Syphilis Flashcards
Syphilis
Type
Transmission routes
Spirochaete
- Close contact with chancre - enters mucosa membranes and enters into lymph glands and disseminated from there. Inflammation with lymphocytes and plasma cells causing necrosis, high amounts of treponema present so ++ infectious.
- Sexual contact
- Vertical/transplacental -> congenital 70-100%
Syphilis
Stages
Primary - chancre/painless raised ulcer on skin, anus, vagina, cervix, mouth. Unilateral rubbery lymphadenopathy. Up to 50% may be asymptomatic. 9-90day incubation. Self-resolves 2-8weeks
Secondary - Systemic illness with malaise, fever, anorexia, hepatitis, nephropathy, alopecia, uveitis, lymphadenopathy, condylomata lata, systemic rash. Onset average 6weeks (2-24weeks) after primary
Latent - asymptomatic. If infection <2years = early latent. If infection >2years = late latent
Tertiary - location dependent e.g. neuro, cardiovascular, gummas (rubbery skin nodules). NB neurosyphilis can occur at any stage
Syphilis
Risks of transmission in each stage
- Early 100% VERY HIGH
- Secondary 70% HIGH
- Early Latent LOW
- Late Latent
- Tertiary VERY LOW
HIGHER later in pregnancy
>20weeks as fetal immune system maturing, response to infection causes changes
Syphilis
Fetal infection
- Stillbirth 30% if infection
- IUGR
- Hydrocephaly
- Hepatosplenomegaly
- Anaemia and elevated MCA Vmax
- Thrombocytopenia
- Ascites
- Hydrops
- Placental thickening and placentomegaly
- Polyhydramnios
- “moth eaten” bones
- Bowel dilation
Syphilis
Features of congenital infection
• Congenital syphilis 1-2% even if treated
• Early: With 2 years, most 5 weeks
- Hepatosplenomegaly
- Long bone deformities
- Jaundice
- Anaemia
- Rash
- Hepatitis
- Fever
- Pneumonia or respiratory distress
- SGA
- Hydrops
- Rhinitis
- Mucous patch
- Condylomata lata
- Nephrotic syndrome
- Myocarditis
- Pancreatitis
- Chorioretinitis
- CNS abnormality
• Late: Akin to tertiary
- Bone and teeth deformity
- Interstitial keratitis
- Neurosyphilis
- Sensorineural hearing lossSyphilis
Investigations
Non-specific - more useful for treatment monitoring
• RPR - correlates to disease activity
• VDRL - better on CSF
Become +ve at 3-5weeks
False +ve: pregnancy, age, chronic inflammatory condition
Specific - for diagnosis. Will always be +ve thereafter
• T.Pallidum EIA (enzyme immune assay).
• TPPA Treponema pallidum particle agglutination - reactivity. Demonstrate anitbody presence IgM, IgG, IgA (no differentiation)
• THPPA (haemagglutination assay)
Cannot culture
May be false -ve: if hasn’t seroconverted
Direct identification
• Dark field microscopy
• Direct fluorescent antigen
• NAAT e.g. PCR
Order:
1. EIA 2. TPPA 3. RPR
Syphilis
Management
MDT - Sexual Health or ID specialists, obstetricians, paeds, midwives, community care workers,
STI screen
Contact trace and treat
Notification to officer of health
Benzathine penicillin (Pen G) 1.8g IM stat
- All stages of disease - Once weekly for 3 weeks if latent disease - 2nd dose 1week later if 3rd trim >28weeks due to physiological changes in pregnancy so less concentration - Desensitisation if allergic
Jarisch-Herxheimer reaction
- post Rx as endotoxins from dead bacteria are released - 44% in pregnancy - Flu-like symptoms, fever, myalgia, FHR abnormalities, reduced FMS, uterine activity -> PTB, - Monitor for UA, FHR
RPR or VDRL monitoring
- 4x fold reduction = response to treatment - Rise = poor response to treatment or new infection
USS surveillance - growth, anomalies
Syphilis
At birth
- Labour fine
- Breastfeeding fine unless chancre on breast
- Placenta - histology, PCR
- Notify NICU
- Examine baby at birth
- Neonatal bloods - EIA, TPPA, IgM RPR , neonatal NOT cord
- Paired RPR with mother
- PCR swab if lesion present
Syphilis
Prevention
- Screen at pregnancy booking
- Repeat at 28weeks and birth if high risk
- Condoms - not altogether as don’t cover all affected areas
- Treat promptly - reduces congenital infection to 8% overall
