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Syphilis Flashcards

1
Q

Stages of syphilis

A

Exposure
Primary
Secondary
Latent
Tertiary

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1
Q

How long after exposure does primary syphilis occur

A

3-4 weeks after exposure

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2
Q

Classical symptom of primary syphilis

A

Chancre at site of infection - firm, round, painless
May go unnoticed if not visible, disappears in 2-8 weeks

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3
Q

When does secondary syphilis occur

A

2-6 weeks after primary infection

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4
Q

What is the rash in secondary sypphilis

A

Gneralised incl palms and soles
Maculopapular, non itchy
Condylomata lata - moist warty lesions in genital area

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5
Q

Systemic secondary syphilis symptoms

A

Fevers, fatigue, lymphadenopathy, splenomegaly, hepatitis, alopecia

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6
Q

How long does the latent phase of syphilis last

A

Early - <2 yeras
late - >2 years after initial infection

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7
Q

Features of early latent syphilis

A

Sexual and vertical transmission
25% have repeat secondary syphilis
Treated with single dose penicillin

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8
Q

Features of late latent syphilis

A

> 2 years after original
Only vertical transmission
Longer treatment required

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9
Q

When does tertiary syphilis occur

A

2-20 years after latency
1/3 develop

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10
Q

Features of tertiary syphilis

A

Gummatous
Cardiovascular
General paresis - progressive dementia
Tabes dorsalis
Ocular syphilis
Neuro syphilis

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11
Q

What is tabes dorsalis

A

neuropahty(loss of proprio and vibrioception), ataxia, pupillary changes (argyl robertson pupil)
Incontinence

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12
Q

CV syphilis causes

A
  • aortitis -> aneurysm, aortic regurg
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13
Q

What see in gummatous syphilis

A

granulomatoous lesion with central necrosis

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14
Q

Ocular syphilis features

A

Painful red eye
Visual distubrance - floaters, flashing lights
May cause blindness

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15
Q

Neurosyphilis features

A

Asymptomatic but abnormal CNS findings
Menningitis
Altered behaviour
Stroke - secondary vasculitis
Tertiary neruosyphilis

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16
Q

When can ocular and neurosyphilis occur

A

Any stage of syphilis infection

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17
Q

What is congneital syphilis

A

Syphilis contracted in pregnancy or prior to

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18
Q

What can congenital syphilis cause

A

Adverse pregnancy outcomes incl miscarraige, stillbirth, prematurity
Early or late congenital syphilis

19
Q

What is earyl congenital syphilis presentation

A

Hepatosplenomegaly, lymphadenopathy, desquemating rash
Severe anaemia, jaundice
Significant mortality

20
Q

Late congenital syphilis presentation

A

Hutchinsons triad - pegged teeth, keratitis, deafness
Saddle nose, bone and joint deformities, developmental delay

21
Q

What is hitchinsons triad and what is it seen in

A

Keratitis, pegged teeth, deafness
Late congenital syphilis

22
Q

Preventing congenital syphilis

A

Routine antenatal screening

23
Q

Direct diagnosis of syphilis what do and when used

A

Primary syphilis
Dark field miscrocopy - spirochetes
PCR

24
Options to detect syphilis
Direct detection - primary syphilis Serological tests: Treponemal tests Non-treponemal tests
25
What are treponemal tests
eg EIA, TPPA, IgM Determine exposure to syphilis but remain positive life long
26
What are non treponemal tests for syphilis
eg RPR, VDRI Determine disease activity Measure response to treatmnet Serial dilutions - measure amount of antibody til disappears
27
What is the treatment for all stages of syphilis
Penicillin by injection
28
Early syphilis treatmnet
Primary, secondary, early latnet Single dose of benzathine benzylpenicillin IM
29
Treatment for late syphilis
Late latent, unknown, tertiary 3 x weekly doses IM enicillin
30
Coular and neurospyhilis treatment
Daily doses for 10-14 dyas
31
How do you monitor efficacy of syphilis treatment
4 fold decrease in non treponemal test titre
32
What is the risk of ssyphilis treatment
Jarisch Herxheimer reaction
33
What happens in a Jarishc-Herxheimer reaction
Triggered by penicillin treatment Acute onset fever, muscle aches, flush, rash and palpitations
34
How manage Jarish-Herxheimmer
Manage conservatively w paracetamol Steroids used preventatively if treating neurosyphilis
35
What is syphilis
Spirchaete treponema pallidum bacteria Sexually transmitted through micro-abrasions
36
Epidemiology of syphilis
300% increase in early syphilis since 2010 MSM 30% HIV + MSM cases in 2019 Indicator disease for other STIs
37
Sexual transmission of syphilis
Only in early syhilis 30-50% contacts infected Vaginal, oral and anal sex
38
Blood borne spread of syphilis
Needle sharing Blood transusion - v rare dies 24-48 hrs fridge,
39
Transplacental route of transmission of syphilis
More common in early syphilis due to high bacteruial load Routine antenatal screening Mostly after infections happen
40
How to reduce transmission of sylhilis
Contact racing/partner notification Decrease transmission - trace, test and treating partners of infected patients Voluntary Patient or provider referral Performed by health advisors Limitations - dating/hook up apps
41
How far back do you notify partners of peole with syphilis early vs late
Primary - partners in last 3 months Secondary/early latent - past 2 years or 3 months before last neg test Late - time when patient last had infections
42
Management of syphilis contacts
Testing and empirical treatmentn Test every 12 months
43
Sexual history tups
Taken last Introduce reason Closed questions Details for all artners last 3 months
44
Questions to ask in sexual history
Gender of partners Last sex Regular or casual Condom? Vaginal, anal, oral Nationality
45
What antibiotic offer if penicllin allergic
Doxycycline 100mg/12h - early 14 dyas late 21 dyas
46
Treatment of syphilis in pregnancy
ERYTHROmycin 500mg/6hrs PO

Infectious disease (37 decks)

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