Syphilis Flashcards
Definition
STI caused by spirochete (meaning ‘spiral-shaped’) bacterium Treponema pallidum.
- The incubation period between the initial infection and symptoms is 21 days on average.
Clinical stages of syphilis
- Primary syphilis
- Secondary syphilis
- Latent syphilis: symptoms disappear and patient becomes ASx 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. - Tertiary syphilis: gummas, CVD and neurological complications
- Neurosyphilis: occurs if the infection involves the central nervous system, presenting with neurological symptoms.
Epidemiology
Men who have sex with men
IV drug users
Sex workers
Multiple sexual partners and the presence of other STI’s
Primary syphilis Signs
Femoral lympadenopathy
Primary Syphilis Symptoms
- A single chancre (painless ulcer), usually on the genital
- Occasionally the chancre appears on the pharynx, anus or intravaginally
- Multiple chancres: rare, more likely if HIV positive
Secondary syphilis signs
- Diffuse maculopapular rash affecting palms and soles, this is the classic presenting feature
- Patchy oral ulceration (‘snail track ulcers’)
- Condylomata lata: wart-like lesions at site of skin friction e.g. perianal, vulval, submammary, axillary
- Patchy alopecia: ‘moth-eaten’ appearance
- Generalised lymphadenopathy (non-tender)
Secondary syphilis symptoms
Fever
Headaches
Neurosyphilis S+S
- Meningovascular syphilis: stroke due to arteritis
- Argyll-Robertson pupil: constricts to accommodation, but does not react to light
- General paralysis of the insane: loss of intellect, insight and memory, with spastic paresis and delusions changes in personality
- Tabes dorsalis: inflammation and degeneration of spinal dorsal columns
Cardiovascular syphilis S+S
- Aortic aneurysm
- Aortic regurg
- Coronary ostia stenosis -> angina and heart failure
- Conduction defects
Gummatous syphilis
- Gumma: a nodule or nodulo-ulcer that heals with central scarring (but remains active in the periphery
- Gummata: Commonly occur on skin but can occur on any organ
- Bony gummata: cause bone destruction
- Gummata in other organs
Diagnosis
ASx Px:
- FIRST LINE: Treponemal-specific antibody test:(usually EIA)
- If +ve = cofirmatory treponemal test (TPPA/TPHA) and non-treponemal test (RPR/VDLR) should be performed.
Sx Px:
- Full syphilis serology screen (EIA, TPPA, RPR)
- Swabs of active ulceration lesions for PCR and microscopy
‘ DARK-GROUND MICRSCOPY’ = Spiral-shaped rods
Treatment
FIRST LINE:
- Early syphilis (primary, secondary, early latent): single dose IM BENZATHINE BENZYLPENICILLIN
- Late latent and gummatous syphilis : 3 doses of IM BENZATHINE BENZYLPENICILLIN once weekly for 3 weeks
- Cardiovascular syphilis : 3 days of oral PREDNISOLON and 3 once-weekly doses of BENZATHINE BENZYLPENICILLIN
Neurosyphilis syphilis : 14 days of IM PROCAINE PENICILLIN and oral PROBENECID
Second line if Px allergic to penicillin
Oral doxycyline
Partner notification
Primary syphilis : all partners in the last 3 months
Secondary/early latent syphilis : all partners in the last 2 years
Late latent or tertiary syphilis : case-by-case basis as determined by staging of the disease
Congenital syphilis
IV benzylpenicillin ( not benzathine penicillin) for 10 days
