Syphilis

Question 1

1) Syphilis is caused by what bacteria?
2) What is the morphology of this bacteria?

Answer 1

1) Treponema pallidum
2) Spirochete

Question 2

Name 3 modes of transmission of of syphilis

Answer 2

• Oral, vaginal or anal sex involving direct contact with an infected area
• Vertical transmission from mother to baby during pregnancy
• IV drug use
• Blood transfusions and other transplants (rare)

Question 3

Syphilis phases (1)
1) What happens in primary syphilis?
2) What happens in secondary syphilis?
3) What is the next phase of syphilis infection, and what happens?
4) What is this phase spilt into, and what happens in them?

Answer 3

1) Painless ulcer (called a chancre) at the original site of infection - usually on genitals
2) Systemic symptoms, particularly of the skin and mucous membranes
3) Latent phase - after the secondary stage of syphilis, where symptoms disappear and the patient becomes asymptomatic despite still being infected
4) Early latent syphilis occurs within two years of the initial infection, and late latent syphilis occurs from two years after the initial infection onwards

Question 4

Syphilis phases (2)
Tertiary syphilis can occur many years after the initial infection and affect many organs of the body - name 2 characteristics of this stage

Answer 4

1) Neurological symptoms (neurosyphilis), cardiovascular symptoms and development of gummas (soft, tumor-like growth of the tissues)

Question 5

Name 2 ways primary syphilis can present

Answer 5

• Painless genital ulcer - chancre
• Local lymphadenopathy

Question 6

Name 2 ways secondary syphilis can present

Answer 6

• Maculopapular rash
• Condylomata lata (grey wart-like lesions around the genitals and anus)
• Low-grade fever
• Lymphadenopathy
• Alopecia (localised hair loss)
• Oral lesions

Question 7

Name 2 ways tertiary syphilis can present

Answer 7

• Gummatous lesions
• Aortic aneurysms
• Neurosyphilis

Question 8

Name 2 ways neurosyphilis can present

Answer 8

• Headache
• Altered behaviour
• Dementia
• Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
• Ocular syphilis (affecting the eyes)
• Paralysis
• Sensory impairment

Question 9

Argyll-Robertson pupil is a specific finding in neurosyphilis - what is this?

Answer 9

Constricted pupil that accommodates when focusing on a near object but does not react to light

Question 10

1) How can syphilis infection be screened?
2) Name a method samples from sites of infection can be tested to confirm the presence of T. pallidum

Answer 10

1) Antibody testing for antibodies to the T. pallidum bacteria
2) Dark field microscopy and PCR

Question 11

A single deep intramuscular dose of what is the standard treatment for syphilis?

Answer 11

Benzathine benzylpenicillin

Question 12

What can be monitored to check for response to syphilis treatment?

Answer 12

Nontreponemal titre - after repeating serology, nontreponemal titre should be decreased by 4 fold