CHAPTER 18: SHYPHILIS 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
has an incubation period of 3 weeks;
painless erosion, not an ulcer;
no surrounding inflammatory zone; and is round or oval.
surface is smooth, dark, velvety red, lacquered appearance
bilateral, nontender, non-suppurative Lymphadenopathy
primary syphilis (chancre)
has a short incubation period of 4–7 days; the ulcer is acutely inflamed, is extremely painful, and has a surrounding inflammatory zone.
ulcer edge is undermined and extends into the dermis.
unilateral, tender, suppurative lymphadenopathy
Chancroid
caused by H. ducreyi
Macular eruptions: Exanthematous erythema 6-8 weeks after chancre development
Papular eruptions: round, raw ham or coppery color
Characteristic palmar and plantar indurated yellow red spots
Annular eruptions: 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
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
if mother has early syphilis and prenatal infection, fetal death can occur when?
After 4th month
Most frequent and often first finding in early congenital syphilis (before 2y)
Snuffles: a form of rhinitis;
nose blocked with blood stained mucus
Hutchinson triad (late congenital syphilis)
Hutchinson’s teeth
opacities of the cornea, and
eighth cranial nerve deafness,
malformation of the central upper incisors that appear in the secondary or permanent teeth.
Occurs in late congenital syphilis
Hutchinson’s teeth
The destructive effects of syphilis in young children often leave scars or developmental defects called _________, which persist throughout life and confirm a diagnosis of congenital syphili
stigmata
The unilateral thickening of the inner third of one clavicle called ________, is a hyperostosis resulting from syphilitic osteitis in indi- viduals who have had late congenital syphilis.
The lesion appears typically on the right side in right-handed persons and on the left side in left-handed persons.
Higouménaki’s sign
Drug of choice for syphilis
primary, secondary, or early latent syphilis known to be of less than 1 year:
benzathine penicillin G 2.4 million units IM SD
In nonpregnant, penicillin-allergic, HIV-negative:
tetracycline, 500 mg 4x daily or doxycycline, 100 mg BID for 2 weeks
alternative:
Ceftriaxone, 1 g IM or IV x 8–10 days,
Treatment for late syphilis
treatment of late or late latent syphilis of more than 1-year duration in an HIV-negative patient:
benzathine penicillin G, 2.4 MU IM SD weekly for 3 weeks
In a penicillin-allergic, nonpregnant, HIV-negative patient:
tetracycline, 500 mg orally four times daily, or
doxy- cycline, 100 mg BID x 30 days
Treatment of neurosyphilis
penicillin G crystalline, 3–4 MU IV every 4 h x 10–14 days, or
procaine penicillin, 2.4 MU/day IM + probenecid, 500 mg orally four times daily x 10–14 days.
followed by benzathine penicillin G, 2.4 MU intramuscularly, once weekly for 3 weeks.
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 or Herxheimer reaction
Sex partners in syphilis should be identified and persons within ______ of diagnosis should be treated presumptively
90 days
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 ( tertiary cutaneous syphilis)
Unilateral, isolated single or disseminated lesions or serpiginous patterns
Extensive central necrosis, deep punched out ulcers with gelatinous necrotic base
Lower legs
Gummas
( late/ tertiary syphilis)
