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Y4 Lecture Day I > Syphilis > Flashcards

Syphilis Flashcards

1
Q

What’s that the presentation of?

A

Syphilis

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2
Q

What organism causes Syphilis?

A

Treponema pallidum

  • gram negative bacterium
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3
Q

How does syphilis enter the body and what happens?

A
  • Treponema pallidum enters through a break in the skin or through intact mucous membranes
  • The bacteria divide and an infectious hard ulcer (chancre) forms at the site of contact after an incubation period of 2-3 weeks

*this is PRIMARY SYPHILIS

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4
Q

What’s incubation period of syphilis?

A

Incubation period 9 to 90 days (usually 21)

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5
Q

What is the pathophysiology behind the systemic symptoms caused by syphilis?

A
  • T. Pallidum damages the arteries (obliterating arteritis)
  • Endothelial cells of the vessels excessively proliferate → narrowed lumen of the vessels→ ischaemia
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6
Q

Risk factors for syphilis infection

A
  • Engaging in unprotected sex – especially with high-risk partners
  • Multiple sexual partners
  • Men who have sex with men (MSM)
  • HIV infection
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7
Q

Features of primary syphilis

A

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)
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8
Q

What is a chancre?

A
  • chancre is a painless ulcer and typically develops 9-90 days post-infection (Syphilis) on a genital site e.g. penis, scrotum, anus, rectum, labia or cervix
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9
Q

Features of chancre

A
  • painless
  • usually singular
  • hard and non-itchy
  • However, chancres may be atypical in that they can appear at other sites e.g. oral, be multiple and painful.

​

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10
Q

Would a chancre heal?

A
  • Classically chancres heal within 3-10 weeks with or without symptoms
  • may persist during secondary syphilis
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11
Q

Tyes of acquired syphilis

A
  • Symptomatic → primary, secondary, tertiary
  • Latent → asymptomatic
  • Late
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12
Q

General (2) types of syphilis

A
  • Congenital
  • Acquired
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13
Q

Types of congenital syphilis

A
  • early (within 2 years)
  • late
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14
Q

Features of secondary syphilis

A

6-10 weeks after primary infection

  • Skin rash – hands and soles of the feet (not usually itchy or painful)
  • Fever
  • Malaise
  • Arthralgia
  • Weight loss
  • Headaches
  • Condylomata lata- elevated plaques like warts at moist areas of skin e.g. inner thighs, anogenital region, axillae
  • Painless lymphadenopathy
  • Silvery-gray mucous membrane lesions – oral, pharyngeal, genital
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15
Q

What’s that?

A

Condylomata lata- elevated plaques like warts at moist areas of skin e.g. inner thighs, anogenital region, axillae

*may manifest in secondary syphilis

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16
Q

What happens after the secondary syphilis?

A

Following secondary syphilis, the disease then enters the asymptomatic latent phase

17
Q

Features of tertiary syphilis

A
  • gummas (granulomatous lesions of the skin and bones)
  • ascending aortic aneurysms
  • general paralysis of the insane
  • tabes dorsalis
  • Argyll-Robertson pupil
18
Q

Features of neurosyphilis

A

Neurosyphilis (tertiary syphilis)

  • Tabes dorsalis – ataxia, numb legs, absence of deep tendon reflexes, lightning pains, loss of pain and temperature sensation, skin and joint damage.
  • Dementia – cognitive impairment, mood alterations, psychosis.
  • Meningovascular complications – cranial nerve palsies, stroke, cerebral gummas.
  • Argyll Robertson pupil – pupil is constricted and unreactive to light, but reacts to accommodation
19
Q

What’s Argyll - Robertson pupil?

A

Argyll Robertson pupil – pupil is constricted and unreactive to light, but reacts to accommodation

*feature of tertiary syphilis

20
Q

Features of cardiovascular syphilis (3)

A

cardiovascular = tertiary syphilis

  • Aortic regurgitation due to aortic valvulitis (diastolic murmur), also aortic root dilatation
  • Angina due to stenosis of the coronary ostia
  • Dilation and calcification of the ascending aorta
21
Q

General modes of investigations for syphilis

A
  • dark ground microscopy → of chancre fluid
  • PCR → swabs form active lesions
  • serology → range of treponemal and non-treponemal tests
  • lumbar puncture → CSF antibody in neurosyphiis
22
Q

Treponemal tests for syphilis

  • what do they assess
  • what do they show
A

Treponemal tests – assess for exposure to treponemes (NB not necessarily syphilis)

  • Treponemal ELISA (IgG/IgM) – remains positive for life
  • TPPA or TPHA – remain positive for life
23
Q

What non-treponemal tests do?

A

Non-treponemal tests:

RPR/VDRL:

  • rises in early disease
  • falling titres indicate successful treatment or progression to late disease
  • False positives can occur in inflammatory conditions or during pregnancy
24
Q

What’s cardiolipin in syphilis?

A

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
25
Q

What can be see in a test results following treatment for syphilis?

A
  • VDRL becomes negative
  • TPHA remains positive

VDRL = during infection production of non-sensitive antibodies reactive to cardiolipin

TPHA = specific antibody

26
Q

Management of Syphilis infection (medication)

A
  • IM benzathine penicillin → the first-line​
  • alternatives: doxycycline
27
Q

Management of syphilis (advice)

A
  • Advising patients to avoid sexual contact of any kind, or exposure of other people to active lesions until the condition has been successfully treated
  • Screening for other STIs
  • Patient education
  • Contact tracing
  • Follow-up serology to determine response to treatment
28
Q

What’s Jarisch-Herxheimer reaction?

A

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
29
Q

Can syphilis affect pregnancy?

A

T. pallidum has the potential to cross the placenta and infect the baby during delivery

30
Q

Features of congenital syphilis

A

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
31
Q

Follow up treatment for syphilis

A
  • Sexual contacts should be traced and followed up
  • Window period of 12 weeks
  • Follow up post treatment until RPR is dropped by at least four fold and stable
32
Q

Are pregnant women tested for syphilis?

A

All pregnant women should be tested for syphilis at week 12

33
Q

Which pregnant women should be treated for syphilis?

A

Treatment should be given to:

  • Untreated patients
  • Those with an unclear history of treatment
  • Consider re-treatment when serology does not show adequate suppression (High RPR)

Y4 Lecture Day I (13 decks)

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