Syphilis Flashcards
What’s that the presentation of?
Syphilis
What organism causes Syphilis?
Treponema pallidum
- gram negative bacterium
How does syphilis enter the body and what happens?
- 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
What’s incubation period of syphilis?
Incubation period 9 to 90 days (usually 21)
What is the pathophysiology behind the systemic symptoms caused by syphilis?
- T. Pallidum damages the arteries (obliterating arteritis)
- Endothelial cells of the vessels excessively proliferate → narrowed lumen of the vessels→ ischaemia
Risk factors for syphilis infection
- Engaging in unprotected sex – especially with high-risk partners
- Multiple sexual partners
- Men who have sex with men (MSM)
- HIV infection
Features of primary syphilis
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)
What is a chancre?
- 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
Features of chancre
- 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.
Would a chancre heal?
- Classically chancres heal within 3-10 weeks with or without symptoms
- may persist during secondary syphilis
Tyes of acquired syphilis
- Symptomatic → primary, secondary, tertiary
- Latent → asymptomatic
- Late
General (2) types of syphilis
- Congenital
- Acquired
Types of congenital syphilis
- early (within 2 years)
- late
Features of secondary syphilis
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
What’s that?
Condylomata lata- elevated plaques like warts at moist areas of skin e.g. inner thighs, anogenital region, axillae
*may manifest in secondary syphilis
What happens after the secondary syphilis?
Following secondary syphilis, the disease then enters the asymptomatic latent phase
Features of tertiary syphilis
- gummas (granulomatous lesions of the skin and bones)
- ascending aortic aneurysms
- general paralysis of the insane
- tabes dorsalis
- Argyll-Robertson pupil
Features of neurosyphilis
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
What’s Argyll - Robertson pupil?
Argyll Robertson pupil – pupil is constricted and unreactive to light, but reacts to accommodation
*feature of tertiary syphilis
Features of cardiovascular syphilis (3)
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
General modes of investigations for syphilis
- 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
Treponemal tests for syphilis
- what do they assess
- what do they show
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
What non-treponemal tests do?
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
What’s cardiolipin in syphilis?
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
