Syphilis

Question 1

Risks of syphilis in pregnancy?

Answer 1

Transmission to fetus resulting in LBW, SB, congenital syphilis

REMAINS part of AN screening programme

Question 2

Stages of syphilis?

Answer 2

Primary - chancre 3 weeks after exposure
Secondary - flu like symptoms 4-10 weeks after chancre
Latent syphilis
Tertiary/late syphilis - neurological, gummatous, cardiovascular

Question 3

Primary syphilis is characterised by?

Answer 3

Single papule at the site at which the infection entered the body – chancre - painless, indurated nonpurulent lesion

CAN be multiple and painful
Heal spontaneously over 3-8 weeks

Question 4

Characteristics of secondary syphilis?

Answer 4

4-10 weeks after chancre

Flu-like symptoms, generalise mucocutaneous rash, perianal condylomata - discoloure warty infectious lesions, meningitis, eye disease, splenomegaly

Resolves within 1-3 months

Question 5

How does baby get infected in pregancy?

Answer 5

Spirochete bacteria cross the placenta from 14 weeks

Risk increases as pregnancy progresses

Question 6

Risk of fetal loss in syphilis?

Answer 6

30-40%

Question 7

Which type of syphilis confers highest risk of transmission to fetus?

Answer 7

Primary - can be as high as 100%

Question 8

Fetal ultrasound features of syphilis?

Answer 8

FGR, hepatosmegaly, thrombocytopenia, anaemia, ascites, placentomegaly, calcified liver

Question 9

How to test for syphilis?

Answer 9

Dark-field microscopy and PCR - detect bacteria before serological response.

Serological tests to look for antibodies to treponemal proteins BUT risk of false positive (espec if SLE+) therefore need confirmation with further serology

Non-treponemal serology = rapid plasma reagin (RPR) and veneral disease research laboratory carbon antigen tests VDRL - which react with IgM and IgG antibodies to demonstrate disease activity

Question 10

What can you offer to people at high risk of syphilis infection?

Answer 10

3 monthly repeat testing

Question 11

What levels should you test prior to initiating treatment?

Answer 11

Quantitiative RPR or VDRL to use for monitoring
Repeat 3 monthly during treatment

Question 12

Treatment for syphilis?

Answer 12

Stat dose IM benzathine penicillin G (2.4 million units)

If in 3rd trimester - 2nd dose recommended

If pen allergic send to allergy services urgently. If non severe can use ceftriaxone 500mg IM for 10/7

Question 13

What is a Jarisch-Herxheimer reaction?

Answer 13

Large nubers of t.pallidum being killed, releases excessive cytokines causing an acute inflammatory reaction.

Fever, rigors, skin rash, uterine contractions

Complicates 50% of syphilis treatment in pregnancy

Question 14

Signs of syphilis at birth

Answer 14

skin rash, meninigitis, jaundice, hepatosplenomegaly, deranged liver function, anaemia