Treponema pallidum: Syhpilis

Question 1

How to classify?

Answer 1

Gram negative spirochaete with internal flagellae

Question 2

What kind of infection is it?

Answer 2

Sexually transmitted infection

Question 3

What is primary syphilis?

Answer 3

Chancre (typically painless and on genitalia), lymph node enlargement

Increases chances of concomitant HIV infection

Question 4

What is secondary syphilis?

Answer 4

Rash (macular or papular/pustular), lymphadenopathy, condylomata lata (warty lesions around anus, genitals or other warm moist areas)
-Palms and soles involved
-Very infectious

Question 5

What is tertiary syphilis?

Answer 5

Gummatous syphilis
Multisystem disease (skin, mucous membranes, other organs, form of necrosis)

Question 6

What does cardiovascular syphilis affect?

Answer 6

Thoracic aorta
- Cornoary arteries (angina, myocardial infarction)
- Aortic valve incompetence
- Aortic aneurysm

Question 7

What does late syphilis cause?

Answer 7

• Cardiovascular syphilis
• Neurosyphilis

Question 8

What does neurosyphilis cause?

Answer 8

Meningovascular, general paresis of the insane (GPI), Tabes dorsalis (damages sensory pathways)

Question 9

What happens in congenital syphilis?

Answer 9

• Baby may appear healthy at birth
• Early lesions resemble secondary syphilis
• Hutchinson’s Triad (VIII Cranial nerve deafness, corneal clouding, notched teeth)

Question 10

How to diagnose syphilis?

Answer 10

Dark ground illumination (DGI) of early lesions (NOT ORAL LESIONS)
Serodiagnosis
- Serology interpretation can be difficult
Does grow in rabit testes but not available

Question 11

What does Syphilis not be seen on?

Answer 11

Gram stain, cultured on agar, in broth

Question 12

What are the 2 types of antibody test for the serodiagnosis?

Answer 12

1. Non-specific test (use cardiolipin antigen, VDRL, RPR)
   - negative VDRL does not exclude syphilis
2. Specific tests (use treponemal antigens, EIA, LIA, TPHA, FTA-Abs)

Question 13

What is the treatment of syphilis?

Answer 13

• Benzathine pencillin G
• Aqueous pencillin G IV for neurosyphilis
• Follow-up and contact tracing (test for other STIs)

Question 14

What reaction to might happen after treatment?

Answer 14

Jarisch-Herxheimer reaction
* transient inflammatory syndrome triggered hours after start of antibiotic treatment

Question 15

What is the prevention and detection of syphilis?

Answer 15

• Antenatal screening
• All STD clinic patients screened
• Contact tracing
• Screen all blood (transfusion, blood products)
• Education (use condoms)