Syphilis

Question 1

How long is the primary stage of syphilis and what do you see at this stage?

Answer 1

Duration: 6 weeks to 6 months

Called chancre-goes away on its own
Bacteria gets into blood at this site

Question 2

How long can it take for the primary sign of syphilis (chancre) to appear? (Incubation period)

Answer 2

9-90 days between infection and first sign

Question 3

How long are the early and late stages of syphilis?

Answer 3

Early: 1-2 years
Late: many years to a lifetime if untreated

Question 4

How long is the secondary phase of syphilis and what would you see at this stage?

Answer 4

18 months

Rash

Question 5

If someone with syphilis is not treAted after the secondary phase of infection, what happens next?

Answer 5

Latent stage
They are asymptomatic
Can be divided into early and late latent stage( based on whether or not you have had infection in the last year)

Question 6

What symptoms are seen in tertiary stage of syphilis?

Answer 6

Neurologic symptoms:dementia

Cardiovascular syphilis

Question 7

What is the main case of pathogen causing syphilis worldwide?

Answer 7

Treponema genus
T.pallidum subspecies pallidum

There are three other endemic treponemes

Question 8

What are the characteristics of a syphilis chancre?

Answer 8

• painless, ulcer with hard(indurated) edge
• resolves in 4-6 weeks on its own
• can be in mouth, on anus, vagina, open cuts
• sometimes may not know its there

Question 9

What are your chances of getting syphilis if you come into contact with a chancre?

Answer 9

Contact leads to infection in up to 50% of cases

-quite infectious

Question 10

What are the signs of the secondary, disseminated stage of syphilis?

Answer 10

1-Rash: classical rash is on soles of feet and palms of hands
-spontaneously resolves but can reoccur 25% within the first year

2-condylomata latum( wart like lesions on genitals)
3-enlarged lymph nodes

Question 11

How is syphilis detected when someone is in the latent stage of the disease?

Answer 11

No symptoms

Diagnosis made in serologic tests

Question 12

How are the two latent stages (early and late) defined? Why are they defined?How long are most people in the latent stage?

Answer 12

For treatment purposes
Early latent syphilis: less than a year in duration
Late latent syphilis: more than a year in duration

Most people(60-85%) are asymptomatic for years without treatment and go on to tertiary syphilis

Question 13

What percentage of people who have not been treated for their syphilis remain asymptomatic and what percent progress to the tertiary stage of syphilis?

Answer 13

70% remain a symptomatic

30% progress to tertiary syphilis

Question 14

What are some clinical manifestations seen in tertiary syphilis?

Answer 14

• gummatous disease :destruction of mucosa ( can lose your nose cartilage)
• argyle Robinson pupils(accommodate for distance but not light)
• bones, heart, liver, brain
• dementia

Question 15

How is syphilis transmitted?

Answer 15

1-sexual contact with an infected person
2- vertical transmission: mom to babe via placenta crossing. Can lead to miscarriage, stillbirth and congenital transmission of syphilis. Pregnant moms are tested

Question 16

What are the early and late symptoms in babies with congenital syphilis?

Answer 16

Early: hepatosplenomegaly, rash, neurosyohilis, pneumomitis

Late: if untreated 40% have deformations including saddle nose, hutchinsons teeth, saber shin, cluttons joints

Question 17

What are the hotspots for transmission for syphilis?

Answer 17

Internet sites

Question 18

What demographics represent Halifax syphilis outbreaks?

Answer 18

Public health survey 
Age: 34
Men who have sex with me 
Anonymous sex
Oral sex
Oral/anal sex

Question 19

How do you diagnosis syphilis?

Answer 19

Serology is the mainstay of diagnosis:evidence of antibodies to the infection

Microscopy looking for spirochetes

Question 20

What are the two different serology tests and what are they used for?

Answer 20

1- treponemal specific test: antibodies against T. Pallidum. ELISA.

2-non-treponemal specific test: not specific to syphilis. Measures antibodies against cardiolipin=tissue damage. Used for monitoring the infections. Rapid plasma reagin test(RPR)

Question 21

How do you treat syphilis?

Answer 21

Specific type of penicillin
Benzathine
It is a intramuscular shot in the bum
Penicillin allergy: doxycycline

Neurosyphilis: IV