Syphilus

Question 1

primary features of syphilllus ?

Answer 1

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)

Question 2

secondary features of syphillus ?

Answer 2

fevers,

lymphadenopathy

rash on trunk, palms and soles

buccal ‘snail track’ ulcers

condylomata lata (painless, warty lesions on the genitalia )

Question 3

tertiary features of syphillus ?

Answer 3

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

Question 4

neurological features of tertiary syphilus ?

Answer 4

Tabes dorsalis -
ataxia,
paralysis,
sensory and reflexes loss,
bladder dysfunction,
and loss of sexual function

Question 5

features of congenital syphillus ?

Answer 5

blunted upper incisor teeth (Hutchinson’s teeth),
‘mulberry’ molars
rhagades (linear scars at the angle of the mouth)
keratitis
saber shins
saddle nose
deafness

Question 6

main diagnosis of syphilus ?

Answer 6

non-treponemal tests

treponemal-specific tests

Question 7

what are the non treponema tests ?

Answer 7

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

Question 8

non treponema tests results can have a lot of ?

Answer 8

FALSE POSITIVES

Question 9

non trepanomal tests such as RPR and VDRL can show FALSE POSITIVITY IN WHAT circumstances ?

Answer 9

pregnancy
SLE
anti phospholipid syndrome
TB
malaria
HIV
leprosy

Question 10

Due to the lost of false positivity from non trepanomal test are they very specific for trepanoma ?

Answer 10

NO

Question 11

when do non trepanomal tests such as RPR and VDRL become negative ?

Answer 11

after treatmnet

Question 12

which test s specific for trepanoma palladium ?

Answer 12

treponemal-specific tests

TP-EIA (T. pallidum enzyme immunoassay),
TPHA (T. pallidum HaemAgglutination test)

Question 13

testing algorithms for syphilis involve

Answer 13

combination of non trepanomal and trepanomal specific test

Question 14

Positive non-treponemal test + positive treponemal test interpretation

Answer 14

active infection

Question 15

Positive non-treponemal test + negative treponemal test

Answer 15

consistent with a false-positive syphilis result e.g. due to pregnancy or SLE (see list above)

Question 16

Negative non-treponemal test + positive treponemal test :

Answer 16

consistent with successfully treated syphilis

Question 17

trepanomal specific test remains positive even after treatment and cure ?

Answer 17

yes

Question 18

first line of syphilus management ?

Answer 18

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

Question 19

what reaction is often seen after treatment syphilus ?

Answer 19

Jarisch-Herxheimer

Question 20

what consisting of Jarisch-Herxheimer reaction ?

Answer 20

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

Question 21

tx for Jarisch-Herxheimer reaction ?

Answer 21

no treatment is needed other than antipyretics if required

Question 22

treponemal-specific tests are qualitative or quantitative

Answer 22

qualitative only and are reported as ‘reactive’ or ‘non-reactive’

Question 23

does trepanoma palladium spontaneously resolve ?

Answer 23

NO