Syphilis

Question 1

T/F: Treponema is Gram +

Answer 1

FALSE: Treponema is too small to see in culture, so no gram stain. Must use DARKFIELD to visualize treponema

Question 2

How do you culture treponema?

Answer 2

YOU CAN’T

Question 3

How does treponema achieve virulence?

Answer 3

immune evasion, low inflammation

Question 4

How is T. pallidum transmitted? What about yaws and pinta?

Answer 4

T. pallidum is transmitted sexually or congenitally

yaws and pinta are transmitted by direct contact

Question 5

What is Argyll-Robertson pupil?

Answer 5

it is diagnostic of neurosyphilis

1 pupil or both fail to constrict in response to light but the pupils constrict when focusing on a near object

Question 6

Immune response to syphilis

Answer 6

immunity is incomplete; late latency has some protection from reinfection

Question 7

How do you treat treponema?

Answer 7

Penicillin G

Question 8

Describe primary syphilis

Answer 8

happens within weeks of infection,

initial replication at site of infection, forms a chancre, initiates bacteremia

Question 9

Describe secondary syphilis

Answer 9

macropapular rash on palms and soles, moist papules on skin and mucous membranes, highly infectious moist lesions on genitals “condylomata lata”
patchy alopecia, constitutional sx, headache, myalgia, lymphadenopathy

Question 10

what happens after secondary syphilis?

Answer 10

1/3 resolve, 1/3 enter latency, 1/3 enter tertiary syphilis

Question 11

What is the difference between early latency and late latency?

Answer 11

Early latency: sx come and go, patient remains infectious (6 mo.)
Late latency: sx gone, not infectious

Question 12

Describe tertiary syphilis?

Answer 12

granulomas/ gummas
CNS involvement: early meningitis (6 mo) low-inflammation
late neurosyphilis - meningovascular syphilis (damage to blood vessels of meninges)
parenchymal neurosyphilis - tabes dorsalis, general paresis

Question 13

how does congenital syphilis affect fetuses?

Answer 13

kills 50% fetus/newborn, survivors are infected –> bone deformities, interstitial keratitis, progresses to secondary and tertiary syphilis if untreated

Question 14

How is syphilis diagnosed?

Answer 14

complete timecourse of sx that are seemingly unrelated

Question 15

positivity of the different tests for syphilis over the timecourse of the disease

Answer 15

1) For the primary chancre, Dark Field microscopy will be positive and VDRL may be also.
2) For secondary disease, VDRL will be positive and pallidum-specific antibody tests like FTA will be also
3) For tertiary disease, VDRL positivity is less reliable, but the specific tests will still be positive

Question 16

What is Yaws?

Answer 16

terponema pertenue
tropical disease of overcrowding and poor sanitation
spread by direct contact with cutaneous lesions
three-phase disease without neuro- cardio- involvement
tests reagin positive
tx_ PCN

Question 17

What is pinta?

Answer 17

treponema carateum 
rarer than yaws - Central and S. America
no constiutional sx, just hypo- and hyper-pigmented skin plaques
spread by direct contact
tests reagin positive
tx: PCN