Sexual Health

Question 1

Syphilis stages

Answer 1

Primary:
o incubation ~3weeks.
o P/W painless genital ulcer which self heals in a few weeks
Secondary:
o incubation 2-24 weeks (Ave 6weeks)
o fever, malaise, lymphadenopathy + skin manifestation (90%)
o Generalised rash affecting palms and soles
o Alopecia
o Condylomata lata
o +/- neuro Sn: CN palsies, eye Sns, meningism
o if untreated resolves over a period of weeks but may recur
Early latent (<2yrs)
o Positive serology, nil Sx
o Implies recent infection and therefore treated as infectious
Late latent (>2yrs)
o >2yrs people no longer infectious to sexual partners, but mothers still to children
Tertiary
o late Sx/Cx develop years after infection (skin, CV, neuro)

Question 2

Syphilis Mx

Answer 2

Primary/early latent syphilis
• IM benzathine penicillin 2.4million units stat
• IM procaine penicillin 600,000 units daily for 10/7
• If penicillin allergy: Doxycycline 100mg BD for 14/7

Late latent syphilis
• IM benzathine penicillin 2.4 million units weekly for 3w
• IM procaine penicillin (600,000 units) daily for 15/7
• doxycycline 100 mg oral BD for 28 days.

Other Mx
• no sex for next 7 days post Mx
• partners should be tested and treated presumptively (from past 6/12), or 12m if early latent
*notifiable disease

Question 3

Syphilis Ix

Answer 3

Serology
-Treponemal (EIA, TPPA): current or prev infectious -stays positive forever
-Non treponemal (RPR, VDRL): indicated current infection
Swabs: ulcer base NATT for T.pallidum