Syphilis Flashcards
What is syphilis caused by?
a bacteria called Treponema pallidum
What type of bacteria is Treponema pallidum and how does it enter the body?
This bacteria is a spirochete, a type of spiral-shaped bacteria.
The bacteria gets in through skin or mucous membranes, replicates and then disseminates throughout the body.
Syphilis is a sexually transmitted condition. true/false?
True
Syphilis is mainly sexually transmitted
Routes of transmission for syphilis?
Oral, vaginal or anal sex involving direct contact with an infected area
Vertical transmission from mother to baby during pregnancy
Intravenous drug use
Blood transfusions and other transplants (although this is rare due to screening of blood products)
Stages of syphilis?
Primary syphilis
Secondary syphilis
Latent syphilis
Tertiary syphilis
Neurosyphilis
Description of primary syphilis?
involves a painless ulcer called a chancre at the original site of infection (usually on the genitals).
Description of secondary syphilis?
involves systemic symptoms, particularly of the skin and mucous membranes.
These symptoms can resolve after 3 – 12 weeks and the patient can enter the latent stage.
Description of latent syphilis?
occurs after the secondary stage of syphilis, where symptoms disappear and the patient becomes asymptomatic despite still being infected.
Early latent syphilis occurs within two years of the initial infection.
Late latent syphilis occurs from two years after the initial infection onwards.
Description of tertiary syphilis?
can occur many years after the initial infection and affect many organs of the body, particularly with the development of gummas and cardiovascular and neurological complications.
Description of neurosyphilis?
occurs if the infection involves the central nervous system, presenting with neurological symptoms.
Clinical presentation of primary syphilis?
A painless genital ulcer (chancre). This tends to resolve over 3 – 8 weeks.
Local lymphadenopathy
Clinical presentation of secondary syphilis?
typically starts after the chancre has healed, with symptoms of:
Maculopapular rash
Condylomata lata (grey wart-like lesions around the genitals and anus)
Low-grade fever
Lymphadenopathy
Alopecia (localised hair loss)
Oral lesions
Clinical presentation of tertiary syphilis?
Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
Aortic aneurysms
Neurosyphilis
Clinical presentation of neurosyphilis?
can occur at any stage if the infection reaches the central nervous system, and present with symptoms of:
Headache
Altered behaviour
Dementia
Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
Ocular syphilis (affecting the eyes)
Paralysis
Sensory impairment
What is “Argyll-robertson pupil”?
a specific finding in neurosyphilis.
It is a constricted pupil that accommodates when focusing on a near object but does not react to light. They are often irregularly shaped. It is commonly called a “prostitutes pupil” due to the relation to neurosyphilis and because “it accommodates but does not react“.
Diagnosis of chlamydia?
Antibody testing for antibodies to the T. pallidum bacteria can be used as a screening test for syphilis.
Patients with suspected syphilis or positive antibodies should be referred to a specialist GUM centre for further testing.
Samples from sites of infection can be tested to confirm the presence of T. pallidum with:
- Dark field microscopy
- Polymerase chain reaction (PCR)
For chlamydia, like other STI’s all patients should be managed and followed up by a specialist service such as GUM (genitourinary medicine). true/false?
True
As with all other STI’s, what do patients require for management purposes?
Full screening for other STIs
Advice about avoiding sexual activity until treated
Contact tracing
Prevention of future infections
What is the standard treatment for syphilis?
single deep intramuscular dose of benzathine benzylpenicillin (penicillin)
What alternative regimes and types of penicillin are used in different scenarios, for example, late syphilis and neurosyphilis?
Ceftriaxone, amoxicillin and doxycycline are alternatives.
Chancre is a painful ulcer that, particularly one that develops on the genitals in venereal (sexual intercourse -related) disease. True/false?
False
Chancre is an ulcer that tends to develop on the genital areas in sexual diseases.
HOWEVER it usually presents as painless NOT painful.
