SYPHILIS

Question 1

Marie is a 30- year old woman of no fixed abode, who presents to the Midwife Obstetric Unit in Malmesbury, unbooked and in labour. She says she is at full term, but appears to be only 34 weeks into gestation. She delivers a live male infant who is small for his gestational age, has microcephaly and an upper lip with a thin vermilion border. A RPR (rapid plasma reagen) is performed on Marie’s blood and comes back positive to a titre of 512.

Explain the basis of the RPR test and what the result means (1½)

Answer 1

A nonspecific test for syphilis (½) detects Ab directed against cardiolipin (½), a positive result means that the patient may have syphilis (½).

A rapid plasma reagin (RPR) test is a blood test used to screen you for syphilis. It works by detecting the nonspecific antibodies that your body produces while fighting the infection.

Question 2

Explain the implications that this result has for Marie’s baby, and describe the action that you would take as a result of these findings (4)

Answer 2

• It means that the baby may have acquired syphilis in utero (1)
• It is difficult to establish whether or not the baby actually has syphilis because the baby has the mother’s antibodies and may not yet be producing enough IgM to detect therefore it is not much value to try and confirm the diagnosis (2)
• The baby should be treated for syphilis. (1)

Question 3

Give the CSF syphilis serology result that would be confirmation of neurosyphilis [1]

Answer 3

VDRL: positive

low Glucose, high protein, Lymphocyte predominant

Question 4

Explain the treatment policy that could have prevented Mr Smit’s neurological syphilis if it had been followed when Mr Smit first visited a clinic [3]

Answer 4

The “Syndromic approach/treatment” is to treat every patient at the time of presentation. The treatment is dictated by the clinical syndrome that the patient presents with. One shot of penicillin at the time when Mr Smit had his genital ulcer would have cured his syphilis.

Syndromic approach- he would have been treated for all causes of genital ulcer disease. He would then receive counselling, condoms, contacts and compliance talk. (explain)
If there was no history of blisters before the ulcer he would receive penicillin for syphilis and treatment for chancroid (eruthromycin)