Syphillis

Question 1

What has higher false positive rate RPR or treponemal serology?

Answer 1

RPR

ie it has a lower PPV and lower specificity

Question 2

When might treponemal tests be less useful?

Answer 2

Initial infection, before development antibodies..at this stage less sensitive…once antibodies present 100% sensitive. So a very good test after first 2 weeks or so…

Question 3

What are treponemal antibody tests?

Answer 3

They detect antibody to any treponema pallidum species ie they will be positive in jaws, pinta, bejel AND syphilis so history is important

Question 4

If treating syphilis with don’t forget to warn about….

Answer 4

Reaction as bacteria die and toxins release-short lived febrile illness jarisch-h

Question 5

Which infants need IgM at birth and 3/12 serology?

Answer 5

All with maternal positive treponemal serology (unless treated pre pregnancy)

Question 6

What is early syphilis?

Answer 6

Primary secondary early latent (<2 years)

Question 7

How is early syphilis treated? (First line)

Answer 7

Benzathine penicillin G 2.4 MU IM single dose

Same in preg up to 28 weeks. After-give second dose.

Question 8

How is late syphilis treated?

Answer 8

Benzathine penicillin G 2.4MU weekly for 3 weeks

Steroids if CVS or brain (3/7 40-60mg pred od starting 24 hrs prior to abx)

Same in pregnancy. No changes.