Syphilis

Question 1

What % of sexual contacts will develop syphilis?

Answer 1

1/3

Rates of 10-60% have been cited

Question 2

Where is typical site of entry for syphilis?

Answer 2

Genital tract

In msm 36% may be extra genital

Question 3

Whats the incubation period for syphilis?

Answer 3

Range 9-90 days

Average 21 days

Question 4

How long does it take the primary chance to heal?

Answer 4

3-8 weeks

Question 5

What % if left untreated will progress to secondary syphilis?

Answer 5

25%

Question 6

When do secondary syphilis symptoms generally start?

Answer 6

4-10 weeks after initial chance

3 months after initial infection

Question 7

What are signs of secondary syphilis?

Answer 7

Rash (70% maculo-papular) can cause alopecia
Mucous patches
Condylomata lata

Less common: hepatitis, golemerulonephritis, splenomegaly, CN palsy, meningitis, uveitis interstitial keratitis, otosyphilis

Question 8

How long does it take secondary syphilis to resolve spontaneously?

Answer 8

3-12 weeks

Question 9

What % of unrated patients will.go on to develop latent disease?

Answer 9

1/3

Question 10

What are features or tabes dorsalis?

Answer 10

Sensory ataxia, absent reflexes, loss of joint position and vibration sense, AR pupil, lightening pain

Question 11

Congential syphilis: what % will be symptomatic af birth?

Answer 11

1/3

Question 12

Most common signs of early congenital syphilis?

Answer 12

Rash
Haemorrhagic rhinitis
Lymphadenopathy, hepatosplenomegaly, skeletal abnormalities

Question 13

What RPR usually represents active disease?

Answer 13

> 1:16

Question 14

Time frame for repeat testing if
A) single high risk exposure
B) ulcerative lesion

Answer 14

A) 6 and 12 weeks

B) 2 weeks

Question 15

When might you get a negative RPR but positive specific tests?

Answer 15

Early infection (takes a while to mount)
Previously treated
Late latent
Levels so high in secondary that serum needs to be diluted (prozone phenomenon)

Question 16

How does the presentation of primary syphilis differ in PLWHIV?

Answer 16

Ulcers may be painful deeper multiple and longer lasting

There may be overlap with secondary disease as they take longer to heal

Question 17

How does the presentation of secondary syphilis differ in PLWHIV?

Answer 17

It doesn’t usually!

Question 18

How do syphilis bloods differ with PLWHIV?

Answer 18

RPR can take longer to decrease

Question 19

What do you do if there is not a 4x decrease within 12 months of therapy?

Answer 19

Consider reinvention
Consider treatment failure
Consider CSF examination ie LP

Question 20

Whats the follow up following treatment for neurosypilis?

Answer 20

Repeat LP at 6 months

Question 21

Whats the abstinence advice for syphilis treatment?

Answer 21

Avoid sex until ulcers healing in.primsry syphilis and until 2 weeks following treatment completion

Question 22

Primary syphilis treatment if penicillin allergic

Answer 22

Doxycycline 100mg bd for 14 days
Cerftiaxone 500mg im od for 10 days
Azithromycin 500mg od for 10 days

Question 23

Late latent treatment main and alternatives

Answer 23

Ben pen 2.4 IM weekly for 3 weeks

Alternative
Doxycycline 100mg for 28 days
Amlxicillin 2g tds + probenecid 500mg qds for 28 days

Question 24

Treatment for neuro syphilis

Answer 24

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

Question 25

Early syphilis treatment in pregnancy

Answer 25

Same up to 28 weeks

If >28 weeks extra dose after 7 days

Question 26

Treatment of congenital syphilis

Answer 26

10 days ben pen iv in divided doses (60-90 mg/ kg daily)

Question 27

Describe the Jarisch Herxheimer reaction

Answer 27

Developes within 4 hours
Resolves within 24 hours
Acute febrile illness with headache myalgia headache and rigors

Can cause foetal distress

Question 28

What can give a false positive VDRL/ RPR?

Answer 28

autoimmune disease and connective tissue disease 
Pregnancy
Febrile illness
Hep C infection
IvDU
Malignancy 
Older age
Tb
Leprosy

Question 29

Whats the normal follow.up following syphilis treatment?

Answer 29

3 6 and 12 months
Then 6 monthly until negative/ sero fast

Annually in PLWHIV

Question 30

What should you do if titres don’t decrease within 12/12?

Answer 30

LP for CSF examination

Question 31

When would you treat for congenital syphilis? Give 5 circumstances

Answer 31

• RPR is rising or not negative within 4 months
• Mother was treated within 4 weeks of delivery
• Signs of congenital STS
• Mother treated with non-first line regimen
• Babies RPR is 4x that of mother