Genital Tract Infection - Syphilis

Question 1

What is Syphilis?

Answer 1

STI with Treponema pallidum.

Question 2

What is Treponema pallidum?

Answer 2

Spirochete (spiral-shaped) bacterium that gets in through skin/mucous membranes, replicates and disseminates throughout body.

Question 3

Incubation Period of Syphilis.

Answer 3

21 Days.

Question 4

Transmission of Syphilis (4).

Answer 4

1. Oral/Vaginal/Anal Sex.
2. Vertical Transmission.
3. IV Drug Use.
4. Blood Transfusion/Transplant (rare due to screening).

Question 5

Stages of Syphlis (5).

Answer 5

1. Primary Syphilis.
2. Secondary Syphilis.
3. Latent Syphilis.
4. Tertiary Syphilis.
5. Neurosyphilis.

Question 6

What is Primary Syphilis?

Answer 6

Painless ulcer - chancre at original site of infection that resolves 3-8 weeks + local lymphadenopathy.

Question 7

What is Secondary Syphilis?

Answer 7

Systemic symptoms, particularly of skin and mucous membranes, resolving after 3-12 weeks.

Question 8

Clinical Features of Secondary Syphilis (6).

Answer 8

1. Maculopapular Rash.
2. Condylomata lata.
3. Low-Grade Pyrexia.
4. Lymphadenopathy.
5. Alopecia (Localised Hair Loss).
6. Buccal ‘Snail-Track’ Ulcers.

Question 9

What is Candylomata late?

Answer 9

Grey wart-like lesions around genitals and anus.

Question 10

What is Latent Syphilis?

Answer 10

Disappearance of symptoms and asymptomatic stage - early latent : within 2 years of initial infection; late latent - after 2 years of initial infection.

Question 11

What is Tertiary Syphilis?

Answer 11

Effects on many organs with development of gummas, cardiovascular (ascending aortic aneurysms), neurological complications.

Question 12

What is a gumma?

Answer 12

Gummatous - Granulomatous lesions affecting the skin, organs and bones.

Question 13

Clinical Features of Neurosyphilis.

Answer 13

1. Headache.
2. Altered Behaviour.
3. Dementia.
4. Paralysis and Sensory Impairment.
5. Tabes Dorsalis.
6. Ocular Syphilis.

Question 14

What is Tabes Dorsalis?

Answer 14

Demyelination affecting the spinal cord posterior columns.

Question 15

What specific ocular finding is found in Neurosyphilis?

Answer 15

Argyll-Roberston Pupil : constricted irregularly shaped ‘prostitute’ pupil that accommodates when focussing on a near object but does not react to light.
ARP - Accommodation Reflex Present and PRA -Pupillary Reflex Absent.

Question 16

Causes of Argyll-Robertson Pupil (2).

Answer 16

1. Diabetes.

2. Syphilis.

Question 17

Clinical Presentation of Congenital Syphilis (6).

Answer 17

1. Hutchinson Teeth - Blunted Upper Incisor Teeth and Mulberry Molars.
2. Rhagades - Linear Scars at Angle of Mouth.
3. Keratitis.
4. Saber Shins.
5. Saddle Nose.
6. Deafness.

Question 18

Investigations of Syphilis (4).

Answer 18

1. Screening Test : Antibody Testing to T. pallid.
2. GUM Referral if Positive/Suspected.
3. Confirm with Dark Field Microscopy or PCR.
4. Non-Specific + Sensitive Non-Treponemal Tests : Rapid Plasma Reagin and Venereal Disease Research Laboratory check for quantity of antibodies produced.
5. CSF Exam - CNS Involvement.

Question 19

Management of Syphilis (6).

Answer 19

1. GUM Specialist Follow-Up.
2. Full Screening of STIs.
3. Single Deep IM Dose of Benzathine Benzylpenicillin.
4. Alternatives : Ceftriaxone, Amoxicillin, Doxycycline.
5. Sexual Abstinence until Treated.
6. Contact Tracing.

Question 20

What reaction can be seen following treatment?

Answer 20

Jarisch-Herxheimer Reaction :

1. Fever, Rash and Tachycardia following 1st dose of antibiotic.
2. Due to release of endotoxins following bacterial treatment.
3. No treatment - just antipyretics.
4. No Wheeze or Hypotension (Allergy/Anaphylaxis).