Syphillis Flashcards
What is syphilis?
A sexually transmitted infection (STI) caused by the spirochete bacterium Treponema pallidum.
What are the key stages of syphilis?
Primary syphilis: Characterized by a painless chancre.
Secondary syphilis: Systemic symptoms and rash.
Latent syphilis: Asymptomatic period.
Tertiary syphilis: Severe systemic complications (e.g., gummas, cardiovascular, neurosyphilis).
Who is most at risk for syphilis?
Sexually active individuals, particularly those with multiple partners.
Men who have sex with men (MSM).
People with HIV.
What bacterium causes syphilis?
Treponema pallidum, a thin, spiral-shaped spirochete.
How is syphilis transmitted?
Sexual transmission: Through direct contact with a chancre or mucocutaneous lesions.
Vertical transmission: From mother to fetus (congenital syphilis).
Rarely through blood transfusion or direct inoculation.
How does Treponema pallidum spread in the body?
Through hematogenous and lymphatic dissemination, leading to systemic involvement.
Why does syphilis progress through stages?
The immune response controls some bacterial spread but allows persistence in latent reservoirs, causing relapse or progression.
What are the hallmark features of primary syphilis?
Chancre: Painless, indurated ulcer at the site of inoculation (e.g., genitals, mouth, rectum).
Regional lymphadenopathy.
When does a chancre appear after exposure?
About 3 weeks post-exposure.
What are the hallmark features of secondary syphilis?
Symmetric, non-itchy maculopapular rash (often on palms and soles).
Condylomata lata: Moist, wart-like lesions in mucocutaneous areas.
Systemic symptoms: Fever, malaise, sore throat, lymphadenopathy.
When does secondary syphilis occur?
6–8 weeks after the primary stage.
What is latent syphilis?
Asymptomatic phase after untreated secondary syphilis, divided into:
Early latent: Within 1 year of infection, still infectious.
Late latent: Beyond 1 year, non-infectious except for vertical transmission.
What are the key manifestations of tertiary syphilis?
Gummas: Granulomatous lesions in skin, bone, or liver.
Cardiovascular syphilis: Aortitis, aortic aneurysms.
Neurosyphilis: Tabes dorsalis, general paresis, cranial nerve abnormalities.
What are the types of neurosyphilis?
Early neurosyphilis: Aseptic meningitis, cranial nerve palsies.
Late neurosyphilis: Tabes dorsalis (sensory ataxia), general paresis (dementia, psychiatric symptoms).
What are the clinical features of congenital syphilis?
Early signs: Snuffles (nasal discharge), rash, hepatosplenomegaly.
Late signs: Hutchinson teeth, saddle nose, frontal bossing, saber shins.
What tests are used to diagnose syphilis?
Non-treponemal tests: RPR (Rapid Plasma Reagin), VDRL (Venereal Disease Research Laboratory).
Treponemal tests: FTA-ABS (Fluorescent Treponemal Antibody Absorption), TP-PA (Treponema Pallidum Particle Agglutination).
What is the purpose of non-treponemal tests?
To screen for syphilis and monitor treatment response (titers decrease after treatment).
What is the purpose of treponemal tests?
To confirm the diagnosis of syphilis; remains positive for life.
How is neurosyphilis diagnosed?
Lumbar puncture with CSF analysis showing:
- Elevated WBCs and protein.
- Positive VDRL in CSF.
What is the first-line treatment for syphilis?
Benzathine penicillin G:
- Single dose for primary, secondary, or early latent syphilis.
- Weekly doses for 3 weeks for late latent or tertiary syphilis.
What is the treatment for neurosyphilis?
IV penicillin G for 10–14 days.
What alternative treatments are available for penicillin-allergic patients?
Doxycycline (14–28 days for early or latent syphilis).
Ceftriaxone for neurosyphilis (if penicillin desensitization is not feasible).
What is the Jarisch-Herxheimer reaction?
An acute febrile reaction with headache and myalgia within 24 hours of treatment, due to rapid lysis of treponemes.
How is the response to treatment monitored?
Repeat non-treponemal titers (e.g., RPR) at 3, 6, and 12 months.
A four-fold decrease in titer (e.g., 1:32 to 1:8) indicates successful treatment.
