Syphillis Flashcards
CDC stages of syphillis
- Infectious (primary, secondary, and early latent of less than 1 yr duration)
- Latent (those lacking clinical manifestations)
- Late latent (duration of 4+ years)
Primary syphillis exam findings
single, painless ulcer (chancre)
Secondary syphilis exam findings
Generalized/localized eruption, palmar or plantar rash, mucous patches, conduloma lata, patchy alopecia
DDx of chancre
Chancroid, herpes progenitalis, Bechets syndrome, and traumatic ulcers
Likelihood of untreated primary syphilis progressing to secondary
25%
Rash characteristics in secondary syphilis
Bilateral, symmetric rash with polymorphic lesions that have a coppery tint. No pain/itching. Usually involves palms and soles
DDx of secondary syphilis
Pityriasis rosea, guttate psoriasis, lichen planus, tinea versicolor, and exanthematous drug and viral eruptions
Tertiary syphilis
Can see CV, neuro dz, as well as systemic granulomas called gummas
Early congenital syphilis
Eruptions similar to secondary syphilis with desquamation of palms and soles, deep fissures at angles of mouth (split papules), snuffles (hemorrhagic nasal discharge)
Late congenital syphilis
evident after age 5
frontal bosses, saddle noes, Hutchinson’s teeth, CN VIII deafness, and interstitial keratitis
Testing for syphilis
Used to be two step, but now do IgG assay to syphilis (treponema pallidum)
- RPR can still be used to determine if a patient has been previously treated as IgG will still remain elevated
When to check for neurosyphilis
If RPR titer is 1:32 or higher, co-HIV infection, signs of ocular disease
Tx of syphilis
Penicillin G. Need antibody titers (RPR or VDRL) to decrease 4-fold within the first 6mo after treatment
Jarish-Herxheimer reaction
transient acute febrile reaction with headache and myalgias within 24 hours of treatment
If allergic to penicillins…
Get desensitized
