Syphilus Flashcards
primary features of syphilllus ?
chancre - firm round painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
often not seen in women (the lesion may be on the cervix)
secondary features of syphillus ?
fevers,
lymphadenopathy
rash on trunk, palms and soles
buccal ‘snail track’ ulcers
condylomata lata (painless, warty lesions on the genitalia )
tertiary features of syphillus ?
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
Argyll-Robertson pupil - bilaterally small pupils that do not constrict when exposed to bright light but do constrict when focused on a nearby object
Optic neuritis
neurological features of tertiary syphilus ?
Tabes dorsalis -
ataxia,
paralysis,
sensory and reflexes loss,
bladder dysfunction,
and loss of sexual function
features of congenital syphillus ?
blunted upper incisor teeth (Hutchinson’s teeth),
‘mulberry’ molars
rhagades (linear scars at the angle of the mouth)
keratitis
saber shins
saddle nose
deafness
main diagnosis of syphilus ?
non-treponemal tests
treponemal-specific tests
what are the non treponema tests ?
rapid plasma reagin (RPR) and
Venereal Disease Research Laboratory (VDRL)
reactivity of infected serum to a cardiolipin-cholesterol-lecithin antigen
- then asses the quantity of antibodies being produced
non treponema tests results can have a lot of ?
FALSE POSITIVES
non trepanomal tests such as RPR and VDRL can show FALSE POSITIVITY IN WHAT circumstances ?
pregnancy
SLE
anti phospholipid syndrome
TB
malaria
HIV
leprosy
Due to the lost of false positivity from non trepanomal test are they very specific for trepanoma ?
NO
when do non trepanomal tests such as RPR and VDRL become negative ?
after treatmnet
which test s specific for trepanoma palladium ?
treponemal-specific tests
TP-EIA (T. pallidum enzyme immunoassay),
TPHA (T. pallidum HaemAgglutination test)
testing algorithms for syphilis involve
combination of non trepanomal and trepanomal specific test
Positive non-treponemal test + positive treponemal test interpretation
active infection
Positive non-treponemal test + negative treponemal test
consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)
Negative non-treponemal test + positive treponemal test :
consistent with successfully treated syphilis
trepanomal specific test remains positive even after treatment and cure ?
yes
first line of syphilus management ?
intramuscular benzathine penicillin
alternative doxycycline
nontreponemal (rapid plasma reagin [RPR] or Venereal Disease Research Laboratory [VDRL]) titres should be monitored after treatment to assess the response
what reaction is often seen after treatment syphilus ?
Jarisch-Herxheimer
what consisting of Jarisch-Herxheimer reaction ?
fever, rash, tachycardia after the first dose of antibiotic
typically occurs within a few hours of treatment
in contrast to anaphylaxis, there is no wheeze or hypotension
tx for Jarisch-Herxheimer reaction ?
no treatment is needed other than antipyretics if required
treponemal-specific tests are qualitative or quantitative
qualitative only and are reported as ‘reactive’ or ‘non-reactive’
does trepanoma palladium spontaneously resolve ?
NO
