Syphilis: Ryan Flashcards

1
Q

What is the etiologic agent of syphilis?

A

Treponema pallidum, a spirochete

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2
Q

How does congenital syphilis happen.

A

T. pallidum can cross the placenta!

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3
Q

What is the hallmark feature of primary syphilis?

A

A painless ulcer called a chancre. Develops at the site of entry of the treponeme.

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4
Q

What is secondary syphilis?

A

A systemic infxn characterized by fever, swollen lymph nodes, mucus membrane lesions, and sometimes a rash that includes the soles and palms and/or wart resembling lesions.

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5
Q

How do we tx syphilis?

A

Penicillin G

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6
Q

How do we find T. pallidum microscopically?

A

Dark field micro. Can’t find on light micro bc too thin.

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7
Q

What is primary responsible for the pathology associated with syphilis?

A

Host immune response.

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8
Q

Describe the diseases of syphilis.

A

Primary: 2-3 wk incubation. Symptoms resolve in 3-6 wks.

2ndary: Manifest 1-2 mo post-infxn. Symp. resolve in 1 mo w/o tx.

Early latent: 1-2 yr period post resolution of 2ndary.

Late latent: begins 1-2 yrs post infxn. May progress to tertiary if not tx, may resolve on its own.

Tertiary: Almost any organ system can be affected (Heart, CNS, skin, bone)

Congenital syphilis: may/may not present at birth. Stigmata may develop >2yrs after birth.

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9
Q

Describe the signs/symptoms of primary syphilis.

A

painless chancre

non-tender lymphadenopathy

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10
Q

Describe the signs/symptoms of secondary syphilis.

A

Disseminated infxn. Many organ systems infected.
Hyperpigmented maculopapular rash extends over entire body w/ time to include palms and soles. Also seen in RMSF, meningococcemia, hand-foot-mouth dz.
Mucus membrane “snail track” lesions in mouth and genital mucosa.
Condylomata lata- wart-like lesions in moist skin folds of anus/perineum.
Pt is sick: fever, headache, diffuse lymphadenopathy (non-tender).

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11
Q

Describe the signs/symptoms and clinical course of early latent syphilis.

A

No symptoms.
Positive serology.
May relapse to secondary.
Preg. women may pass infxn in utero.

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12
Q

What about clinical course differentiates early from late latent syphilis?

A

Can’t relapse to secondary.

Not contagious, even to fetus.

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13
Q

Describe the signs/symptoms and clinical course of tertiary syphilis.

A

Progressive, inflammatory dz that may take yrs to develop.
Tertiary syphilis is an endarteritis (aorta, aortic valve regurg.)
Pt not infectious
Gummas: charac. skin and bone lesions
CNS: Acute meningitis (asymptomatic)
Meningovascular syphilis
Paresis- many spirochetes, changes in personality, insanity, paranoia.
Tabes dorsalis- demyelination of posterior columns and dorsal roots. Pt shuffles when walks. Lightening pains.

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14
Q

Describe the signs/symptoms and clinical course of congenital syphilis.

A

Still birth or spontaneous abortion common
May/may not be symptoms at birth
Disseminated infxn transmitted across placenta
Early symptoms may include: serous runny nose, bullous rash, snail track lesions on mucosa, condylomata lata at birth, enlarged liver/spleen.
Late congenital syphilis: stigmata develop over years. Generally starting around age 2. Bone abnormalities: saber shins, frontal bossing.
Vision defects (gun barrel sight.
Hutchinson’s triad: cone teeth, keratitis, deafness

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15
Q

How do we diagnose syphilis?

A

These are NONTREPONENAL serological screenings
::Rapid plasma reagin (RPR) test
Carbon particles coated with cardiolipin; mix w/ dilutions of pt serum; observe agglutination.
::Venereal disease research lab test

Test is cheap and fast.

Have high sensitivity, can have false positives.

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16
Q

Describe the treponemal diagnostic tests.

A

Fluorescent Treponemal Antigen-Absorbed (FTA-ABS) test
T. pallidum commercially prepared and fixed on microscope slide.
Pt serum first absorbed w/ nonpathologic treponemes to remove cross-reactive abs against normal flora.
Mixed absorbed serum w/ antigen fixed to slide.
Add fluoro dye.
Observe for fluorescent staining spirochetes. If they fluoro, means pt has abs to pathogen and they are infected.
Cons: titers remain high for years after cure.
Test is cumbersome and expensive.
Test IS definitive.

17
Q

Ok, this has nothing to do with syphilis, but what is the causative agent of chancroids and what differentiates these lesions from charcres of syphilis?

A

Hemophilus ducreyi.

Lesions are bigger and PAINFUL. Chancres are not painful.