Syphilis Flashcards
What is the drug of choice for treating syphilis? How did they used to treat it?
Penicillin is the gold standard. Old days they used to use heavy metals like arsenic (idiots)
What causes syphilis? specifically the organism.
spirochete, T. pallidum
Is syphilis cultivatable with consistency in artifical lab medias?
nope, cant grow that sh’t
True or False: Outside of the host, syphilis is extremely susceptible to physical and chemical agents
true
T. Pallidum causes?
Syphilis, worldwide location
T. pallidum (varient) causes? name a few locations associated with it
Causes Bejel, located in mediterranean, balkans and north africa
T. pertenue causes? name a few locations associated with it
Causes Yaws, located in the caribbean, latin america, central africa and far east
T carateum causes? location?
Pinta in latin America
What are the three reportable diseases by the CDC?
Chlamydia, gonorrhea and Syphilis
True or False: Syphilis is higher in men than women
true (long live carlos)
Syphilis is considered what type of diease?
primary venereal disease and is the most common STD in the U.S
What are the two basic transmission routes of the pathogenic treponemes?
transmission via direct contact or infections of the skin/oral regions that contain spirochetes that may be transmitted by personal, not necessarily venereal contact
true or false: syphilis can be aquired by kissing a person with active lesions/bed sharing
yes true duh
what is the risk of acquiring syphilis through blood transfusions?
In the US transmission is low since we dont do donor-to-donor and syphilis has a short survivial in blood <72 hrs, risk in countries that do d-t-d
Untreated syphilis leads to what chronic disease?
subacute chronic disease w/ symptomatic and asymptomatic periods
What are the progressional stages to syphilis? (there are 4)
primary, secondary, latent (hidden) and tertiary
How does T. pallidum infect the host?
via penetration of intact mucus membranes or enters the body through defects in the epithelium
How long is the incubation period for syphilis?
usually about 3wks but can range from 10-19 days
Primary Syphilis: what is the defining characteristic and other characteristics?
Chancres in primary inflammation developed at the end of the incubation period, relatively painless and single. Typically around genitalia but can be other places. 50-70% will develop inguinal adenopathy
How long does the primary chanchre presist?
1-5wks then heals completely within 4-6 weeks without treatment
Secondary Syphilis characteristics
signs and symptoms usualy devlp 2-8 wks after chancre (as long as 6mos). can overlap with primary and never notice the chancre. Has a generalized illness-begins like a viral infection
Secondary syphilis disease progression
lymphadenopathy (75%) lesions of skin and MM (80%). lesions contain high spirochete numbers. CNS asymp in 1/3 of pt. Usually resolves within 2-6wk even without treatment
Latent syphilis
after untreated secondary syphilis, pt enters the non infectious stage (diag. only through serology). during the first 2-4yr after infefction, can relapse into secondary. relapses rare after 4yrs, 1/3 pt spontaneously cured. 1/3 will never have more manifestations or they will develope late syphilis
Tertiary (late) syphilis
3-10yrs after primary infection, 15% untreated indiv. develope late benign syphilis - destructive granulomas. cardiovascular manifestations and CNS is possible. Spirochetes may infect brain and cause personality changes…etc
Meningovascular syphilis usually manifests as what?
seizures or strokes
Congenital syphilis characteristics
major problem in Africa and Far east, can be reduced by treating syph in preggo women. Caused maternal spirochetemia and transplacental transmission. Untreated can cause stillbirtht
true or false: congenital syphilis can be prevented if already transmitted with penicillin at least 30 days before delivery
true
How do you classify congenital syphilis?
according to age at diagnosis, early stages seen in 2yrs or younger and late stages in older than 2yrs (hutchinson triad)
Neurosyphilis characteristics
may be asympt. symptomatic form includes: menigeal syph (1 yr after infection) and meningovascular syph. 5-10yrs after infection or parenchymatous syphilis
Characteristics of meningeal syphilis
involves brain or spinal cord, headaches and stiff neck
meningovascular syphilis characteristic
inflammation of the pia mater and arachnoid space w/ focal arteritis
parenchymatous syphilis characteristic
general paresis, joint degeneration and demyelination of columns
what are the two classes of Ag recongnized in treponemes?
ag restricted to one or a few species and Ag shared by many different spirochetes
what are the specific antitreponemal Ab’s produced in early syphilis?
IgM and rapidly followed by IgG
True or false: delayed hypersensitivity immune mech are also involved in syphilis
ture, ab-ag complexes have been detected in secondary syphilis and can cause glomerunlonephritis
Diagnostic evaluations: what are the two types of ab used to measure classical methods?
nontreponemal and treponemal/traditional and “reverse” algorithms
why are direct observations of spirochetes often unavailabe?
uses a darkfield microscope and can miss up to 30% of primary cases, needs a pt with active syphilitic lesions
What do nontreponemal methods do?
determine the presence of reagin, use rapid plasma reagin (RPR), measures IgM and IgG ab, if present they agglutinate to charcoal particles. More sensitive than VDRL test for syphilis
does reactive RPR test confirm T. pallidum infections?
no
Nontreponemal methods
VDRL tests, also focculation (qual/quanitative) serum must be heated to 56 degrees celcius for 30 min. measures IgG and IgM, doesnt confirm T. pallidum
what is the preferred test for CSF in suspected teritary syphilis?
VDRL with reflex to titer
Chemiluminescene immunoassay (CIA/EIA)
treponemal method low cost automated equipment becoming more popular
Positive ELISA means what with a T.pallidum infection?
suggest current or past infection, can also distinguish between IgG ab and neonatal IgM
TP-PA Test
treponemal, semiquan, not for CSF cant distinguish between IgM and IgG, good to resolve inconclusive FTA result
FTA-ABS Test
confirms positive non treponemal test, determins titers, may be helpful in late neurosyph when RPR is negative
sensitivity procedures in primary, secondary, latent and late stages
Primary: serology active 30% after 1wk, 90% after 3wk, reagin titer increase rapidly during first 4wk
Secondary: sero positve
Latent: grad. return of nonreactive manifestation
Late: trep test generally reacitve, nontrep non reactive
true or false: CDC suggests the use of TP-PA to rule out false positives?
true
