Syphillis

Question 1

What is Syphillis (aetiology and RF)

Answer 1

Infection by Treponoma pallidum -
from sexual contact, blood born or vertical

RF - young (under 29), african american, IVDU, ohter STI, sex worker, HIV

Question 2

Sx of syphillis (and clinical course)

Answer 2

Primary - first infection/contact (3-8w)
painless chancres where got it + lymphadenopathy

secondary only 25% get sx (2-12weeks)
Rough papulonodular rash on body/feet trunk, snail track oral ulcer, uveitis, systemic sx

then either LATENT or TERITARY

latent - no sx, detected on routine BT-
early latent  (less then 2y after infection) or late -after 2y

tertiary- 1/3rd of untreated
this is like reactivation (from latent or direct from secondary
eg-
gummatous symphylis- 15% (erosive skin and bone)
cardiovascular syphilis- 10% (aortitis, A regurg, HF)

Neurosyphillis
Meningovascular- 5/10y- sichemia, insmnia, emotional issues
General -10-25- dementia
Tabes doralsis -15-20y - sensory problems, lighting pains, absent

Question 3

Mx and complications of Shyphillis

Answer 3

This is for mother/adults
Early Syph (1st and 2ndary)
Benzyathin penicilin IM STAT (or doxy BD 14/7)

Late - late latent, non neuro 3rd- benzathine pen, IM, 3/52 (or doxy BD 28/7)

Neuro- penicllin IV 4 hourly, 14/7
prednisolone OD 3/7-start 24h before to reduce Jarish Herxheimer reactions (release of inflam cyokine from dying cells)

+ partner notif, repeat bloods at 3/12

complications-
risk in pgrenancy-ben-pen improves greatly foetus outcome ( reduce, FGR, foetal hdrops, congenital syphillis, stillbirth)
COngenital syphilis