Syphilis, Yaws, and Pinta Flashcards
What’s the scientific name for Syphilis?
Treponema pallidum (T. pallidum)
Can Syphilis be cultured?
No
Can syphilis be viewed using simple light microscopy? Describe the motion of syphilis.
Yes, specifically dark field microscopy. Flagellar “corkscrew” motion
How is syphilis transmitted?
sexual contact (acquired) and transplacentally (congenital)
Primary treatment for syphilis? Secondary?
Prim.: Penicillin G (long release), treat preggos by 5 mos
Sec.: tetra/doxycycline, erythromycin, ceftriaxone (MUCH less effective)
Describe the initial syphilis infection.
Penetrate mucous membranes (sex!), grow in vascular endothelium, enter lymphatic and bloodstream. Unique: systematic infection occurs immediately. CNS invaded early.
Host immune response to syphilis?
Very non-immunogenic.
No strong inflammatory response.
Useless antibodies produced: non-specific anti-treponemal antibodies used for diagnoses.
Describe primary syphilis.
3-6 weeks post-infect., painless chancre @ site of transmission. Highly infectious. Heals/goes away in 3-12 weeks.
Easiest to treat at this stage. One shot of penicillin.
Describe secondary syphilis.
4-10 weeks post-infect., systemic symptoms.
Flu-like: Fever, malaise, myalgias, arthralgias, lymphadenopathy.
Musculocutaneous lesions, patchy alopecia, condylomata lata (gun metal gray skin plaques)
High antibody titers - very diagnosable.
Two possible endpoints for syphilis infection?
Latent syphilis (2/3) and Tertiary syphillis (1/3)
Describe latent syphilis.
Recurrence and resolution of secondary symptoms intermittently over lifetime
Describe tertiary syphilis.
Fatalities possible.
A. Gummatous syphilis: granulomatous necrotic lesions in skin, liver, testes and bone (classic presentation: “deep, boring pain in a long bone at night.”)
B. Cardiovascular syphilis (>10 yrs): aneurysm of asc. aorta). Look for diastolic murmur with a tambour quality.
C. Neurosyphilis (another card)
D. Jaundice
Describe neurosyphilis.
A. Syphilitic meningitis (within 6 mos): Low grade
B. Meningovascular syphilis
C. Parenchymal neurosyphilis: spinal cord damage (impaired sensation, wide based gait), disruption of dorsal roots (loss of nociception, areflexia), general paresis, dementia
Describe the link between syphilis and HIV.
Syphilitic ulcerations facilitates HIV entry.
HIV immunosuppression accelerates syphilis course.
Which exam is diagnostic of neurosyphilis (tertiary) syphilis?
Argyll-Robertson pupil.
One/both pupils fails to constrict in response to light.
Constriction in response to accommodation is intact.
What are some imaging diagnostic tests for syphilis?
CT imaging: for gummas
Angiographs: for CV syphilis
Lumbar puncture: for neurosyphilis; specific, but not sensitive
Microscopy: swab skin lesions, use dark field microscopy. Doesn’t culture/stain.
What are some serological diagnostic tests for syphilis?
Serology (non-treponemal specific): VDRL, RPR, or ICE syphilis antigen test
Serology (trep. specific antibodies): See presentation. Not very useful. Tells you exposure, not current disease state.
Best diagnostic during primary chancre phase (10-90 days)?
Dark field
Best diagnostic during secondary eruptions (6 mos)?
RPR or VDLR
Best diagnostic during tertiary disease (10-30 years)?
Specific treponemal antibody tests: TP-PA, AIA, FTA
Histological presentation of syphilis?
Endarteritis, plasma cell rich infiltrate in gummatous ulcerations
What is the Jarisch-Herxheimer rxn?
8-24 hrs post treatment, flu-like symptoms develop
How do you protect against syphilis?
CONDOMS, CONDOMS, CONDOMS!
A pt with no syphilis risk factors presents with cutaneous skin lesions and a very high RPR or VDLR test. What is the most likely explanation?
Pt most likely has Yaws (T. pertunue) or Pinta
