The Treponema: Syphilis, Yaws, Pinta

Question 1

What method must be performed to identify Treponema pallidum on standard microscopy?

Answer 1

Darkfield uscopy w/o gram stain

Question 2

What is the culture procedure for T. pallidum?

Answer 2

Can’t be cultured

Question 3

What makes T. pallidum so virulent?

Answer 3

Immune evasion and low inflammation

Question 4

How is T. pallidum transmitted?

Answer 4

Sexually or congenitally

Question 5

How are yaws and pinta passed?

Answer 5

Direct contact

Question 6

Describe the immune reaction to T. pallidum.

Answer 6

Humans raise mostly useless Abs (reagin)

Question 7

What are the four stages of syphillis?

Answer 7

Primary chancre, Secondary body-wide rashes (condylomata lata, and patchy alopecia), latent period, teriary (gummas, neurosyphilis, cardiac involvement

Question 8

Describe the pupillary findings in neurosyphilis

Answer 8

One or both eyes fails to constrict in response to light while they both constrict in order to accommodate (Argyll-Robertson pupil

Question 9

What are the effects of congenital syphilis?

Answer 9

(50%) Death, Bone deformities, interstitial keratitis, progress rapidly to Syx of secondary and tertiary syphilis

Question 10

What is the major strategy for syphilis Dx?

Answer 10

Assemble accurate timecourse of the many varied Syx

Question 11

What are the lab tests helpful for syphilis Dx?

Answer 11

Reagin (VDRL, RPR); Confirm with treponeme-specific Abs

Question 12

What is the Tx for treponema?

Answer 12

Penicillin G

Question 13

What are the mechanisms of transmission of T. pallidum?

Answer 13

Sexual contact, blood, transplacentally

Question 14

What is the major virulence factor for T. pallidum?

Answer 14

Immune evasion

Question 15

What is the lesion of primary syphilis?

Answer 15

Chancre

Question 16

What are the typical lesions found in secondary syphilis?

Answer 16

Mucocutaneous lesions, condylomata lata, patchy alopecia

Question 17

What complicates treatment of syphilis at the primary and secondary stage?

Answer 17

Lesions eventually go away so patients don’t present

Question 18

Following secondary syphilis, what are the two possible routes of pathogenesis?

Answer 18

1. Latent
2. Teritary Syphilis

Question 19

What are the typical lesions in a person with tertiary syphilis?

Answer 19

Gummatous lesions and cardiovascular syphilis

Question 20

What are possible sequale of neurosyphilis?

Answer 20

1. Syphilitic meningitis (early)
2. Meningovascular syphilis
3. Parenchymal neurosyphilis (Tabes dorsalis [Degeneration of nerves of dorsal column], General paresis)

Question 21

What is the relationship b/w syphilis and HIV?

Answer 21

Ulcerations of syphilis facilitate HIV infection. HIV accelerates syphilis course due to immunosuppresion

Question 22

What is the time span which tertiary syphilis can occur

Answer 22

3-10 years after infection

Question 23

What congenital abnormalities are observed in a patient with congenital syphilis infection?

Answer 23

• Facial deformities (Hutchinson’s teeth, Mulberry molars)
• Bone and joint deformities
• Neuro (Tabes dorsalis, paresis)

Question 24

What are the typical Dx issues and strategies for syphilis?

Answer 24

Problems:

Won’t culutre and two small to Gram stain

Strategy:

Darkfield uscopy/IF, CSF, Venereal Disease Research Lab (VDRL), Rapid Plasma Reagin (RPR), or ICE Syphilis recombinant antigen test

Question 25

How does the VDRL/RPR Flocculation Assay work?

Answer 25

Reagin + Ox Heart Extract = Aggregates

Question 26

What is the primary and secondary Tx for syphilis. What is the issue with secondary Tx?

Answer 26

Primary: Penicillin G

Secondary: Tetracycline/doxycycline, erythromycin, ceftriaxone

Secondary Tx are much less effective

Question 27

How are the RPR and VDRL results for Yaws and Pinta the same? Different?

Answer 27

They both give RPR+ and VDRL+ tests

Question 28

What are the bugs for Yaws and Pinta? How are their presentations different?

Answer 28

Yaws: T. pertenue

Pinta: Treponema carateum

Pinta has hyperpigmentation