Sexually Transmitted Infections: SYPHILIS

Question 1

SYPHILIS Clinical Feature

Answer 1

characterized initially by a painless ulcer (chancre)

• following inoculation, systemic infection with secondary and tertiary stages

Question 2

Etiology

Answer 2

Treponema pallidum

• transmitted sexually, congenitally, or rarely by transfusion

Question 3

Natural History of Untreated Syphilis

Answer 3

• Inoculation
• Primary syphilis (10-90 d after infection)
• Secondary syphilis (simultaneous to
primary syphilis or up to 6 mo after
healing of primary lesion)
• Latent syphilis
• Tertiary syphilis (2-20 yr)

Question 4

Latent Syphilis

Answer 4

70% of untreated patients will remain in
this stage for the rest of their lives and are
immune to new primary infection

Question 5

Primary Syphilis. Clinical Feature Lesion

Answer 5

Single red, indurated, painless chancre, that develops
into painless ulcer with raised border and scanty
serous exudate

Question 6

Primary Syphilis

Course

Answer 6

Chancre develops at site of inoculation after 3 wk

of incubation and heals in 4-6 wk;

Question 7

Primary Syphilis other sites

Answer 7

chancre may also

develop on lips or anus

Question 8

Primary Syphilis prodrome

Answer 8

Regional non-tender lymphadenopathy appears

<1 wk after onset of chancre

Question 9

Primary Syphilis DDx

Answer 9

chancroid (painful), HSV (multiple lesions)

Question 10

Primary Syphilis Investigations

Answer 10

CANNOT be based on Clinical
Feature alone
VDRL negative – repeat
weekly for 1 mo
FTA-ABS test has greater
sensitivity and may detect
disease earlier in course
Dark field examination –
spirochete in chancre fluid or
lymph node aspirate

Question 11

Primary Syphilis Management

Answer 11

Penicillin G, 2.4
million units IM,
single dose

Question 12

Secondary Syphilis onset

Answer 12

2-6 mo after primary infection (patient may

not recall presence of primary chancre)

Question 13

Secondary Syphilis Systemic features

Answer 13

generalized lymphadenopathy,
splenomegaly, headache, chills, fever, arthralgias,
myalgias, malaise, photophobia

Question 14

Secondary Syphilis remision and recurence

Answer 14

Lesions heal in 1-5 wk and may recur for 1 yr

Question 15

Secondary Syphilis

types of lesions:

Answer 15

1. Macules and papules: flat top, scaling,
   non-pruritic, sharply defined, circular/annular
   rash (DDx: pityriasis rosea, tinea corporis, drug
   eruptions, lichen planus)
2. Condyloma lata: wart-like moist papules around
   genital/perianal region
3. Mucous patches: macerated patches mainly
   found in oral mucosa

Question 16

Secondary Syphilis Investigations

Answer 16

VDRL positive
FTA-ABS +ve; –ve after 1
yr following appearance of
chancre
Dark field +ve in all secondary

Question 17

Secondary Syphilis

Management

Answer 17

As for primary

syphilis

Question 18

Tertiary Syphilis

Clinical features. Onset. Main skin lesion

Answer 18

Extremely rare
3-7 yr after secondary
Main skin lesion: ‘Gumma’ – a granulomatous nontender
nodule

Question 19

Tertiary Syphilis

Investigations

Answer 19

As in primary syphilis, VDRL

can be falsely negative

Question 20

Tertiary Syphilis

Management

Answer 20

Penicillin G, 2.4
million units IM
weekly x 3 wk