Syphilis

Question 1

Syphilis Bacterium and Entry Method, Why does it facilitate HIV?

Answer 1

• Treponema Pallidum
• Enters via abraded skin or mucous membranes and distributes via the bloodstream and lymphatics
• Important facilitator of HIV transmission
• Acquired or congenital

Question 2

Syphilis Acquired

Answer 2

• Primary incubation 2-3 weeks, local infection
• Secondary incubation 6-12 weeks, generalised infection
• Early latent, asymptomatic of less than 2 years duration
• Late latent, asymptomatic of two years or longer
• Late symptomatic (tertiary), cardiovascular syphilis, neurosyphilis, gummatous syphilis

Question 3

Syphilis Primary Presentation

Answer 3

-Primary lesion develops and heals after 2-6 weeks
-Small painless papule rapidly forms ulcer
-Chancre usually single, round, painless, bright red margin , indurated with a clean base, discharging clean serum
-May be atypical
Usually found on coronary sulcus, glans and inner surface of prepuce but may appear on shaft and beyond
-Extragenital sites

Question 4

Syphilis Secondary Presentation

Answer 4

• Usually 6 weeks after primary lesion
• Multisystem involvement within first two years
• Systemic symptoms mild but include night-time headaches, malaise, slight fever and chills
• Generalised polymorphic rash affects palms sole and face, classically non-itchy
• Enlarge into condyloma lata, mucocutaneous lesions

Question 5

Syphilis Latent Syphilis

Answer 5

• After secondary stage
• Early; positive serological test with no evidence of infection within two years
• Late; positive serological test after two years

Question 6

Syphilis Tertiary Presentation

Answer 6

• Three major clinical manifestations
• Neurosyphilis
• Asymptomatic neurosyphilis; abnormal CSF no associated neurological signs or symptoms
• Symptomatic; dorsal column loss, dementia, meningovascular disease
• Tabes dorsalis occurs 15-25 years after infection, sensory ataxia, lightning pains
• Half of patients with neurosyphilis have HIV
• Cardiovascular
• Aortitis, spreads from aortic root
• Aortic regurg, aneurysm, angina
• Gummata
• Inflammatory fibrous nodules or plaques which may be locally destructive
• Can occur anywhere but most commonly affect bone and skin

Question 7

Syphilis Differentials

Answer 7

• Herpes, chancroid, lymphogranuloma venereum, donovanosis
• Pityaris rosea, viral exanthema
• Neuro and CV conditions

Question 8

Syphilis Ix

Answer 8

• Screen for all STIs
• All patients with neurological signs should have a lumbar puncture
• Cardiac investigations may be appropriate
• Blood test

Question 9

Syphilis Management

Answer 9

• Benzathine penicillin IM single dose
• Oral azithromycin second line
• Procaine penicillin for neurosyphilis

Question 10

Syphilis Jarisch-Herxheimer Reaction

Answer 10

• Reaction to treatment
• Acute febrile illness, myalgia, chills, rigors resolves within 24 hours
• Occurs in 44% of pregnant women with syphilis
• Treat with antipyretics and reassurance