Syphilis

Question 1

What is the definition of syphilis?

Answer 1

Contagious systemic disease caused by treponema pallidum.

Question 2

What is the pathophysiology of syphilis?

Answer 2

Treponema pallidum enters via abraded skin or intact mucous membrane and distributes via the bloodstream and lymphatics after an incubation period of around three weeks

Question 3

How long is the incubation period of primary syphilis?

Answer 3

2-3 weeks

Question 4

How long is the incubation period of secondary syphilis?

Answer 4

6-12 weeks

Question 5

How long is the incubation period for latent syphilis?

Answer 5

Early: less than 2 years
Late: two years or longer

Question 6

What stages of syphilis are non-infectious?

Answer 6

Late latent syphilis
Tertiary syphilis

Question 7

How does primary syphilis present?

Answer 7

Painless chancre at the site of inoculation
Non-tender local lymphadenopathy

Question 8

How does secondary syphilis present?

Answer 8

Macular, follicular or pustular rash on palms and soles
Lesions of mucous membranes
Generalised lymphadenopathy, fever, sore throat
Malaise
Anterior uveitis
Cranial nerve lesions
Condylomata lata

Question 9

How does latent syphilis present?

Answer 9

Positive serological tests but no symptoms or signs of syphilis

Question 10

How does tertiary syphilis present?

Answer 10

Cardiovascular syphilis
Neurosyphilis
Gummatous syphilis

Question 11

What are some investigations for syphilis?

Answer 11

Serological testing
- Non-treponemal tests for screening and monitoring treatment response (eg VDRL, RPR)
- Treponemal tests for confirmation of diagnosis (eg EIA, TPPA, FTA-ABS)
Dark-field microscopy
CSF examination (for tertiary syphilis)

Question 12

What is the management of syphilis?

Answer 12

Early: 2.4MU benzathine penicillin (IM)
Late: 2.4MU benzathine penicillin weekly x 3 weeks
Follow up: until negative RPR or serofast