Syphilis Flashcards
Syphilis is a sexually transmited disease caused by the bacteria______
Treponema pallidum
Syphilis can spread through direct contact from a
person with a syphillic core, or known as______.
chancre
T or F
● A pregnant woman with syphills may transmit the disease to its unborn child.
True
● Trivia: “Syphilis” is the disease brought by ________from the New world to the Old world.
the crew of Christopher Columbus
These painless chancres can occur in locations that make
them difficult to notice (e.g. the vagina or anus)
SECONDARY STAGE
EPIDEMIOLOGY
● According to the World Health Organization,______ new cases of venereal syphilis occur globally
each year.
● Globally,______ pregnant women are estimated to be infected each year; approximately one third of
these infections will result in stillbirth
11 million
1.5 million
In developing countries, transmission is largely_______, while transmission among men who have sex with men predominates in industrialized
nations.
heterosexual
caused by syphilis are a major cofactor
for bidirectional transmission of human
immunodeficiency virus (HIV).
● Genital ulcers
A single______ marks the onset of the primary stage of syphilis, but there may be multiple sores.
chancre
The chancre is usually (but not always) [3].
It appears at the location where syphilis enters the body.
firm, round, and painless
What mark the second stage of symptoms?
Skin rashes and/or mucous membrane lesions (sores in the
mouth, vagina, or anus)
This stage typically starts with the development of a rash
on one or more areas of the body
Secondary stage
In addition to rashes, signs and symptoms of secondary
syphilis may include
● fever
● swollen lymph nodes
● sore throat
● patchy hair loss
● headaches
● weight loss
● muscle aches
● fatigue
are large, raised, gray or white lesions.
They may develop in warm, moist areas like the mouth, underarm or groin region.
Condyloma lata
The ________stage of syphilis is a period when there are no visible signs or symptoms of syphilis.
latent (hidden)
● is latent syphilis where infection occurs within the past 12 months.
● is latent syphilis where infection occurs more than 12 months ago.
Early latent syphilis
Late latent syphilis
is when there is not enough evidence to confirm initial infection was within the previous 12 months.
Latent syphilis of unknown duration
Tertiary syphilis is rare and develops in a subset of untreated syphilis infections. It can appear_____ after a person gets the infection, and it can be fatal.
10-30 years
T ertiary
syphilis can affect multiple organ systems, including the:
● brain
● nerves
● eyes
● heart
● blood vessels
● liver
● bones
● joints
Occurs in around one third of untreated individuals
Tertiary syphilis
Tertiary syphilis
Has three major manifestations:
• Gummatous syphilis.
• Cardivoascular disease
• Neurosyphilis
are localized areas of granulomatous inflammation most often found on bones, skin, or subcutaneous tissues
• They contain lymphocytes, epithelioid cells, and fibroblastic cells
• They represent the host’s response to the infection
Gummas
• malaise, fever, pharyngitis
• early signs of neurologic involvement (40%): visual disturbances, hearing loss, etc.
Secondary
- painless, wart-like lesions
Condylomata lata
is the complication most often associated with the tertiary stage but can actually occur anytime after primary syphilis and con span all stages of the disease
Neurosyphilis
● nervous system ()
● visual system ()
● auditory and/or vestibular system ().
neurosyphilis
ocular syphilis
otosyphilis
Non treponemal tests
VENEREAL DISEASE RESEARCH LABORATORIES (VDRL) TEST
RAPID PLASMA REAGIN (RPR) TEST
TOLUIDINE RED UNHEATED SERUM TEST (TRUST)
● Determine the presence of an antibody that forms around____, a lipid material released from
cells
● This antibody is sometimes referred to as____
NONTREPONEMAL TESTS
cardiolipin
reagin
● In general, nontreponemal tests are positive within______after the appearance of the primary
chancre.
● Titers usually peak during the _______stages.
1 to 4 weeks
secondary or early latent
● In primary disease, between 13% and 41% of individuals appear nonreactive; however, by the secondary stage almost all patients have reactive test results.
● However, testing of sera from patients in the secondary stage is subject to false negatives because of the prozone phenomenon (antibody excess).
● In this case, a nonreactive pattern that is typically granular or rough in appearance is seen.
● If a prozone is suspected, serial two- fold dilutions of the patient’s sera should be made to obtain a titer.
●________ tend to decline in the later stages of the disease, even if the patient remains untreated.
● After several years, about 25% of untreated syphilis cases become nonreactive for reagin. This decline
occurs more rapidly in individuals who have received treatment.
Cardiolipin antibody titers
● A first-time infection, if in the primary or secondary stage, should show a four-fold decrease in titer by the third month following treatment and an eight-fold decrease by 6 to 8 months.
● Following successful treatment, tests typically become completely nonreactive within 1 to 2 years
➔ The most widely used nontreponemal tests are
VDRL (Venereal Disease Research Laboratory)
Rapid Plasma Reagin
● These tests are based on the flocculation reactions in
which patient’s antibody complexes with the
cardiolipin antigen
Nontreponemal tests
VDRL (Venereal Disease Research Laboratory)
Rapid Plasma Reagin
is a special type of precipitation that
occurs over a narrow range of antigen
concentrations
Flocculation
● is usually found in the serum of patients with syphilis and several other diseases.
● An antigen complex composed of CLC is used in the reaction to detect nontreponemal reagin antibdoeis, which are in the class of IgM or IgG
Reagin
cardiolipin, lecithin and cholesterol
Nontreponemal/ Screening tests
Rapid Plasma Reagin (Qualitative)
Venereal Disease Research
Laboratory (Qualitative and
Semi-Quantitative)
tests are based on flocculation
reactions in which patient antibody
complexes with cardiolipin antigen
Nontreponemal tests
Treponemal/ Diagnostic tests
● Fluorescent Treponemal Antibody Absorption Test (FTA-ABS)
● Treponema pallidum Hemagglutination Test (TPHA)
is both a qualitative and quantitative slide flocculation test for serum that includes a modification for use on spinal fluid.
VDRL
VDRL
● Antigen for all tests must be prepared fresh daily and in a highly regulated fashion. The antigen is an alcoholic solution of (3)
0.03% cardiolipin
0.21% lecithin
0.9% cholesterol
The____ test is a modified VDRL test involving macroscopic agglutination.
RPR
RPR
● The cardiolipin-containing antigen suspension is bound to_____ particles; this makes the test easier to read.
Positive result will be subjected to confirmatory tests (specifically treponemal tests) to confim for Syphilis infection.
charcoal
RPR
● The suspension is contained in small glass vials, which are stable for up to 3 months after opening.
The antigen is similar to the VDRL antigen with the addition of (3), which stabilize the antigen and inactivate complement so that serum does not have to be heat-inactivated before use.
ethylenediaminetetraacetic acid
(EDTA), thimerosal, and choline chloride
Is a nontreponemal serologic test for syphilis that detects the reagin, an antibody formed against cardiolipin during the progress of the disease.
The RPR (Rapid Plasma Reagin) 18-mm Circle Card Test
RPR
● The antigen consists of cardiolipin mixed with carbon particles, cholesterol, and lecithin. If antibody is present in the patient specimen, flocculation occurs
with coagglutination of the carbon particles, resulting in____ clumps against the____ background of the plastic-coated card.
black
white
RPR
● Nonreactive specimens appear to have an even,_____ color
light-gray color.
RPR
PROCEDURE
1. Place a______ of unheated serum or plasma on an ___mm circle card
2. Place the same amount of positive and negative controls into appropriately labeled cells.
3. Spread the serum or plasma using the flat end of dispenstir, as well as the controls. Be careful not to scratch the surface of the card.
4. Shake the dispensing bottle assembly and genty tap the needle to remove air bubbles.
5. Position the needle______ to the test card and add exactly one drop (_____mL) of the RPR card test antigen suspension to each test area containing the serum. Do not stir.
6. Rotate the test card for____ minutes, under a humidfier cover, on a mechanical rotator at_____ pm.
7. Immediately following the mechanical rotation, briefly rotate by hand with tilting the card three to four to- and-fro motions).
8. Read macroscopically in the “wet” state under a high-intesntiy incandescent lamp or strong daylight
- Report as reactive any specimen showing characteristic clumping, ranging from slight but definite to marked and intense, and as nonreactive, any specimen showing slight roughness or no clumping
- Upon the completion of the tests, remove the needle from the dispensing botti and rinse with distilled water or deionized water. Do not wipe the needle
because this may remove the silicon coating and affect the accuracy of delivery.
0.05 mL or 50uL; 18-
perpendicular; 1/60
8 ; 100
