Syphilis

Question 1

Syphilis is caused by what spirochete bacteria?

Answer 1

Treponema pallidum

Question 2

How is Syphilis most commonly transmitted?

Answer 2

Sex

Question 3

What is the risk of transmitting Syphilis during unprotected sex?

Answer 3

30 - 50%

Question 4

Most cases of Syphilis are seen among what population?

Answer 4

Men who have sex with Men (MSM)

Question 5

How often should MSM be screened for Syphilis?

Answer 5

Every 3 - 6 months

Question 6

When should pregnant patients be screened for Syphilis?

Answer 6

First Prenatal Visit
Third Trimester
Delivery (if high risk)

Question 7

Includes primary lesions of chancre (painless) that are usually on the penis, labia, cervix, anorectal, and sometimes in the oropharynx?

Answer 7

Primary Syphilis

Question 8

How soon after inoculation does Primary Syphilis occur

Answer 8

10 - 90 days

Question 9

A painless, “punched out” appearing ulcer, that is indurated with a raised border, and a red and smooth base with very little serous secretions.

Answer 9

Chancre

Question 10

A type of Syphilis test that detects antibodies to lipoidal antigens.

Answer 10

Non-Treponemal Tests

Question 11

What are the two Non-Treponemal Tests used to screen for Syphilis?

Answer 11

VDRL and RPR
- Venereal Disease Research Laboratory
- Rapid Plasma Reagin

Question 12

What can be used to confirm the diagnosis of Syphilis following a non-treponemal test?

Answer 12

Treponemal Test

Question 13

What are the two Treponemal Test used to diagnose Syphilis?

Answer 13

TPPA and FTA-ABS
- (T. pallidum Particle Agglutination)
- (Fluorescent Treponemal Antibody Absorption Test)

Question 14

What two immunoassays can be used to diagnose or screen for Syphilis?

Answer 14

EIA-Enzyme
CIA-Chemiluminescence

Question 15

Without treatment, how long will it take for the Chancre to resolve?

Answer 15

1 - 3 weeks

Question 16

Once a Syphilis Chancre resolves on its own, what happens next?

Answer 16

Patient will still progress to Secondary or Latent infection

Question 17

What is the treatment for Primary Syphilis?

Answer 17

Penicillin G (IM)
2.4 million units

Question 18

Stage of Syphilis that is asymptomatic but highly infectious and occurs within one year of Primary Syphilis. It can convert to Secondary Syphilis if not adequately treated.

Answer 18

Latent Syphilis (Early)

Question 19

What is the treatment for Latent Syphilis (Early)

Answer 19

Penicillin G (IM)
2.4 million units

Question 20

Syphilis infection that occurs a few weeks to 6 months after Chancre. Presents with systemic signs such as a fever and lymphadenopathy. Infectious lesions will be distant from the site of inoculation.

Answer 20

Secondary Syphilis

Question 21

What is the most common finding in Secondary Syphilis?

Answer 21

Skin and Mucosal Lesions
(Maculopapular Rash)

Question 22

Wart-like, weeping papule on moist skin that resemble genital warts and are seen in Secondary Syphilis.

Answer 22

Condyloma Lata

Question 23

What is seen in 80% of cases of Secondary Syphilis?

Answer 23

Rash of Palms and Soles

Question 24

How is Secondary Syphilis diagnosed?

Answer 24

Serologic Testing

Question 25

What is the treatment for Secondary Syphilis?

Answer 25

Penicillin G (IM)
50,000 units per Kg

Question 26

What reaction is commonly seen in Syphilis patients being treated with antibiotics?

Answer 26

Jarisch-Herxheimer Reaction

Question 27

Type of Latent Syphilis that occurs after one year of being infected with Syphilis. It can still be transmitted to the fetus and diagnosis can only be made if there is no evidence of tertiary disease or neurosyphilis. It may last a lifetime.

Answer 27

Latent Syphilis (Late)

Question 28

What is the treatment for Latent Syphilis (Late)

Answer 28

Penicillin G (IM)
1 dose per week for 3 weeks
2.4 million units per dose

Question 29

Stage of Syphilis that may occur anytime after Secondary stage (1 - 20+ years)

Answer 29

Tertiary Syphilis (Late)

Question 30

Infiltrative tumors of the skin, bones and liver that are seen in Tertiary Syphilis. Localized with a rapid onset and respond to treatment.

Answer 30

Gummas

Question 31

Specific type of Tertiary Syphilis that causes aortitis, aneurysms, and aortic regurgitation.

Answer 31

Cardiovascular Syphilis

Question 32

Type of Syphilis that can occur at any stage of infection. Presents with headaches, meningitis, dementia, vision and hearing loss, incontinence and psychosis. Can be disabling and life-threatening.

Answer 32

Neurosyphilis

Question 33

Bilateral, small, irregular pupils that constrict with accommodation but do not react (constrict) when exposed to bright light. Seen in Neurosyphilis.

Answer 33

Argyll Robertson Pupil

Question 34

Demyelination of posterior columns and spinal nerve roots, leading to areflexia, burning pain, weakness, severe unprovoked radicular pain as well as ataxia caused by loss of proprioception. Seen in Neurosyphilis and Congenital.

Answer 34

Tabes dorsalis

Question 35

Treatment for Tertiary Syphilis

Answer 35

Penicillin G (IM)
2.4 million units x3 weeks

Question 36

Treatment for Neurosyphilis

Answer 36

High Dose PCN (IV)
18 - 24 million units per day
x10 - 14 days

Question 37

Rash, condylomas, mucous membrane patches, and nasal discharge are the most common findings of what type of Syphilis?

Answer 37

Congenital

Question 38

Congenital Syphilis that usually presents between ages 2-8 weeks with persistent clear, purulent, or bloody rhinorrhea and a maculopapular rash. May also have Hepatomegaly or Splenomegaly. Lymphadenopathy, skeletal abnormalities, joint pain, and pseudoparylsis.

Answer 38

Early-Onset Disease
(2 years old or younger)

Question 39

Congenital Syphilis that has similar manifestations as Early-Onset Disease, but may also include visual changes, tabes dorsalis, nystagmus, headache, hearing loss, Hutchinson Teeth, Clutton’s Joints, and Saddle Nose deformity.

Answer 39

Late Onset Disease
(2+ years old)

Question 40

How do the majority of Neonates with Syphilis present at birth?

Answer 40

Asymptomatic