaxone 1g IM x 8-10 days
Treatment for late syphilis
HIV negative- 2.4 MU IM benzathine Pen G once a week for 3 weeks
Allergy- tetracycline 500mg QID or doxy 100mg BID X 30 days
Treatment of neurosyphilis
Pen G crystalline 3-4MU IV Q4 x 10-14 days
Febrile reaction that occurs after initial dose of syphilitic tx
6-8h after tx- shaking chills, fever, malaise, sore throat, myalgia, exacerbated inflammatory reaction ar sites of infection
Jarisch-Herxheimer reaction
Sex partners in syphilis should be identified and persons within ______ of diagnosis should be treated presumptively
90 days
