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Trop Med > Syphilis & non-syphilitic treponema > Flashcards

Syphilis & non-syphilitic treponema Flashcards

1
Q

When is RPR highest in syphilis?

A

Secondary syphilis
RPR = rapid plasma reagin

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2
Q

Why may an RPR be negative in secondary syphilis?

A

Prozone effect (antibodies/antigens clump)
Can also be seen in pregnancy/neurosyphilis/HIV

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3
Q

Patchy alopecia - differential?

A

Syphilis

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4
Q

What is this and what is key about it?

A

Secondary syphilis
HIGHLY infectious

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5
Q

What is this?

A

Lues maligna (malignant syphylis)
Secondary syphylis rash, very aggressive

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6
Q

Incubation period for syphilis?

A

10-21 days until chancre appears (primary)
Not many people develop a chancre or do not notice it

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7
Q

When does secondary syphilis present? What symptoms?

A
  • 3 weeks to 3 months
  • Not always clinically obvious
  • Rash: macular, papular, pustular (can be vesicular), condyloma lata, mucous patches
  • Fever, malaise, generalized
    lymphadenophathy, alopecia, interstitial
    keratitis, uveitis, liver/kidney involvement
  • Lasts 2-6 weeks
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8
Q

Stages of syphilis?

A

primary (Only around 50%)
secondary
Latent (early or late)
tertiary - 30% develop this
Phases can overlap

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9
Q

Features of tertiary syphilis?

A

gumma - soft non cancerous growth
bone
cardiac - aortitis/vasculitis

neuro/Late ocular/otic syphilis - not limited to tertiary but often a feature

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10
Q

Diagnosis of syphilis, and organism?

A

Microscopy
Treponema pallidum
Gram -ve

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11
Q

Chancre in syphilis appearance? where is it found? what proportion will be RPR positive?

A

Clean based painless single indurated round bordered non tender ulcer
Seen anywhere - direct contact - often genitalia
RDR + in 70%

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12
Q

Difference between genital warts and syphilis warts?

A

Condyloma acuminata - HPV - genital warts, verrucous
Condyloma lata - occur at moist body sites, fleshy, flat top, highly infectious. Occur mucous membranes

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13
Q

Rash on hands and soles classic appearance in syphilis?

A

Hyperkeratitis

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14
Q

Classic finding in eyes in ocular syphilis?

A

Anterior uveitis
Sometimes see retinitis, retinal detachment/haemorrhage

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15
Q

Latent syphilis defintion?

A

Defined by positive treponemal serology in the absence of clinical manifestations
<1 yr - early latent
>1 yr - late latent
66% of people can be latent all life without Rx!

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16
Q

Features of neurosyphilis?

A
  • meningitis: asymptomatic (abnormal
    CSF), or chronic or acute meningitis
  • meningovascular -> stroke
  • parenchymatous disease (generalized
    paresis)
  • posterior column (tabes dorsalis)
17
Q

What should you do if you get positive syphilis test?

A

Confirm diagnosis with treponemal test - Treponemal Tests: TP-PA (particle agglutination), FTA-ABS - stays positive for life

Also HIV test!

18
Q

What is the screening test for syphilis?

A

Nontreponemal: VDRL (venereal disease research laboratory) & RPR (rapid plasma reagin)
– Antibody to cardiolipin-lecithin-cholesterol antigen; not specific to T. pallidum

19
Q

CSF fingings in syphilis? How to diagnose syphilis?

A

Lymphocytic WCC
High protein

CSF VDRL - insensitive

20
Q

Treatment of syphilis?

A

Primary, secondary, early latent: single dose IM Benpen
Have to know they contracted syphilis in past 12 months(e.g. test from 12 months ago that was neg)
Late latent: 3 weekly doses of IM Benpen

Alternatives: ceftriaxone, doxycycline

21
Q

Screening for syphilis in pregnancy?

A

Screen first trimester
Repeat at 28 weeks in high risk groups

22
Q

What can cause a false positive test for syphilis?

A

Viral infections
Autoimmune diseases
Pregnancy
Hyper IG

23
Q

Treatment of neurosyphilis?

A

Aqueous Penicillin G IV for 10-14 days - BEN PEN DOES NOT PENETRATE CNS

Alternative is procaine penicillin IM daily plus probenecid for 10-14 days

Also treat people with ear or eye disease same way (A form of neuro syphilis)

24
Q

How do you follow up someone following Rx for syphilis?

A

Non-treponemal test (RPR or VDRL) should be repeated every 6 months after completion of therapy (more frequent in HIV - 3 monthly)

Adequate response defined by fourfold reduction in titer by 6 months and non reactive at 12 months

25
Q

What are the screening and confirmatory tests for syphilis?

A

Screening: VDRL and RPR (detects IgM and IgG) non treponemal titres

Confirmatory: T pallidum particle agglutination (TP-PA) assay and FTA-ABS (antibody)

26
Q

What is defined as Rx failure in syphilis? What to do?

A

Failure of nontreponemal titers to decrease 4-fold (2 dilution change)
Do:
- LP to rule out neurosyphilis
- Repeat Rx but with Pen G

27
Q

Secondary syphilis rare presentation?

A

syphilitic hepatitis
Lymphadenopathy
Renal failure

28
Q

Meaningful response to Rx re: titres - if titre is 1:128 and 1:16?

A

1:128 needs to go to 1:32
1:16 needs to go to 1:4

29
Q

What to do with a partner of someone diagnosed with primary/sec/early latent syphilis?
What about late latent?

A

Treat for syphilis (if within 90 days - even if test is negative)

evaluate clinically/serologically (late syphilis is not infective)

30
Q

Titres not decreasing >4 fold. 3 possibilities?

A

1) Reinfection
2) Treatment failure
3) Serofast
Serofast state - defined as a less than four-fold decrease in non-treponemal titres after a 6-month follow-up in the absence of symptoms of syphilis

31
Q

What other treponemal spirochetes are there?

A

Yaws skin, bone T. pallidum pertenue (TPE)
Endemic syphilis (Bejel) systemic T. pallidum endemicum
Pinta (Carate) skin T. carateum

32
Q

Transmission of treponema?

A

Mucous membranes

33
Q

Disease affecting children and causing chronic infection of skin, bone, cartilage?

A

Yaws
T. pallidum pertenue

34
Q

Diagnosis?

A

Yaws - primary
Painless papule
T. pallidum pertenue

35
Q

Secondary yaws?

A

disseminated ulcero-papillomatous or maculo-papular ring-shaped lesions (“daughter yaws”)
Lymphadenopathy
Malaise
Osteoperiostitis
Dacylitis

36
Q

Tertiary yaws?

A

Gummatous nodules

37
Q

Where is Yaws?

A
38
Q

Diagnosis and Treatment of Yaws?

A

Serology
Benpen IM
Azithromycin can be given for mass Rx

39
Q

How to differentiate between species of syphilis?

A

Multiplex PCR

Trop Med (49 decks)

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