Syphilis

Question 1

Features of treponema pallidum (4)

Answer 1

coiled bacterium
no vaccine available
cannot be cultured
cofactor for HIV transmission

Question 2

Routes of transmission and risk (3)

Answer 2

transmitted via mucosal lesions e.g. oral/anal/vaginal
condoms not necessarily protective
risk of transmission from UPSI is 30-50%

Question 3

Features of primary syphilis (3)

Answer 3

occurs 2-3wks after exposure
chancre-PAINLESS, indurated w. hard edge,
local lymphadenopathy
(examine all genital regions for other ulcers)

Question 4

Features of secondary syphilis (9)

Answer 4

occurs 2-3 months after exposure
generalised rash: mac-pap, mainly palms and soles, not itchy
generalised lymphadenopathy
bacteraemia
may have constitutional symptoms
in warm, opposed areas of the body e.g. labia and anus, lesions may coallesce to form fleshy masses-condylomata lata
may have features of vasculitis e.g. nephritis (urine dip), hepatitis (LFTs), CN lesions
other mucosal ulcers: snail track ulcers
primary lesions may still be present

Question 5

Features of latent syphilis

Answer 5

asymptomatic

early: infection <2yrs ago
late: infection >2yrs ago

Question 6

Features and manifestation of tertiary syphillis

Answer 6

occurs several years after infection (v. rare)
neurosyphils
cardiovascular disesase
gummatous disease

Question 7

Features of neurosyphilis (5)

Answer 7

hearing loss
stroke
dorsal column loss> balance, proprioception, vibration
cerebral atropy>dementia
argyll-robertson pupil

Question 8

cardiovascular pathology in tertiary syphilis (4)

Answer 8

aortitis
heart failure
angina
aortic aneurysms

Question 9

Features of gummatous disease (2)

Answer 9

necrotic skin lesions-large ulcers

bone lumps

Question 10

features of congenital syphilis (5)

Answer 10

miscarriage/stillbirth
deafness
blindness
rhinitis
Hutchinson's incisors
(mainly occurs when primary maternal infection was <2yrs ago)

Question 11

two types of testing for syphilis

Answer 11

treponemal

non-treponemal (non-specific)

Question 12

Features of the treponemal test (3)

Answer 12

ET: EIA for screening TPPA for Dx
remain positive lifelong after having infection
false +ve from yaws (another spirochete)

Question 13

Features of the non-treponemal test (4)

Answer 13

RPR: measures disease activity so -ve if cured
false +ves in pregnancy, AID and antiphospholipid syndrome
between secondary and tertiary infection, levels CAN become undetectable (but not necessarily)
cure results in a 4-fold drop in titre
(if RPR has a 4-fold increase on later screening, this implies re-infection)

Question 14

Other Ix for syphilis (2)

Answer 14

LP for neurosyphilis: high WCC and protein, +ve EIA and TPPA

CXR for CVD

Question 15

Screening groups for syphilis (2)

Answer 15

booking for pregnancy

regularly for MSM

Question 16

Rx for syphilis (3)

Answer 16

for primary, secondary or early latent: single dose IM benzathine penicillin 1st line and doxycyline 2nd line.
for late late syphilis: IM benzathine penicillin for 3 consecutive wks
Test for other STIs

Question 17

Potential SE of syphilis Rx

Answer 17

Jarisch-Herxheimer reaction w. Sx of sepsis, myalgia and skin lesions.