syphilis Flashcards
what is the causative organism behind syphilis ?
treponema pallidum
how is syphilis transmitted ?
can be vertically transmitted or sexually
what group of people are at a higher risk of getting syphilis ?
homosexual men
what other STD is commonly associated with syphilis ?
HIV
what are the stages of infection of syphilis ?
primary syphilis
secondary syphilis
latent or dormant phase
tertiary syphilis ( which is rare nowadays due to availability of penicillin )
what are the features of primary syphilis ?
single shallow painless ulcers on mucous membranes , this is also accompanied by regional lymphadenopathy
what are the features of secondary syphilis ?
generalized rash
generalized lymphadenopathy
most patients experience signs of vasculitis
where are rashes commonly found in secondary syphilis ?
palm and soles
How is congenital syphilis acquired ?
through vertical transmission , common cause of miscarriages
what are the features of latent syphilis ?
no symptoms or signs after syphilis infection
how long does the latent phase usually last ?
2-3 years
what are the features of tertiary syphilis ?
bacteria has reached the blood and affects the heart and brain
what are the symptoms pf tertiary syphilis ?
neurosyphilis ( dementia/stroke/spinal cord)
cardiovascular syphilis ( heart failure/angina/aortic aneurysm)
Gummata (necrotic skin/bone lumps)
how can we generally make a diagnosis of syphilis ?
clinical assesment
tests : direct test
serology
what are the direct tests that are used for the detection of syphilis ?
PCR
dark ground microscopy
what is dark ground microscopy ?
a sample from the ulcer ground/base is taken and examined under dark ground microscopy
what are the tests used in serology to detect syphilis ?
treponemal test
non-treponemal tests ( RPR )
how accurate is using PCR for the detection of syphilis ?
the most sensitive and specific , a positive result indicates early syphilis
what are the treponemal tests ?
EIA/TPPA
what are the features of the TPPA test ?
stays positive lifelong even after treatment of syphilis
and will only be positive for syphilis
what are the features of non-treponemal tests ?
they can be positive for several conditions not just necessarily syphilis
which test is used for the screening of syphilis ?
EIA
which test is used for the confirmation of syphilis after using EIA ?
TPPA
which test is used for follow up purposes after treatment of syphilis ?
RPR
how can we detect that the patient has been re infected with syphilis ?
if there is a 4 fold increase in RPR
what special investigations can be performed if a patient presents with neurological manifestations and is suspected to have syphilis ?
lumbar puncture and perform serology on the sample
after a diagnosis of syphilis is made what is the best next step in management ?
advice on further investigations
STI/HIV screening
partner notification
what is the treatment for primary syphilis ?
long acting penicillin single dose ( benzathine)
what is the treatment for secondary latent and tertiary syphilis ?
long acting penicillin in 3 doses , one dose a week
if the patient is found to be allergic penicillin what other medication can be used for treatment ?
doxycycline (vibramycin)
