Syphilis Flashcards
What % of sexual contacts will develop syphilis?
1/3
Rates of 10-60% have been cited
Where is typical site of entry for syphilis?
Genital tract
In msm 36% may be extra genital
Whats the incubation period for syphilis?
Range 9-90 days
Average 21 days
How long does it take the primary chance to heal?
3-8 weeks
What % if left untreated will progress to secondary syphilis?
25%
When do secondary syphilis symptoms generally start?
4-10 weeks after initial chance
3 months after initial infection
What are signs of secondary syphilis?
Rash (70% maculo-papular) can cause alopecia
Mucous patches
Condylomata lata
Less common: hepatitis, golemerulonephritis, splenomegaly, CN palsy, meningitis, uveitis interstitial keratitis, otosyphilis
How long does it take secondary syphilis to resolve spontaneously?
3-12 weeks
What % of unrated patients will.go on to develop latent disease?
1/3
What are features or tabes dorsalis?
Sensory ataxia, absent reflexes, loss of joint position and vibration sense, AR pupil, lightening pain
Congential syphilis: what % will be symptomatic af birth?
1/3
Most common signs of early congenital syphilis?
Rash
Haemorrhagic rhinitis
Lymphadenopathy, hepatosplenomegaly, skeletal abnormalities
What RPR usually represents active disease?
> 1:16
Time frame for repeat testing if
A) single high risk exposure
B) ulcerative lesion
A) 6 and 12 weeks
B) 2 weeks
When might you get a negative RPR but positive specific tests?
Early infection (takes a while to mount)
Previously treated
Late latent
Levels so high in secondary that serum needs to be diluted (prozone phenomenon)
How does the presentation of primary syphilis differ in PLWHIV?
Ulcers may be painful deeper multiple and longer lasting
There may be overlap with secondary disease as they take longer to heal
How does the presentation of secondary syphilis differ in PLWHIV?
It doesn’t usually!
How do syphilis bloods differ with PLWHIV?
RPR can take longer to decrease
What do you do if there is not a 4x decrease within 12 months of therapy?
Consider reinvention
Consider treatment failure
Consider CSF examination ie LP
Whats the follow up following treatment for neurosypilis?
Repeat LP at 6 months
Whats the abstinence advice for syphilis treatment?
Avoid sex until ulcers healing in.primsry syphilis and until 2 weeks following treatment completion
Primary syphilis treatment if penicillin allergic
Doxycycline 100mg bd for 14 days
Cerftiaxone 500mg im od for 10 days
Azithromycin 500mg od for 10 days
Late latent treatment main and alternatives
Ben pen 2.4 IM weekly for 3 weeks
Alternative
Doxycycline 100mg for 28 days
Amlxicillin 2g tds + probenecid 500mg qds for 28 days
Treatment for neuro syphilis
Procain penicillin 1.8-2.4 im OD + probenecid 500mg qds for 14 days
Or
Ben pen 10.8-14.4 split into 4 hourly IV for 14 days
Doxy 28 days
Amoxicillin and probenecid 28 days
Ceftriaxone 2g im for 10 days
