Syphillis

Question 1

How is maternal infection with syphilis diagnosed?

Answer 1

Dark field microscopy, active chancre or condyloma latum, direct fluorescent antibody (DFA)

Question 2

How do you counsel a patient with a positive RPR or VDRL?

Answer 2

False positives may occur

Confirm with antitreponemal ab tests - FTA-ABS, MHA-TP

Question 3

What are possible explanations for a false positive RPR or VDRL?

Answer 3

Hepatitis, viral pneumonia, measles, malaria, pregnancy, mononucleosis, chicken pox, Immunization, drug use, technical error, lupus, Ig abs, narcotic addiction, aging, leprosy and malignancy

Question 4

What are the stages of syphilis infection?

Answer 4

Primary
Secondary
Tertiary
Latent

Question 5

What are signs of primary syphilis?

Answer 5

painless ulcers or chancre at infection site

Question 6

What are signs of secondary syphilis?

Answer 6

skin rash, lesions, lymphadenopathy, condyloma lata (males)

Question 7

What are signs of tertiary syphilis?

Answer 7

Gumma, cardiovascular Neurosyphilis or eye disease, alopecia

Question 8

What is early vs late latent stage of syphilis?

Answer 8

Early latent - acquired within preceding year

Late latent - 1 year or unknown duration { x 3 at 1 week intervals}

Question 9

What are maternal symptoms of syphilis infection?

Answer 9

Fever, sore throat, headache, skin rash, weight loss and fatigue

Question 10

What ultrasound findings are consistent with in utero syphilis infection?

Answer 10

fetal ascites
placentomegaly
low birthweight
IUFD

Question 11

How is in utero syphilis infection confirmed?

Answer 11

amniocentesis

Question 12

If performing an ultrasound for suspected syphilis infection, what tests will you order on the amniotic fluid?

Answer 12

Rabbit infectivity test, PCR and darkfield microscopy

Question 13

What is the risk of fetal transmission of syphilis for primary/secondary infection vs latent infection?

Answer 13

Primary/secondary - 60-80%

Latent - 10%

Question 14

In which trimester(s) of pregnancy is the greatest risk of fetal syphilis infection?

Answer 14

Highest in untreated first and second trimesters

Question 15

How is maternal syphilis treated?

Answer 15

Penicillin

Question 16

How do you treat primary and secondary syphilis?

Answer 16

Benzathine PCN G 2.4mU IM x 1

Question 17

How do you treat latent syphilis?

Answer 17

Benzathine PCN G 2.4mU IM x 3 doses, weekly-will need to restart if pt misses > 14 days

Question 18

How do you treat neurosyphilis?

Answer 18

Aqueous crystalline PCN G 18-24 mU IV x 10-14 days

Procaine PCN G 2.4 mU IM qd + Probenecid 500 mg qid x 10-14 days

Question 19

How do you manage pregnant women with syphilis and a high-risk penicillin allergy?

Answer 19

Desensitization

• Admit to ICU
• Prepare epinephrine, methylprenisolone 125 mg q8hrs(1st dose 1hr prior to desensitization)
• diphenhydramine 50 mg IVq6hrs (1st dose 1hr prior to desensitization)
• PCN G 1,000,000 U/ml and prepare six dilutions (stock solution)

Question 20

What is Jarisch-Herxheimer reaction?

Answer 20

a transient clinical phenomenon that occurs in patients infected by spirochetes who undergo antibiotic treatment

Question 21

What percentage of patients will develop a Jarisch-Herxheimer reaction following treatment for syphilis?

Answer 21

estimated to be 10%–25% and may be as high as 50%–75% among patients with primary and secondary syphilis

Question 22

What causes the Jarisch-Herxheimer reaction?

Answer 22

The breakdown of the spirochete after the use of antibioticscauses the release of toxins and cytokines.