Syphillis

Question 1

What is the typical history associated with syphilis?

Answer 1

Painless ulcer (chancre) at site of infection in primary stage. Rash, mucous membrane lesions, and lymphadenopathy in secondary stage. Asymptomatic latent stage. Neurological and cardiovascular symptoms in tertiary stage.

Question 2

What are the key physical examination findings in syphilis?

Answer 2

Chancre: painless, indurated ulcer. Secondary stage: widespread rash, often on palms and soles, mucous patches, condylomata lata. Tertiary stage: gummas, neurological deficits.

Question 3

What investigations are necessary for diagnosing syphilis?

Answer 3

Nontreponemal tests (RPR, VDRL) for screening. Treponemal tests (FTA-ABS, TP-PA) for confirmation. Darkfield microscopy or PCR for early syphilis.

Question 4

What are the non-pharmacological management strategies for syphilis?

Answer 4

Educate on prevention and safe sex practices. Notify and treat sexual partners. Regular follow-up and testing for HIV and other STIs.

Question 5

What are the pharmacological management options for syphilis?

Answer 5

Penicillin G is the treatment of choice. Alternatives for penicillin allergy: doxycycline or azithromycin. Monitor for Jarisch-Herxheimer reaction.

Question 6

What are the red flags to look for in syphilis patients?

Answer 6

Neurological symptoms: headache, vision changes, hearing loss, ataxia. Cardiovascular symptoms: chest pain, shortness of breath. Persistent or recurring lesions.

Question 7

When should a patient with syphilis be referred to a specialist?

Answer 7

Neurosyphilis or cardiovascular syphilis. Penicillin allergy with severe disease. Treatment failure or relapse. Pregnant women with syphilis.

Question 8

What is one key piece of pathophysiology related to syphilis?

Answer 8

Caused by Treponema pallidum, a spirochete bacterium. Bacteria penetrate intact mucous membranes or abraded skin. Spread via lymphatic system and bloodstream to various organs.