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4: Y4 - Gynaecology [8] > [8] Syphilis > Flashcards

[8] Syphilis Flashcards

1
Q

What is syphilis?

A

An STI caused by Treponema pallidum

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2
Q

What type of organism is Treponema pallidum?

A

Spiochete gram-negative bacteria

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3
Q

How many cases of syphilis were diagnosed in the UK in 2015?

A

5,000

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4
Q

What is happening to the incidence of syphilis?

A

Increasing

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5
Q

What groups is incidence of syphilis markedly increasing in?

A

High risk groups e.g. MSM

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6
Q

What other conditions can be caused by other types of Treponemes?

A
  • Bejel
  • Yaws
  • Pinta
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7
Q

What is Bejel?

A

A chronic skin and tissues disease

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8
Q

What is Yaws?

A

A disease of the bones and joints

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9
Q

What is Pinta?

A

A skin disease

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10
Q

How are other Treponeme diseases spread?

A

Any close contact but not mother to foetus

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11
Q

What does the increasing rates of syphilis in MSM suggest?

A

They still have high rates of condomless sex

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12
Q

How can syphilis be transmitted?

A
  • Sexual transmission
  • Mother to foetus via placenta
  • Infected blood products
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13
Q

What is it called if a foetus gets syphilis across the placenta?

A

Congenital syphilis

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14
Q

How does Treponema pallidum enter the host?

A

Through breaks in the skin or intact mucous membranes

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15
Q

What forms at the site of contact in syphilis after an incubation period of 2-3 weeks?

A

Infectious hard ulcer (chancre)

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16
Q

What is the chancre in syphilis an indicator of?

A

The first stage of acquired symptomatic syphilis - Primary syphilis

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17
Q

What can happen if syphilis is left untreated?

A

T. pallidum can persist and cause systemic damage via obliterating arteritis

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18
Q

What is obliterating arteritis?

A

Where the endothelial cells of the vessels excessively proliferate causing lumen of the vessels to narrow

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19
Q

What can occur as a result of obliterating arteritis?

A

Ischaemia at the tissues supplied by the arteries which leads to symptoms associated with syphilis

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20
Q

What are the risk factors for syphilis?

A
  • Unprotected sex
  • Multiple partners
  • MSM
  • HIV infection
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21
Q

What are the two types of syphilis?

A
  • Acquired

- Congenital

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22
Q

What are the forms of acquired syphilis?

A
  • Asymptomatic (latent)

- Symptomatic

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23
Q

What are the stages of symptomatic syphilis?

A
  • Primary
  • Secondary
  • Tertiary
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24
Q

What forms the basis of primary syphilis?

A

Chancre formation

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25
Q

How does the chancre form in primary syphilis?

A

A papule forms at the inoculation site which will ulcerate into a chancre

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26
Q

What is a chancre?

A

A painless ulcer that is usually singular, hard and non-itchy

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27
Q

When does a chancre develop after inoculation with syphilis?

A

9-90 days post infection

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28
Q

Where does the syphilis chancre present?

A
  • Penis
  • Scrotum
  • Anus
  • Rectum
  • Labia
  • Cervix
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29
Q

What is an atypical syphilis chancre?

A
  • One that appears on unusual sites e.g. oral
  • Multiple
  • Painful
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30
Q

When do syphilis chancres typically heal?

A

Within 3-10 weeks with or without symptoms but can persist into secondary syphilis

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31
Q

When does secondary syphilis typically develop?

A

3 months post infection

32
Q

What are the signs and symptoms of secondary syphilis?

A
  • Skin rash
  • Fever
  • Malaise
  • Arthralgia
  • Headaches
  • Condylomata lata
  • Painless lymphadenopathy
  • Silvery-grey mucous membrane lesions
33
Q

What sort of skin rash develops in secondary syphilis?

A

Painless and non-itchy rash usually on the hands or soles of feet

34
Q

What is condylomata lata?

A

Elevated plaque like warts on moist areas of the skin e.g. inner thighs, anogenital region and axillae

35
Q

Where do secondary syphilis mucous membrane lesions form?

A
  • Oral
  • Pharyngeal
  • Genital
36
Q

What are some other manifestations of secondary syphilis?

A

Affecting kidneys or brain and many other sites

37
Q

What happens after secondary syphilis?

A

The disease enters a latent asymptomatic phase

38
Q

What is tertiary syphilis?

A

Syphilis that presents many years after the initial infection

39
Q

How can tertiary syphilis be classified?

A
  • Gummatous syphilis
  • Neurosyphilis
  • Cardiovascular syphilis
40
Q

What happens in gummatous syphilis?

A

Granulomas can form in the bone, skin, mucous membranes of the upper respiratory tract, mouth and viscera or connective tissue

41
Q

Are patients with gummatous syphilis infectious?

A

No

42
Q

What can result from neurosyphilis?

A
  • Tabes dorsalis
  • Dementia
  • Meningovascular complications
  • Argyll Robertson pupil
43
Q

What is tabes dorsalis?

A
  • Ataxia
  • Numb legs
  • Absence of deep tendon reflexes
  • Lightning pains
  • Loss of pain and temperature sensation
  • Skin and joint damage
44
Q

What can be caused by syphilis dementia?

A
  • Cognitive impairment
  • Mood alterations
  • Psychosis
45
Q

What are the meningovascular complications of tertiary syphilis?

A
  • Cranial nerve palsies
  • Stroke
  • Cerebral gummas
46
Q

What is an Argyll Roberston pupil?

A
  • Constricted
  • Unreactive to light
  • Reactive to accommodaiton
47
Q

What can happen in cardiovascular syphilis?

A
  • Aortic regurgitation
  • Angina
  • Dilation and calcification of the ascending aorta
48
Q

What causes aortic regurgitation in cardiovascular syphilis?

A

Aortic vasculitis

49
Q

What causes angina in cardiovascular syphilis?

A

Stenosis of the coronary ostia

50
Q

What are the differentials for primary syphilis?

A
  • Herpetic ulcers
  • Chancroid
  • Lymphogranuloma venereum
  • Donovanosis
51
Q

What are the differentials for the rash seen in secondary syphilis?

A
  • Pityriasis rosea

- Viral exanthema

52
Q

Why are the differentials for tertiary syphilis so variable?

A

The presentation is so variable

53
Q

Who should tertiary syphilis be considered in?

A

Anyone with neurological or cardiac signs or symptoms

54
Q

What tests are available for syphilis?

A
  • Dark ground microscopy of chancre fluid
  • PCR testing of swab from active lesion
  • Serology
  • Lumbar puncture
55
Q

What does dark ground microscopy look for?

A

Spirochaete in primary syphilis

56
Q

What serology tests can be used to look for syphilis?

A
  • Treponemal tests

- Non-treponemal tests

57
Q

What do treponemal serology tests do?

A

Assess for exposure to treponemes (not necessarily syphilis)

58
Q

What are the treponemal tests used to look for syphilis?

A
  • Treponemal ELISA

- TPPA or TPHA

59
Q

What are the non-treponemal serology tests for syphilis?

A

RPR/VDRL

60
Q

When are RPR/VDRL tests for syphilis highest?

A

In early disease

61
Q

When can RPR/VDRL tests for syphilis results fall?

A

In successful treatment or advanced disease

62
Q

When can false positive RPR/VDRL tests for syphilis results occur?

A
  • Inflammatory diseases

- Pregnancy

63
Q

Why may LP be useful for assessing for syphilis?

A

CSF antibodies are present in neurosyphilis

64
Q

What drug is the treatment of choice for syphilis?

A

Penicillin

65
Q

What should be considered in patients with syphilis and penicillin allergy?

A

Desensitisation

66
Q

What is the first line regimen for early syphilis?

A

Benzathine penicillin 2.4 MU IM single dose

67
Q

What is the first line regimen for late syphilis?

A

Benzathine penicillin 2.4 MU IM 3 doses at weekly intervals

68
Q

How is neurosyphilis treated?

A

Procaine penicillin plus probenecid for 14 days

69
Q

What additional management steps are required in syphilis?

A
  • Advise to avoid any sex until treated
  • Screen for other STIs
  • Patient education
  • Contact tracing
  • Follow-up serology
70
Q

What is the Jarisch Herxheimer reaction?

A

An inflammatory response to death of treponemes and results in a flu-like illness within 24 hours of treatment for syphilis

71
Q

How is Jarisch Herxheimer reaction managed?

A

Supportive care and oral steroids in cardiovascular or neurosyphilis

72
Q

How is syphilis detected in pregnancy?

A

Screening alongside HIV and Hep B at first antenatal appointment

73
Q

Why is it important to screen for syphilis in pregnancy?

A

T. pallidum can cross the placenta or infect the baby during delivery

74
Q

Why should women with syphilis in pregnancy be treated ASAP?

A

To reduce the risk of adverse outcomes

75
Q

What are the risks of untreated syphilis in pregnancy?

A
  • Miscarriage
  • Stillbirth
  • Pre-term labour
  • Congenital syphilis
76
Q

How severe is congenital?

A

Usually severe and debilitating

77
Q

What can congenital syphilis present with?

A
  • Saddle nose
  • Rashes
  • Fever
  • Failure to gain weight

4: Y4 - Gynaecology [8] (52 decks)

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