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DipGUM 🤦‍♀️ > STS > Flashcards

STS Flashcards

1
Q

Incubation for primary sts and percentage that go on to secondary when untreated

A 
21 days (9-90) chancre 
25% usually 4-10 weeks post chancre
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2
Q

Secondary sts Sx

A

3/12 post initial infection
Widespread macularpapular rash
Mucous patches mouth
Condylomata lata
Can get hepatitis, glomerulonephrtisi and splenomegaly
1-2% neuro complications - acute meningitis, cranial nerve palsies (8) eye involvement (uveitis, optic neuropathy)

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3
Q

Definition of latent sts

A

Secondary sts resolves spont in 3-12 weeks
Early in 2 years
25% recurrence of secondary during latent

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4
Q

Late tertiary

A

1/3 untreated

Cv/ neuro/ gummatous

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5
Q

Late neurosyphilis - types and symptoms

A

Meningovascular - 2-7 years - focal infective arteritis inducing infarction (ischameic stroke usually MCA). Occasional prodrome - headache, insomnia
Parenchymous
1) general paresis 10-20 years cortical neuronal loss. Dementia, cognitive decline, emotional labile, psychosis
2) tabes dorsalis- inflam of dorsal column - lightening pains, areflexia, sensory ataxia, parastjeisa, optic neuropathy, Argyll Robertson pupil

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6
Q

Loss of dorsal column Sx

A

Absent reflexes

Loss of joint position and vibrational sense

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7
Q

Pupil changes found with STS

A

Argyll Robertson pupil

Small bilat pupils- no constriction with light but accommodation reflex with near object

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8
Q

Late sts CV Sx (10-30 years)

A 
Aortitis (ascending)
Substernal pain
Aortic regurg 
Coronary Ostial stenosis
Angina
Aneurysm
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9
Q

Other treponemes and where originate

A

Yaws- pertenue humid equatorial countries
Pinta- carateum Mexico , s and c America
Bejel - endemicum- hot dry regions of eastern med and Western Africa

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10
Q

Dark ground for chancres and when most sensitive

A

Can’t use for oral

Less reliable for rectal or non penile genital

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11
Q

Positive sts screening test ( TPPA or EIA)

A

Confirm with second test

If this is neg then do IgG immunoblot

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12
Q

Window when need to repeat sts screen after single high risk exposure

A

6 and 12 weeks post

2 weeks after those with neg dark ground or PCR and ulcer

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13
Q

When might get false neg sts?

A

Before chancre and for 2 weeks after

Secondary or early latent or late sts

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14
Q

When might get a false Positive STS test?

A 
Old
Autoimmune
PWID
Febrile illnesses
Pregnancy
Hep C
Tb
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15
Q

When to do LP?

A

Neuro Sx and RPR >1:32

Late sts and suspicion of neuro sts or Rx failure

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16
Q

Hiv neg CSF criteria for STS

A

WCC > 5
Protein > 0.45
RPR positive
TPPA >1:320

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17
Q

HIV positive and CSF interpretation of sts

A

WCC >20 or 6-20 and undetectable VL or CD4 <200
Protein >0.45
RPR pos
TPPA >1:320

18
Q

Diagnosis congenital sts

A

Four fold greater RPR or TPPA than morther
Four fold greater increase in RPR or TPPA within 3/12 of birth
Child >18months and positive treponemal test

19
Q

General Mx sts - when can have sex?

A

Leaflet

No sex until chancre healed and two weeks from completing Rx

20
Q

Mx of sts in pregnancy - from screening test if old infection

A

If pos and RPR excludes new infection and prev Rx ok - NFA

Retreat if concerns re Rx, country, not sero cure evidence didn’t have four fold drop

21
Q

When to refer to FMU sts in pregnancy

A

26weeks

22
Q

Adverse outcomes of sts in pregnancy

A

Poly
Preterm del
Still birth
Hydrops 2 or more cavities ascites pericardial etc

23
Q

Mx of infants with CS and criteria for probability

A 
Major
Rhinitis
Condylomata lata
Osteochondritis
Periostitis
Minor
Jaundice
Low weight
Anaemia
Lymphadenopathy 
Large spleen and liver
Pyrexia 
Can’t move and extremity

Definite CS - PCR or dark ground neg
Probable - rising RPR over 3/12 or pos RPR which isn’t neg within 4/12. One major and one minor. One major plus pos RPR of IgM
Possible CS - pos RPR or IgM with no clinical signs
Unlikely - pos IgM or RPR but mother adequately Rx

24
Q

When should passively transferred maternal antibodies decline in neonate?

A

By 3/12
And be neg by 6/12
Treponemal antibodies should be neg by 18months

25
Q

How frequently measure RPR and igm in neonate?

A

Birth

3/12 and then 3/12ly until neg. if titres remain stable or increase ?CS and Rx

26
Q

When to treat infants for sts?

A

Suspected CS
Born to mothers who Rx less than 4/52 pre del
Mother had non penicillin Rx
Mother not Rx

27
Q

Epidemiological treatment with alternatives for sts

A

Benzathine penicillin G MU IM

Doxy 100mg bd for 14/7
Azithromycin 2g stat

28
Q

Early sts Rx

Primary, secondary, early latent)

A

Benzathine penicillin 2.4 MU IM

Alternatives
Procaine penicillin 600,000units IM OD for 10/7
Doxy 100mg BD for 14/7
Ceftriaxone 500mg IM daily for 10/7
Amox 500mg Qds plus probenecid 500mg qds for 14/7
Azith 2g stat or azith 500mg OD for 10/7
Erythromycin 500mg QDS for 14/7

29
Q

Late latent , CV or gummatous sts Rx

A

Benzathine penicillin G MU IM 2.4 for 3 weeks

Alt
Doxy 100mg bd for 28days
Amox 2g TDS plus probenecid 500mg qds for 28 days
Steroids for CV 40-60mg pred 3/7

30
Q

Neuro sts in early sts Rx

A

Procaine penicillin 1.8 -2.4 MU IM OD plus probenecid 500mg QDS for 14/7
Benzylpenicillin 1.8-2.4g IV every 4 hours for 14/7

Alternatives
Doxy 200mg BD for 28 days
Amoxicillin 2g TDS plus probenecid 500mg QDS for 28 days
Ceftriaxone 2g IM or IV for 10-14/7
Steroids for all
31
Q

Early sts Rx in pregnancy

A

Up to 27+6
Benzathine penicillin G 2.4 MU IM

Third trimester
Benzathine on d1 and d8

Alternatives
Procaine penicillin G 600,000 daily IM for 10/7
Amox 500mg QDS plus probenecid 500mg QDS for 14/7
Ceftriaxone 500mg IM for 10 days
Erthyromycin 500mg qds for 14/7
Azithromycin 500mg daily for 10/7

32
Q

Late sts Rx in pregnancy (late latent, gummatous if CV)

A

Benzathine penicillin G 2.4 MU IM weekly on d 1,8,15
Steroids for cardiac

Alts
Procaine pencillin 600,000units for 14/7 IM OD
Amox 2g TDS plus probenecid 500mg qds for 28 days

33
Q

Neuro sts in pregnancy Rx

A

Procaine penicillin G 1.8-2.4 MU IM plus probenecid 500mg QDS for 14/7
Benzylpenicillin 1.8-2.4g IV every 4 hours for 14/7

Alts
Amox 2g TDS plus probenecid for 28 days
Ceftriaxone 2g IM daily or IV for 10-14 days

Steroids for all

34
Q

Congenital sts Rx drug

A

Benzylpenicillin sodium 60-90mg/kg daily IV (30mg/kg 12 hourly in first 7 days then 8 hourly after for 10/7

Alt
Procaine 50,000u/kg daily IM for 10/7
Prefer IV neonate

35
Q

When to restart whole sts course

A

If more than 24 hours - restart course

36
Q

JH reaction

A

Jarisch herxheimer
Acute febrile reaction
Common in early sts
Paracetamol

37
Q

Procaine reaction

A 
Procaine psychosis/ mania
Inadvertent IV injection
Fear of impending death
Lasts less than 20mins
Hallucinations or fits
38
Q

Pn for STS

A

Primary sts 3/12

Secondary or early latent 2 years

39
Q

Follow up of sts post Rx

A

RPR at 3/12 6/12 and 12/12 then 6 monthly until RPR neg or serodast
4fold increase or more - reinfecuon of Rx failure
If no 4 fold increase over 1 year - LP and retreat. If CSF normal - benzathine over 3 weeks

40
Q

Contraindications to IM procaine and benzathine

A

Anticoags

Haemophilia

41
Q

Birth plan options

A

1) successful Rx prior to pregnancy - NFA
2) Rx during pregnancy but low risk for CS - infant screen. Bloods for RPR and IgM repeat at 3/12 and every 3/12 until neg
3) significant risk of CS- infant screen. Sts screen as above and FBC LFT U+E LP. Long bone X-ray and CXR. Ophthalmology and audiology review. PCR or dark ground is lesions. Bloods at 1/12 and 3/12. RPR only at 6 and 12/12. Discharge when 4 fold drop in RPR e.g from 1 in 32 to 1 in 8

42
Q

Macrolides for sts in pregnancy and what action for infant?

A

Neonate Needs pen at birth as macrolides don’t cross placental barrier

DipGUM 🤦‍♀️ (29 decks)

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