Syphillis Flashcards
How is maternal infection with syphilis diagnosed?
Dark field microscopy, active chancre or condyloma latum, direct fluorescent antibody (DFA)
How do you counsel a patient with a positive RPR or VDRL?
False positives may occur
Confirm with antitreponemal ab tests - FTA-ABS, MHA-TP
What are possible explanations for a false positive RPR or VDRL?
Hepatitis, viral pneumonia, measles, malaria, pregnancy, mononucleosis, chicken pox, Immunization, drug use, technical error, lupus, Ig abs, narcotic addiction, aging, leprosy and malignancy
What are the stages of syphilis infection?
Primary
Secondary
Tertiary
Latent
What are signs of primary syphilis?
painless ulcers or chancre at infection site
What are signs of secondary syphilis?
skin rash, lesions, lymphadenopathy, condyloma lata (males)
What are signs of tertiary syphilis?
Gumma, cardiovascular Neurosyphilis or eye disease, alopecia
What is early vs late latent stage of syphilis?
Early latent - acquired within preceding year
Late latent - 1 year or unknown duration { x 3 at 1 week intervals}
What are maternal symptoms of syphilis infection?
Fever, sore throat, headache, skin rash, weight loss and fatigue
What ultrasound findings are consistent with in utero syphilis infection?
fetal ascites
placentomegaly
low birthweight
IUFD
How is in utero syphilis infection confirmed?
amniocentesis
If performing an ultrasound for suspected syphilis infection, what tests will you order on the amniotic fluid?
Rabbit infectivity test, PCR and darkfield microscopy
What is the risk of fetal transmission of syphilis for primary/secondary infection vs latent infection?
Primary/secondary - 60-80%
Latent - 10%
In which trimester(s) of pregnancy is the greatest risk of fetal syphilis infection?
Highest in untreated first and second trimesters
How is maternal syphilis treated?
Penicillin
How do you treat primary and secondary syphilis?
Benzathine PCN G 2.4mU IM x 1
How do you treat latent syphilis?
Benzathine PCN G 2.4mU IM x 3 doses, weekly-will need to restart if pt misses > 14 days
How do you treat neurosyphilis?
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
How do you manage pregnant women with syphilis and a high-risk penicillin allergy?
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)
What is Jarisch-Herxheimer reaction?
a transient clinical phenomenon that occurs in patients infected by spirochetes who undergo antibiotic treatment
What percentage of patients will develop a Jarisch-Herxheimer reaction following treatment for syphilis?
estimated to be 10%–25% and may be as high as 50%–75% among patients with primary and secondary syphilis
What causes the Jarisch-Herxheimer reaction?
The breakdown of the spirochete after the use of antibioticscauses the release of toxins and cytokines.
