Syphilis

Question 1

What is primary syphilis

Answer 1

occurs 3-4 wks post exposure. Painless ulcer (chancre)- clear margins and punched out crater-like appearance. Heals spontaneously without treatment.

Question 2

What is secondary syphilis?

Answer 2

occurs 4-8 weeks post-chancre.
- Maculopapular rash of torso, palms/soles, lymphadenopathy, condylomata lata (painless mucosal warty lesions)

Question 3

What is tertiary syphilis?

Answer 3

occurs 1-10 yrs post-infection.
Gummas (granulomatous lesion), cardiovascular syphilis, vascular anueyrms, tabes dorsalis (degeneration of spinal cord-pain and sensory ataxia), ARgyll-Robinson pupil

Question 4

What is neurosyphilis?

Answer 4

can occur at any time in process. Need IV PCN.

Question 5

What is RPR?

Answer 5

Non-treponemal test. RPR titer at time of initial ddx. 4-fold (1:32 to 1:8 is considered adequate). Early syphilis: check at 6, 12 months. Late syphilis: 6,12,24 months.

Rapid plasma reagin (RPR) - tests for reagin antibodies.

Question 6

What is latent syphilis?

Answer 6

Positive testing with no signs/symptoms. after UNTREATED secondary stage.
Early latent: <1 yr since infection: tx w/ PCN G 2.4million units IM x 1 dose
Late latent> 1 year - PCN G 2.4 million units weekly x 3 doses

Question 7

What are causes of false positive RPR?

Answer 7

Autoimmune disease (SLE), smallpox vaccination, malaria, Pregnancy (1%), malaria, HIV, IV drug use.

Question 8

What are alternative treatments for syphilis?

Answer 8

Doxycycline 100mg BID x14d or ceftriaxone 1g IM/IV x 10-14d.

Question 9

What are the different serologies for syphilis?

Answer 9

Non-specific: VDRL, STS, RPR. screening, +false positives, not permanent. can return to zero but can remain weakly positive for life after treatment.

Specific: fTA-Abs, TPI, TPHA: confirmatory tests. no false positives, permanent.

sero-conversion takes 4-6 weeks.

Question 10

What are syphilis titers?

Answer 10

Generally:
Should get 4-fold decline within 3 months
8-fold decline within 6 months
non-reactive within 1 year
- screening tests may be weakly positive indefinitely

Question 11

What is the Jarisch-Herxheimer reaction?

Answer 11

acute febrile illness (Fever, HA, myalgias, rash).
occurs within 6-8 hrs of treatment with PCN
- often mistaken for PCN allergy
can cause PTL/fetal distress
due to release of toxins from dying spirochetes.

Question 12

What is treatment for syphilis?

Answer 12

penicillin. If pregnant, desensitize since tetracycline contraindicated (yellow teeth) and erythromycin doesn’t adequately treat fetus.

if penicillin sensitive, given erythromycin if not pregnant.

Question 13

What are the differences between syphilis and chancroid?

Answer 13

Syphilis: single, painless, clear margin (crater-like), rubbery painless nodes, treponema palladium

Chancroid: multiple, painful, vague margin, painful nodes, hemophilus ducreyi.

Question 14

What are sonographic features of in-utero syphilis?

Answer 14

• hepatosplenomegaly
• intrahepatic calcifications
• placentomegaly
• fetal ascites

In severe cases there may be evidence of hydrops