Syphilis Flashcards
Cause? Course?
Syphilis is a sexually transmitted infection caused by the spirochaete Treponema pallidum.
Infection is characterised by primary, secondary and tertiary stages. The incubation period is between 9-90 days
Primary features?
Chancre - painless ulcer at the site of sexual contact
Local non-tender lymphadenopathy
Often not seen in women (the lesion may be on the cervix)
Secondary features?
Occurs 6-10 weeks after primary infection
Systemic symptoms: fevers, lymphadenopathy
Rash on trunk, palms and soles
Buccal ‘snail track’ ulcers (30%)
Condylomata lata (painless, warty lesions on the genitalia )
Tertiary features?
Gummas (granulomatous lesions of the skin and bones) Ascending aortic aneurysms General paralysis of the insane Tabes dorsalis Argyll-Robertson pupil
Features of congenital syphilis?
Blunted upper incisor teeth (Hutchinson’s teeth), ‘Mulberry’ molars
Rhagades (linear scars at the angle of the mouth)
Keratitis
Saber shins
Saddle nose
Deafness
Diagnosis of syphylis?
Treponema pallidum is a very sensitive organism and cannot be grown on artificial media. The diagnosis is therefore usually based on clinical features, serology and microscopic examination of infected tissue
Serological tests can be divided into: cardiolipin tests (not treponeme specific) treponemal-specific antibody tests
What are cardiolipin tests?
Syphilis infection leads to the production of non-specific antibodies that react to cardiolipin
Examples include VDRL (Venereal Disease Research Laboratory) & RPR (rapid plasma reagin)
insensitive in late syphilis
Becomes negative after treatment
Mx?
IM benzathine penicillin is the first-line management
Alternatives: doxycycline
the Jarisch-Herxheimer reaction is sometimes seen following treatment. Fever, rash, tachycardia after first dose of antibiotic. It is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment. No treatment is needed other than antipyretics if required
