UGI 4

Question 1

how is syphilis transmitted

Answer 1

direct contact with primary or secondary lesions

Question 2

what stages is syphilis curable

Answer 2

this genital ulcerative disease is easily curable in the primary and secondary stages

Question 3

what is seen in primary stage of syphilis

Answer 3

hard, painless but sensitive ulcers aka chancre 9-90 days post infection with syphilis

Question 4

what happens if you treat or don’t treat syphilis in its primary stage

Answer 4

treat: disappears in a week
untreated: disappears in 4-12 weeks or could progress to secondary stage

Question 5

definitive diagnosis of early syphilis and what test is not done and why?

Answer 5

definitive: darkfield microscopy

not done: serology because no antibodies in this stage

Question 6

what is seen in secondary stage of syphilis

Answer 6

• generalized maculopapular rash
• symptoms indicative of systemic infection
• flulike syndrome
• condylomata lata

Question 7

what is typically not seen in secondary stage of syphilis and if seen what should be considered

Answer 7

usually do not see chancre (painless ulcers) in secondary stage but if seen usually suggestive of an additional STI

Question 8

what is condylomata lata

Answer 8

wet mucous patches that are contagious

Question 9

where is the maculopapular rash of syphilis usually seen

Answer 9

palm, soles of feet, face

Question 10

syphilis is common in what population

Answer 10

males - especially men who have sex with men

Question 11

what is early latent and late latent phase of syphilis

Answer 11

it is a state after secondary but before tertiary where persons are not in diseased state

Question 12

what is seen in tertiary phase of syphilis

Answer 12

comes 15-20 years post infection

• neurosyphilis (dementia, hallucinations, neurological symptom can happen in any stage but more common here
• cardiovascular effects
• gummatous: destroys viscera and mucocutaneous areas

Question 13

how does congenital syphilis occur

Answer 13

treponema pallidum crosses uterine or placental membrane leading to systemic infection in developing fetus

Question 14

what occurs as a result of treponema pallidum crossing the uterine or placental membrane

Answer 14

• most cases leads to spontaneous, septic abortion

- those that become live birth –> actively infected with syphilis

Question 15

what is seen in late stage congenital syphilitic infection

Answer 15

• stromal haze due to interstitial keratitis
• saddle nose
• Hutchinson’s teeth

Question 16

characteristics of treponema pallidum

Answer 16

• spirochete
• 3 flagella so motile
• replicates slowly so no in vitro culture
• obligate human pathogen
• unusual outer membrane so no LPS or porins

Question 17

pathogenesis of treponema pallidum

Answer 17

• enters subepithelial tissues via skin breach: fastidious
• evasion of the immune system
• diffuse chronic inflammation and damage to CNS

Question 18

what does it mean for treponema pallidum to be fastidious

Answer 18

it does not tolerate a wide range of environmental conditions

Question 19

importance of hyaluronidase in syphilis

Answer 19

it facilitates perivascular infiltration aka it is the spreading factor

Question 20

what protects treponema pallidum from phagocytosis

Answer 20

coating of fibronectin

Question 21

why is there tissue damage and destruction in syphilis

Answer 21

patient’s immune response to the infection

Question 22

specimen and definitive diagnosis for early syphilis

Answer 22

• specimen is exudate from skin lesion

- definite diagnosis is the darkfield microscopy

Question 23

how do you detect the actual organism - the treponema pallidum

Answer 23

PCR

Question 24

the difference between the two presumptive diagnostic tests of syphilis

Answer 24

• nontreponemal test: tests for diseased states so you can get both false negative and false positives –> just not specific enough
• treponemal test: used for monitoring treatment of syphilis

Question 25

types of nontreponemal and treponemal test

Answer 25

• nontreponemal: VDRL (venereal disease research laboratory) and RPR
• treponemal: FTA-ABS (fluorescent treponemal antibody absorbed) and TP-PA (treponema pallidum passive particle agglutination) and EIAs

Question 26

those who test positive for syphilis should also be tested for what and why?

Answer 26

HIV - increase chance of transmission because of the ulceration making infiltration easier

Question 27

treatment in primary, secondary, early latent is possible. what tx should you use?

Answer 27

benzathine penicillin

Question 28

pathogen in chancroid and where is this popular

Answer 28

obligate human pathogen hemophilus ducreyi

popular in Africa, Asia, and Latin America

Question 29

clinical presentation of chancroid

Answer 29

• soft chancre or chancroid
• painful genital ulcer
• spontaneously rupturing buboes

Question 30

characteristic of hemophilus ducreyi

Answer 30

• gram neg anaerobic rods called coccobacilli which just means it is pleomorphic
• fastidious

Question 31

how do you view hemophilus ducreyi/diagnose it

Answer 31

use gram stain (gentian violet simple stain)

Question 32

what does hemophilus ducreyi resist

Answer 32

phagocytosis

Question 33

virulence factor of hemophilus ducreyi

Answer 33

• outer membrane serum resistance protein

- two toxin: hemolysin and CDT (cytolethal distending toxin) which causes tissue destruction

Question 34

other than microscopy exam, what is another way of diagnosing chancroid

Answer 34

excluding treponema pallidum and HHV 1 and 2

Question 35

difference between chancroid and syphilis

Answer 35

• chancre has soft chancre while syphilis has hard chancre
• chancroid is painful ulcers no matter what while syphilis is usually painless unless secondarily infected
• chancroid is diagnosed with gram stain while syphilis is diagnosed with darkfield