Syphilis Flashcards
Tx of syphilis
PCN
(T/F): Treponema pallidum cannot be cultured OR gram stained
True
What causes the symptoms of syphilis?
Host inflammatory response
How can early syphilis be diagnosed?
Dark field microscopy
Can’t be cultured or gram stained and antibodies have not yet developed for serological testing
What is the structure of Treponema pallidum?
Inner membrane + periplasmic space + outer membrane
What is contained in the periplasmic space?
Peptidoglycan + axial filaments
How does Treponema pallidum outer membrane differ from gram - outer membranes?
Contains lipids and lipoproteins rather than LPS; these MAY contribute to the inflammatory response
How does T. pallidum move?
Flagella-like organelles called axial filaments which are in the periplasm
Timeframe: primary syphilis
2-3 weeks after infection; resolves in 3-6 weeks
Timeframe: secondary syphilis
A month after infection; resolves in ~ 1 month if untreated
Timeframe: early latent syphilis
1-2 year period after resolution of 2 syphilis
Timeframe : late latent syphilis
1-2 years post-infection; can last lifetime
Possible outcomes of late latent syphilis?
Spontaneously resolve, progress to tertiary syphilis, or infection remain latent for lifetime
(T/F): Congenital syphilis will be apparent immediately following birth
False - not always; may present 2+ years after birth
2 big sx of primary syphilis
Chancre + nonpainful inguinal lymphadenopathy
7 big sx of secondary syphilis
Rash (all over body + hands and feet) Condylomata lata (perineal and anal areas) Fever HA (mild meningitis) Hair loss Snail-track lesions (oral + genital) Non-tender, diffuse lymphadenopathy
No sx but positive serology
Early and late latent stages
Positive serology but not infectious
Late latent (tertiary may not have titers)
Late vs. early latent syphilis
Both have positive titers but early latent can relapse to secondary and is infectious while late does not relapse and is not infectious
Endarteritis
Tertiary syphilis
7 big sx of tertiary syphilis
Gummas (skin and bone lesions)
Tabes dorsalis (shuffling gait + lightening pain)
Paresis
Personality change, insanity, paranoia
Meningovascular syphilis (occlusion/infarction of cerebral arteries)
Meningitis
Aortic aneurysm/aortic valve regurgitation
9 big sx of congenital syphilis
Snuffles Bullous rash Snail track lesions Condylomata lata Saber shins Frontal bossing Gun barrel vision Hepatosplenomegaly Hutchison's triad (sharp teeth + keratitis + deaf)
(T/F): Since syphilis isn’t viable outside of the body for more than a few minutes, it can only be transmitted via sexual contact.
False - may also be transmitted by biting, handling a contaminated catheter, or touching a crack in skin of chancre or snail track lesion
In which demographic groups are syphilis rates the highest?
Urban, AA, and MSM populations
Tests sensitive for syphilis
Non-treponemal = RPR and VDRL
Tests specific for T. pallidum
Treponemal = FTA-abs
How does RPR/VDRL work?
Carbon coated with beef cardiolipin then patient serum added; if agglutination occurs, positive tests
Conditions associated with a false positive RPR
Viral hepatitis, lupus, pregnancy, mono
How does FTA-abs work?
Use non-pathogenic treponemes cross-reacted with patient serum to remove antibodies; mix serum with T. pallidum on slide; add fluorescent antibodies; if fluorescence observed in the dark, positive
How can you monitor syphilis response to Abx?
With non-treponemal tests (RPR/VDRL) because these titers reduce with cure while FTA-abs titers tend to remain for months to years after cure
Chancroid vs. chancre
Chancroid - H. dupreyi; soft; painful
Chancre - T. pallidum; hard; nonpainful
Tx of syphilis
Large, single IM dose of PCN G
