18-Syphilis

Question 1

Most widely used non treponemal tests

Answer 1

RPR (rapid plasma reagin)

VDRL (venereal disease research lab)

Question 2

Nontreponemal tests can be positive within how much time after infection?

Answer 2

5-6 weeks

Question 3

Tests used to confirm syphilis

Answer 3

Treponemal tests:
MHA-TP
FTA-ABS

Positive earlier than nontreponemal and remain positive for life

Question 4

What to do?

(+) Initial screening treponemal test
(-) nontreponemal

Answer 4

Ask for history of prior syphilis and treatment

Serofast- if with no evidence of syphilis after tx

Question 5

What to do?

(-) nontreponemal
(+) 2nd treponemal test

Answer 5

No prior history and tx

Patient is considered to have late latent syphilis

Question 6

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

Answer 6

Secondary syphilis

Question 7

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

Answer 7

Condyloma lata

Question 8

Most common mucosal lesion in the early phase of secondary syphilis

Answer 8

Syphilitic sore throat

Question 9

Most characteristic mucous membrane lesions of secondary syphilis

Answer 9

Mucous patches

Question 10

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

Answer 10

Nodular syphilid

Late stage

Question 11

Unilateral, isolated single or disseminated lesions or serpiginous patterns

Extensive central necrosis, deep punched out ulcers with gelatinous necrotic base

Lower legs

Answer 11

Gummas

Question 12

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

Answer 12

Tabes dorsalis

Question 13

Basic lesion of cardiovascular syphilis

Answer 13

Aortitis

Question 14

Fetal death can occur if mother has early syphilis and prenatal infection occurs when?

Answer 14

After 4th month

Question 15

Most frequent and often first finding in early congenital syphilis (before 2y)

Answer 15

Snuffles- nose blocked with blood stained mucus

Question 16

Hutchinson triad (late congenital syphilis)

Answer 16

Hutchinson teeth
Corneal opacity
CN 8 deafness

Question 17

Malformation of central upper incisors that appear in permanent teeth

Occurs in late congenital syphilis

Answer 17

Hutchinson teeth

Question 18

Drug of choice for syphilis

Answer 18

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

Question 19

Treatment for late syphilis

Answer 19

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

Question 20

Treatment of neurosyphilis

Answer 20

Pen G crystalline 3-4MU IV Q4 x 10-14 days

Question 21

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

Answer 21

Jarisch-Herxheimer reaction

Question 22

Sex partners in syphilis should be identified and persons within ______ of diagnosis should be treated presumptively

Answer 22

90 days