CD - syphilis, congenital syphilis

Question 1

what is the agent for syphilis (1)

Answer 1

1- treponema pallidum

Question 2

what is the reservoir for syphilis (1)

Answer 2

1- humans

Question 3

what are risk factors for acquiring syphilis -

‘Sex/other behaviours’ - 4 (SIMM)
‘SDoH’ - 1 (H)
‘Medical hx’ - 1 (H)

(6)

Answer 3

1- sex workers and partners
2- injection drug use
3- history of STI
4- homeless population and youth
5- MSM
6- multiple sex partners

Question 4

what is the mode of transmission for syphilis (2)

Answer 4

1- direct contact with infectious lesion
2- vertical

Question 5

what is the incubation period for syphilis - depends on the stage (4)

Answer 5

1- Primary: 3 weeks
2- Secondary: 2 – 12 weeks
3- early latent: 2 – 30 years
4- late latent: months to years

Question 6

what is the communicable period for syphilis - depends on the stage (2)

Answer 6

1- primary, secondary and early latent are communicable as long as mucocutaneous lesions are present
2- late latent is not communicable

Question 7

what is the clinical presentation of primary syph - CL (2)

Answer 7

1- painless ulceration (chancre) in genital region, intra-anal, oral, intra-genital
2- regional lymphadenopathy may be present

Question 8

what is the clinical presentation of secondary syph - MAHLFR (6)

Answer 8

1- maculopapular rash on palms, soles (“copper penny rash”)
2- lymphadenopathy
3- fever
4- malaise
5- headache
6- alopecia

Question 9

what is the clinical presentation of early latent syph (1)

Answer 9

1- asymptomatic infection for duration < 1 year

Question 10

what is the clinical presentation of late latent syph (1)

Answer 10

1- asymptomatic infection for duration > 1 year

Question 11

when does neurosyphilis present among the stages of syph (1)

Answer 11

1- neurosyphilis can present anytime in syph infection - early neurosyph occurs in first year of infection, late occurs >1 year after infection

Question 12

what is the clinical presentation of neurosyphilis - HAV-DA-POO (7)

Answer 12

1- headache
2- ataxia
3- vertigo
4- dementia
5- Argyll Robertson pupil (accommodates as you come close, doesn’t react to light)
6- personality changes
7- otic symptoms (e.g. tinnitus)
8- ocular symptoms (e.g. flashing lights)

Question 13

what are the presentations of tertiary syphilis (2)

Answer 13

1- cardiovascular syph (aortic aneurysm, aortic regurg)
2- syphilitic gumma (soft non-cancerous growth, causes tissue destruction, can occur in any organ)

Question 14

syph case mgmt: how do you manage primary, secondary or early latent syph (medication and serology - same for all three) (2)

Answer 14

1- benzathine penicillin G (bicillin) 2.4 MU IM x 1
2- serology: treatment day, 3, 6, 12 months post-tx (and 24mo if HIV+)

Question 15

syph case mgmt: what is the treatment for primary, secondary or early latent syph if patient has penicillin allergy (1)

Answer 15

1- doxycycline 100mg PO BID x 14d

Question 16

syph case mgmt: what is the management for late latent syphilis (medication and serology) (2)

Answer 16

1- bicillin 2.4 MU IM weekly x 3 (3 injections)
2- serology: treatment day, 12 and 24 months

Question 17

syph case mgmt: what is the treatment for late latent syph if patient has penicillin allergy (1)

Answer 17

1- doxycycline 100mg PO BID x 28d

Question 18

what is contact management of syphilis (items 1, 2) and what is the look-back period for tracing based on the stage (item 3)

Answer 18

1- contact tracing for testing
2- treat if tested positive OR consider empiric treatment (bicillin 2.4 MU IM x 1) if contact within 3mo look-back period, may be hard-to-reach
3- 3mo, 6mo, 1yr look-back period for primary/secondary/early latent, respectively

Question 19

what is congenital syphilis (2)

Answer 19

1- Vertical transmission during pregnancy (can occur at any stage) OR
2- transmission at time of delivery (lesion)

Question 20

when is baby at greatest risk of contracting syphilis (i.e. if infection is contracted how far along in pregnancy) (1)

Answer 20

1- greatest risk if infection contracted closer to term (37 wks GA and up)

Question 21

what is the treatment for congenital syph, for baby - generally (1)

Answer 21

1- IV Penicillin G

Question 22

what is treatment for pregnant women who have infectious syphilis (1)

Answer 22

1- bicillin 2.4 MU IM x1 or x2 (one week apart)

Question 23

how far before delivery should treatment start for a pregnant women with infectious syphilis (1)

Answer 23

1- treatment should be initiated at least 1 month prior to delivery

Question 24

what is the case definition of confirmed early congenital syph (2)

Answer 24

1- lab detection (serology PCR)
2- <2 years old at time of diagnosis (and therefore symptom onset)

Question 25

what is the case definition of confirmed late congenital syph (2)

Answer 25

1- lab detection (serology PCR)
2- >2 years old at time of diagnosis (and therefore symptom onset)

Question 26

why is congenital syph a hot topic - SCAR (4)

Answer 26

1- rates - increase in rates across Canada, especially since 2018 (almost 600% increase from 2018-2022)
2- change -this represents a change in populations affected (i.e. female/maternal cases)
3- syndemic - Specific underlying syndemic drivers have lead to increase in cases (i.e. housing instability, substance use etc.)
4- avoidable - congenital syphilis is totally avoidable

Question 27

what are pregnancy-related complications of a women having syphilis - PMS (3)

Answer 27

1- miscarriage
2- stillbirth
3- pre-term delivery

Question 27

what are risk factors (on the part of mom) for development of congenital syphilis - L-SHIM (5)

Answer 27

1- Lack of prenatal care
2- Multiple sexual partners
3- Substance use disorder
4- Homeless
5- Incarcerated

Question 27

what are early symptoms of congenital syphilis - SOS TAJ (5)

Answer 27

1- Skeletal malformations
2- Anemia
3- Thrombocytopenia
4- Jaundice
5- Ocular abnormalities
6- sniffles (rhinitis)

Question 28

how do you prevent congenital syphilis (and 2 specific ways) (3)

Answer 28

1- avoid contracting syphilis while pregnant
2- practice safer sex - e.g. use condoms
3- reduce number of sexual partners

Question 28

what are screening recommendations in pregnancy for syphilis (1, 2, 2ab)

Answer 28

1- universal 1st TM screening
2- repeat in 3rd TM and at delivery if:
2a- at ongoing risk of reinfection or
2b- in areas experiencing outbreaks

Question 28

what are late symptoms of congenital syphilis - FHHH (3)

Answer 28

1- Facial, dental, skeletal malformations
2- Hemoglobinuria
3- Hearing loss
4- hepatosplenomegaly

Question 29

why is it so important to treat a pregnant women with syphilis during pregnancy (1)

Answer 29

1- treating mother significantly reduces the risk of congenital syphilis in neonate