STIs

Question 1

Classic symptoms of early syphilis

Answer 1

Classic one (or more) chancre, indurated, well-circumscribed, round or oval, painless ulcer that appears at the site of infection usually 3 wks after infection but as early as 10 days and as late as 90 days after infection. Chancre (Usually resolves on its own within 1-6wks).

Question 2

Less typical symptoms of early syphilis:

Answer 2

Painful or multiple lesions (test for HSV too).

Question 3

Symptoms of secondary stage syphilis:

Answer 3

• Flu-like symptoms (headache, weight loss, malaise, anorexia, sore throat, muscle aches).
• Diffuse rash involving PALM of HANDS, entire trunk
• Palpable lymph node enlargement–epitrochlear nodes (near elbow)
• Condylomata Lata (moist, wart-like papules found in warm areas)

Question 4

When does secondary syphilis usually appear?

Answer 4

3wks to 6 mons

Question 5

When do secondary syphilis symptoms clear?

Answer 5

2-6wks without treatment, but can last up to 6 months. My have recurrence.

Question 6

When is syphilis most contagious?

Answer 6

When secondary stage symptoms are present (esp. with direct contact of moist lesions or in utero).

Question 7

What causes syphilis?

Answer 7

Treponema pallidum

Question 8

What is latent syphilis?

Answer 8

+T. pallidum serologic testing without s/sx of primary, secondary or tertiary syphilis.

Question 9

Latent syphilis is classified into which 3 subcategories?

Answer 9

1. Early Latent: <1 year, +contagious
2. Late Latent: >1 year, no evidence of transmission, not contagious.
3. Latent Syphilis of Unknown duration (tx the same as late latent)

Question 10

Though, rare, __% of UNTREATED syphilis will go on to develop tertiary syphilis.

Answer 10

30%

Question 10

Though, rare, __% of UNTREATED syphilis will go on to develop tertiary syphilis.

Answer 10

30%

Question 11

Are folks with tertiary syphilis contagious?

Answer 11

No, except for in utero transmission.

Question 12

Symptoms of tertiary syphilis

Answer 12

Gummas, hearing loss, vision problems, cardiovascular problems, meningitis, and dementia.
CAN be FATAL

Question 13

When can neurosyphilis occur?

Answer 13

Primary or secondary stage.

Question 14

How can neurosyphilis manifest?

Answer 14

• Meningitis, w/ cranial nerve involvement

- Meningovascular syphilis (stroke-like symptoms)

Question 15

When does late neurosyphilis present?

Answer 15

10-30 years after onset of infection.

Question 16

S/sx of late neurosyphilis

Answer 16

Paralysis r/t inflammation of the brain
Tabes dorsalis (loss of coordination of movement due to degeneration of the spinal nerves)

Question 17

Diagnosis of syphilis requires a:

Answer 17

Treponemal-abs present or not–does not tell if previously infected or current infection.
-may be false pos

and

nontreponemal test (RPR/VDRL)–to tell stage/current infection, but may be false neg. Retest in 2-4wks

Question 18

Reportable DOH STIs

Answer 18

-Syphilis

Question 19

Reasons for false negative nontreponemal results.

Answer 19

VERY early syphilis, so if you have s/sx of early syphilis (chancre), do reverse testing, with T. Pallidum testing first.

Tertiary or late syphilis (may want to perform both tests if s/sx).

Prozone reaction 2% *high abs/antigen. (Pregnancy, HIV, neurosyphilis).

Question 20

Tx for primary, secondary and early latent syphilis

Answer 20

IM 2.4mu Benzathine Penicillin

Question 21

Tx for late latent and tertiary syphilis (presence of cardiac involvement or gummas)

Answer 21

IM 2.4mu benzathine Penicillin x3, 1 week apart (7.2 total)

Question 22

Tx of neurosyphilis

Answer 22

Aqueous crystalline penicillin 18-24 million units per day

for 10-14 days

Question 23

Tx of syphilis in pregnancy

Answer 23

Per stage; however, evidence shows that they might benefit from another shot 1 week after the first (2 doses) for primary, secondary and early latent syphilis.

Question 24

When should patients should be evaluated clinically for symptoms and with a nontreponemal serologic test after tx of syphilis?

Answer 24

6 & 12 mons after tx.

For late latent or HIV: follow for 24 mons

Question 25

After tx of syphilis, titers should decrease ___fold

Answer 25

fourfold (from 1:64 to 1:16)

Question 26

When should syphilis reinfection or tx failure be suspected?

Answer 26

Persistent or recurrent s/sx or >/= fourfold increase in nontreponemal titers for at least 2 weeks. Should be reevaluated by a specialist.***