Syphilis

Question 1

Which of the following cause syphilis?

1 - Chlamydia trachomatis
2 - Neisseria gonorrhoeae
3 - Treponema pallidum
4 - Mycoplasma hominis

Answer 1

3 - Treponema pallidum

• spirochete bacterium
• obligate bacteria that cannot survive without a human host

Question 2

Treponema pallidum is what cause syphilis. This can be called acquired or congenital syphilis. How can syphilis be contracted?

1 - broken skin
2 - mucous membranes
3 - unprotected sex
4 - all of the above

Answer 2

4 - all of the above

Question 3

Congenital syphilis is passed on from an infected mother to the foetus. How is this possible?

1 - bacteria crosses placenta
2 - during vaginal delivery
3 - either of the above

Answer 3

3 - either of the above

Presents as:
- generalised rash
- discharge from the nose
- wrinkled appearance in the face

Question 4

Does everyone with syphilis transmit syphilis during unprotected sex?

Answer 4

• no
• 1/3 will develop the disease

Question 5

Gay/bisexual men are most likely to contract syphilis, but which of the following has the highest incidence?

1 - caucasians
2 - black ethnic backgrounds
3 - asians
4 - all equal

Answer 5

2 - black ethnic backgrounds

Question 6

There are 4 stages of acquired syphilis. Stage 1 is the incubation period which typically presents as a local infection. How long does this period typically last?

1 - 9-90 days
2 - 20-70 days
3 - 100-200 days
4 - 4 to 10 weeks

Answer 6

1 - 9-90 days

Question 7

There are 4 stages of acquired syphilis. Stage 1 is the incubation period which typically presents as a local infection over 9-90 days. At the site of infection what is the most common sign that presents in stage 1 acquired syphilis?

1 - purulent discharge
2 - pelvic pain
3 - painless chancre
4 - painful erythema rash

Answer 7

3 - chancre
- painless and clean round ulcer 1-2 cm
in diameter are most common
- chancres heal in 3-10 weeks
- can also have slightly enlarged lymph nodes
- diagnosed used dark field microscopy

Question 8

Secondary syphilis presents as a generalised multi system presentation. Which of the following are common presentations?

1 - lymphadenopathy non-tender
2 - systemic illness
3 - mimic any rash
4 -all of the above

Answer 8

4 -all of the above

• rashes are typically symmetrical maculopapular and non-itchy rashes (patchy rash with some raised points)
• rarely papule (pus filled)

Question 9

There are 4 stages of acquired syphilis. Secondary syphilis also includes an incubation period, which is typically how long?

1 - 9-90 days
2 - 20-70 days
3 - 6-12 weeks
4 - 4 to 10 weeks

Answer 9

3 - 6-12 weeks
- typically occurs 4-10 weeks after the initial chancre.

Question 10

Secondary syphilis presents as a generalised multi system presentation. One of the most common signs of syphilis are maculopapular and non-itchy rashes (patchy rash with some raised points). Although the rash can occur in all of the following, which of the following is most common in syphilis?

1 - face and palms of soles
2 - palms of soles and hands
3 - trunk and legs
4 - face and back

Answer 10

2 - palms of soles and hands

Features of rash include:
- patients are asymptomatic
- papulosquamous
- symetrical and generalised

Can also cause mucocutaneous lesions, such as in the mouth

Question 11

Secondary syphilis can lead to a vast array of symptoms, which of the following are common?

1 - Mucous patches (buccal, lingual and genital)
2 - Condylomata lata (anogenital warts)
3 - Hepatitis
4 - Splenomegaly
5 - Glomerulonephritis
6 - all of the above

Answer 11

6 - all of the above

Question 12

Secondary syphilis can lead to a vast array of neurological symptoms, which of the following are common?

1 - Acute meningitis
2 - Cranial nerve palsies
3 - Uveitis (inflamed inside of the eye)
4 - Optic neuropathy
5 - Interstitial keratitis and retinal involvement (corneal involvement)
6 - all of the above

Answer 12

6 - all of the above

Question 13

The third type of syphilis is early latent syphilis, which is when patients are asymptomatic for how long?

1 - <6 weeks
2 - <6 months
3 - <1 years
4 - <2 years

Answer 13

4 - <2 years

Question 14

The fourth type of syphilis is late latent syphilis, which is when patients are asymptomatic for how long?

1 - >6 weeks
2 - >6 months
3 - >1 years
4 - >2 years

Answer 14

4 - >2 years
- must also have positive serological tests (plasma and other bodily fluids)

Question 15

When trying to diagnose syphilis all of the following can be used, EXCEPT which one?

1 - serology
2 - urinalysis
3 - dark field microscopy
4 - PCR
5 - skin biopsy

Answer 15

2 - urinalysis
- may be used to rule out UTI, but not able to diagnose syphilis

Question 16

Which of the following antibiotics is the 1st line for treating patients with confirmed syphilis?

1 - cephalexin
2 - metronidazole
3 - doxycycline
4 - benzathine penicillin

Answer 16

4 - benzathine penicillin
- 2.4 mega units given IM

• all treatments for STIs must also include education, partner notification and abstinance

Question 17

The 1st line medication for syphilis is benzathine penicillin. What is the name given to a reaction that is common following administration of this medication, which includes headache, myalgia, chills and rigors and typically resolves within 24 hours?

1 - Lewy body syndrome
2 - Jarisch-Herxheimer reaction
3 - Bartonella herx
4 - Corrisons reaction

Answer 17

2 - Jarisch-Herxheimer reaction

• must warn the patient about this
• treat with rest and analgesia

Question 18

The 1st line medication for syphilis is benzathine penicillin, but if this is unsuitable procaine penicillin can be used as an alternative. This can elicit a reaction in some patients with commonly causes what?

1 - anaphylaxis shock
2 - impending doom feeling with hallucinations
3 - syncope
4 - all of the above

Answer 18

2 - impending doom feeling with hallucinations

• typically lasts 30 minutes and