Mehl. STDs treponena pallidum Flashcards
Spirochete (spiral-shaped bacterium) visible under ….
dark-field microscopy.
Primary syphilis =?
painless chancre (painless ulcer) on genitalia.
Secondary syphilis =?
6 weeks to 6 months after appearance and disappearance of the initial chancre, patient can get body rash that includes PALMS + SOLES, and condylomata lata (painless genital plaques).
Tertiary syphilis = ?
years later, patient can get gummas (appear as painless chancres but are on other areas of the body such as the face/nose), arthritis, and
ascending aortitis (tree-barking of vasa vasorum).
years later, patient can get gummas (appear as painless chancres but are on other areas of the body such as the face/nose), arthritis, and
ascending aortitis (tree-barking of vasa vasorum).?????
Tertiary syphilis
6 weeks to 6 months after appearance and disappearance of the initial chancre, patient can get body rash that includes PALMS + SOLES, and condylomata lata (painless genital plaques).\?????
Secondary syphilis
painless chancre (painless ulcer) on genitalia.???
Primary syphilis
Neurosyphilis can occur at what stage?
can occur at any stage; it is not sequential where we have 1 –> 2 –> 3 –> neurosyphilis. There is a 2CK Neuro Q that gives neurosyphilis in an 18-
year-old.
Neurosyphilis CP?
Neurosyphilis presents as tabes dorsalis (obliteration of dorsal columns, with loss of vibration/proprioception + a positive Romberg sign, where patient falls over when standing with eyes closed), Argyll-Robertson pupil (i.e., “prostitute pupil”; accommodates but doesn’t react), and “stroke without hypertension” (i.e.,
sometimes findings akin to stroke but in a younger patient).
Diagnosis of primary syphilis is made via?
visualizing the spirochetes from a
chancre scraping under dark-field microscopy.
Diagnosis of secondary, tertiary, and neurosyphilis can be done with????
serology, where a VDRL and/or RPR is done first (sensitive but not specific); an FTA is done
as confirmatory (specific but not sensitive).
!!!!!VDRL test mixes the patient’s serum with cardiolipin antigen. If antibodies
against T. pallidum are present, the test demonstrates clumping/flocculation. The
RPR enhances this reaction by using charcoal particles. There is an NBME Q floating around where they say something about a patient whose test results demonstrate clumping with charcoal particles, and the answer is SLE.
.
Patients with SLE who have anti-phospholipid syndrome can what VDRL?
can get false-positive VDRL tests because this syndrome is often caused by antibodies against cardiolipin (in SLE, we simply call these antibodies “lupus anticoagulant”).
FTA mixes a patient’s serum with fluorescent Treponema antibodies. If binding occurs, this confirms the diagnosis of syphilis.
.
USMLE will show you 24-year-old male with rash on his back + KOH prep is
negative + ask what’s most likely to diagnose =??
FTA.
Tx?
- Treatment for all syphilis types is penicillin.
What is has allergy to penicillins?
If patient has Hx of anaphylaxis to beta-lactams but is pregnant or has tertiary or
neurosyphilis, the answer is desensitize + give penicillin. This is because penicillin
is the most efficacious and needs to be given in severe cases.
If patient has Hx of mere rash to beta-lactams, but not anaphylaxis, then the beta-lactam can be given anyway.
.
Cia prie TORHeS lenteles buvo 2 sakiniia.
Highest yield point is that it can cause tooth abnormalities (mulberry molars/incisors).
Can cause “saber shins” (bone abnormalities), saddle nose, deafness, and cataracts.
.
