Syphillis Flashcards
What is syphillis?
It is an infection caused by a spirochete bacteria called Treponema pallidum
What are the two mechanisms in which syphillis can be transmitted?
Sex
Vertical transmission
How does syphillis tend to present?
Asymptomatically
What are the four stages of syphillis?
Primary
Secondary
Latent
Tertiary
What are the two clinical features of primary syphillis?
Chancre
Local lymphadenopathy
What is a chancre?
It is is a painless genital ulcer
How do we treat a chancre?
This tends to resolve over three to eight weeks
When does secondary syphillis begin?
It starts after the chancre has healed
When do the symptoms of secondary syphillis resolve?
They resolve after three to twelve weeks
What are the six clinical features of secondary syphillis?
Maculopapular Rash
Condylomata Lata
Alopecia
Oral Lesions
Fever
Lymphadenopathy
In what three locations does the maculopapular rash appear?
Trunk
Palms
Soles
What is condylomata lata?
They are grey wart-like lesions around the genitals and anus
What is latent syphillis?
It occurs after the secondary stage of syphilis and the patient becomes asymptomatic despite still being infected
When does early latent syphillis occur?
Within 2 yrs of the initial infection
When does late latent syphillis occur?
After 2 yrs of the initial infection
When does tertiary syphillis occur?
Years after the initial infection
What are the three clinical features of tertiary syphillis?
Gummatous Lesions
Cardiological Features, such as ascending aortic aneurysms
Neurosyphilis
What cardiological feature is associated with tertiary syphillis?
Ascending aortic aneurysm
What is neurosyphilis?
It occurs when the infection reaches the CNS
What are the five clinical features of neurosyphilis?
Tabes Dorsalis
Argyll Robertson Pupil
Headache
Dementia
Paralysis
What is tabes dorsalis?
This is demyelination affecting the spinal cord dorsal columns
What is Argyll Robertson Pupil?
This is a constricted pupil that accommodates when focusing on a near object but does not react to light
Are motor deficits associated with neurosyphilis?
No
What are the three investigations used to diagnose syphillis?
Blood Tests
Polymerase Chain Reaction
Dark Field Microscopy
How are blood tests generally used to diagnose syphilis?
They are used to check for the presence of antibodies that the body produces to fight infection
What four blood tests are used to assess for active syphillis infection?
Rapid plasma regain (RPR) test
Venereal disease research laboratory (VDRL) test
Enzyme immunoassay test (EIA)
Treponema pallidum particle agglutination assay (TPPA)
What is a RPR test?
It assesses the quantity of antibodies being produced by the body to an infection with syphilis
How do we interpret PRP test results?
It is written as the number of times a sample of containing syphilis needs to be diluted before it becomes undetectable
Therefore, 1 in 2 means it needs to be diluted twice
However, 1 in 32 means it needs to be diluted 32 times. This means the disease activity is greater in this sample
What are the four causes of a false positive RPR/VDRL result?
Some Times Mistakes Happen
SLE
TB
Malaria
HIV
What is an EIA test?
It detects an acute IgM antibody to syphillis
What EIA test result indicates syphillis infection?
Positive
What is a TPPA test?
It is used to detect the presence of treponema pallidum within a blood sample
What TPPA test result indicates syphillis?
Positive
How do we treat syphillis?
IM Benzathine Penicillin
What is a common side effect after syphilis treatment?
Jarisch Herxheimer reaction
What is the Jarisch Herxheimer reaction?
It is the rapid killing of Treponema pallidum and the release of endotoxins, which occurs 24 hours after starting syphilis treatment
What are the four features of a Jarisch Herxheimer reaction?
Fever
Rash
Tachycardia
Myalgia
How do we manage Jarisch Herxheimer reaction?
It requires supportive management, with oral paracetamol, usually resolving within 24 hours
How can we determine whether reinfection with syphillis has occurred?
The RPR level rises by 4 fold or more
The TPPA result will be positive
The EIA results may be negative
How do we treat a reinfection with syphillis?
We administer another IM benzathine penicillin G dose
What is the first line management option of syphillis during pregnancy?
IM Benzathine Penicillin
What is the second line management option of syphillis during pregnancy?
Orał doxycycline
What are the four features of congenital syphillis?
Hutchinson’s teeth
Saddle nose
Mulberry molars
Linear scars at the angle of the mouth
