Syphilis & non-syphilitic treponema Flashcards
When is RPR highest in syphilis?
Secondary syphilis
RPR = rapid plasma reagin
Why may an RPR be negative in secondary syphilis?
Prozone effect (antibodies/antigens clump)
Can also be seen in pregnancy/neurosyphilis/HIV
Patchy alopecia - differential?
Syphilis
What is this and what is key about it?
Secondary syphilis
HIGHLY infectious
What is this?
Lues maligna (malignant syphylis)
Secondary syphylis rash, very aggressive
Incubation period for syphilis?
10-21 days until chancre appears (primary)
Not many people develop a chancre or do not notice it
When does secondary syphilis present? What symptoms?
- 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
Stages of syphilis?
primary (Only around 50%)
secondary
Latent (early or late)
tertiary - 30% develop this
Phases can overlap
Features of tertiary syphilis?
gumma - soft non cancerous growth
bone
cardiac - aortitis/vasculitis
neuro/Late ocular/otic syphilis - not limited to tertiary but often a feature
Diagnosis of syphilis, and organism?
Microscopy
Treponema pallidum
Gram -ve
Chancre in syphilis appearance? where is it found? what proportion will be RPR positive?
Clean based painless single indurated round bordered non tender ulcer
Seen anywhere - direct contact - often genitalia
RDR + in 70%
Difference between genital warts and syphilis warts?
Condyloma acuminata - HPV - genital warts, verrucous
Condyloma lata - occur at moist body sites, fleshy, flat top, highly infectious. Occur mucous membranes
Rash on hands and soles classic appearance in syphilis?
Hyperkeratitis
Classic finding in eyes in ocular syphilis?
Anterior uveitis
Sometimes see retinitis, retinal detachment/haemorrhage
Latent syphilis defintion?
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!
Features of neurosyphilis?
- meningitis: asymptomatic (abnormal
CSF), or chronic or acute meningitis - meningovascular -> stroke
- parenchymatous disease (generalized
paresis) - posterior column (tabes dorsalis)
What should you do if you get positive syphilis test?
Confirm diagnosis with treponemal test - Treponemal Tests: TP-PA (particle agglutination), FTA-ABS - stays positive for life
Also HIV test!
What is the screening test for syphilis?
Nontreponemal: VDRL (venereal disease research laboratory) & RPR (rapid plasma reagin)
– Antibody to cardiolipin-lecithin-cholesterol antigen; not specific to T. pallidum
CSF fingings in syphilis? How to diagnose syphilis?
Lymphocytic WCC
High protein
CSF VDRL - insensitive
Treatment of syphilis?
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
Screening for syphilis in pregnancy?
Screen first trimester
Repeat at 28 weeks in high risk groups
What can cause a false positive test for syphilis?
Viral infections
Autoimmune diseases
Pregnancy
Hyper IG
Treatment of neurosyphilis?
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)
How do you follow up someone following Rx for syphilis?
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
