Syphilis Flashcards
Stages of syphilis
Exposure
Primary
Secondary
Latent
Tertiary
How long after exposure does primary syphilis occur
3-4 weeks after exposure
Classical symptom of primary syphilis
Chancre at site of infection - firm, round, painless
May go unnoticed if not visible, disappears in 2-8 weeks
When does secondary syphilis occur
2-6 weeks after primary infection
What is the rash in secondary sypphilis
Gneralised incl palms and soles
Maculopapular, non itchy
Condylomata lata - moist warty lesions in genital area
Systemic secondary syphilis symptoms
Fevers, fatigue, lymphadenopathy, splenomegaly, hepatitis, alopecia
How long does the latent phase of syphilis last
Early - <2 yeras
late - >2 years after initial infection
Features of early latent syphilis
Sexual and vertical transmission
25% have repeat secondary syphilis
Treated with single dose penicillin
Features of late latent syphilis
> 2 years after original
Only vertical transmission
Longer treatment required
When does tertiary syphilis occur
2-20 years after latency
1/3 develop
Features of tertiary syphilis
Gummatous
Cardiovascular
General paresis - progressive dementia
Tabes dorsalis
Ocular syphilis
Neuro syphilis
What is tabes dorsalis
neuropahty(loss of proprio and vibrioception), ataxia, pupillary changes (argyl robertson pupil)
Incontinence
CV syphilis causes
- aortitis -> aneurysm, aortic regurg
What see in gummatous syphilis
granulomatoous lesion with central necrosis
Ocular syphilis features
Painful red eye
Visual distubrance - floaters, flashing lights
May cause blindness
Neurosyphilis features
Asymptomatic but abnormal CNS findings
Menningitis
Altered behaviour
Stroke - secondary vasculitis
Tertiary neruosyphilis
When can ocular and neurosyphilis occur
Any stage of syphilis infection
What is congneital syphilis
Syphilis contracted in pregnancy or prior to
What can congenital syphilis cause
Adverse pregnancy outcomes incl miscarraige, stillbirth, prematurity
Early or late congenital syphilis
What is earyl congenital syphilis presentation
Hepatosplenomegaly, lymphadenopathy, desquemating rash
Severe anaemia, jaundice
Significant mortality
Late congenital syphilis presentation
Hutchinsons triad - pegged teeth, keratitis, deafness
Saddle nose, bone and joint deformities, developmental delay
What is hitchinsons triad and what is it seen in
Keratitis, pegged teeth, deafness
Late congenital syphilis
Preventing congenital syphilis
Routine antenatal screening
Direct diagnosis of syphilis what do and when used
Primary syphilis
Dark field miscrocopy - spirochetes
PCR
Options to detect syphilis
Direct detection - primary syphilis
Serological tests:
Treponemal tests
Non-treponemal tests
What are treponemal tests
eg EIA, TPPA, IgM
Determine exposure to syphilis but remain positive life long
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
What is the treatment for all stages of syphilis
Penicillin by injection
Early syphilis treatmnet
Primary, secondary, early latnet
Single dose of benzathine benzylpenicillin IM
Treatment for late syphilis
Late latent, unknown, tertiary
3 x weekly doses IM enicillin
Coular and neurospyhilis treatment
Daily doses for 10-14 dyas
How do you monitor efficacy of syphilis treatment
4 fold decrease in non treponemal test titre
What is the risk of ssyphilis treatment
Jarisch Herxheimer reaction
What happens in a Jarishc-Herxheimer reaction
Triggered by penicillin treatment
Acute onset fever, muscle aches, flush, rash and palpitations
How manage Jarish-Herxheimmer
Manage conservatively w paracetamol
Steroids used preventatively if treating neurosyphilis
What is syphilis
Spirchaete treponema pallidum bacteria
Sexually transmitted through micro-abrasions
Epidemiology of syphilis
300% increase in early syphilis since 2010
MSM
30% HIV + MSM cases in 2019
Indicator disease for other STIs
Sexual transmission of syphilis
Only in early syhilis
30-50% contacts infected
Vaginal, oral and anal sex
Blood borne spread of syphilis
Needle sharing
Blood transusion - v rare
dies 24-48 hrs fridge,
Transplacental route of transmission of syphilis
More common in early syphilis due to high bacteruial load
Routine antenatal screening
Mostly after infections happen
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
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
Management of syphilis contacts
Testing and empirical treatmentn
Test every 12 months
Sexual history tups
Taken last
Introduce reason
Closed questions
Details for all artners last 3 months
Questions to ask in sexual history
Gender of partners
Last sex
Regular or casual
Condom?
Vaginal, anal, oral
Nationality
What antibiotic offer if penicllin allergic
Doxycycline 100mg/12h - early 14 dyas
late 21 dyas
Treatment of syphilis in pregnancy
ERYTHROmycin 500mg/6hrs PO
