*(XIII)Spiral bacteria Spirochaete (3) *Treponema pallidum

Question 1

What shape is syphillis?

Answer 1

Spirochete

Question 2

How to diagnose syphilis?

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Answer 2

How to diagnose syphilis?

• Dark ground illumination (DGI) of early lesions (NOT ORAL LESIONS)
• Serodiagnosis (ab tests)

CANNOT be seen on gram stain/cultured on agar or in broth
But can grow in rabbit testes

Nonspecific ab tests vary with disease activity (meaning that VDRL & RPR reflects disease activity)
Specific ab tests stay positive long term

Question 3

Hutchinson’s triad is a common pattern of presentation for

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and consists of three phenomena:
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Answer 3

Hutchinson’s triad is a common pattern of presentation for

congenital syphilis

and consists of three phenomena:
- Interstitial keratitis (aka corneal scarring/clouding)
- Hutchinson’s teeth (notched teeth)
- CN8 deafness

Early lesions resemble secondary syphilis (e.g rash)

Question 4

In syphilis serology, a negative VDRL (non specific ab test) […] exclude syphilis

Answer 4

In syphilis serology, a negative VDRL (non specific ab test) DOES NOT exclude syphilis

Nonspecific ab tests vary with disease activity (meaning that VDRL & RPR reflects disease activity)

Question 5

Treponema pallidum clinical presentation (IMPT!!!)

Primary syphilis
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Secondary syphilis (Treponemes spread throughout body):
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Latent syphilis
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Tertiary/Quarternary Syphillis
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Answer 5

Treponema pallidum clinical presentation (IMPT!!!)

Primary syphilis
- Chancre (typically painless). Often on genitalia
- lymph node enlargement
- Extragenital sites may be affected too: mouth, lips, anal canal, finger (needlestick injury)
- Increases chances of concomitant HIV infection ***note: check for HIV as well

Secondary syphilis (Treponemes spread throughout body):
- Rash (often macular, may be papular or pustular), often involving palms & soles **
- Mucous patches (lesions on mucous membranes, e.g. snail track ulcers in mouth) **
- **Condylomata lata (warty lesions around anus, genitals or other warm moist areas)
- *Lymphadenopathy
- *Acute meningitis may occur

Latent syphilis
- All signs disappear, but secondary lesions may relapse (more common in early latent stages)
- 70% never develop further disease, the rest develop chronic symptomatic infection

Tertiary/Quarternary Syphillis
“niu rou on your gum satisfies your heart”
1. Neurosyphilis
- Meningovascular syphilis: stroke after a period of other CNS disease
- General Paresis of the Insane (GPI)
- Tabes dorsalis
2. Gummatous syphilis
- granulomatous lesions which become necrotic, leading to gumma formation on skin, mucous membranes or other organs
3. Cardiovascular syphilis
- aortitis of the thoracic aorta
- narrowing of coronary arteries (angina, myocardial infarction)
- aortic valve incompetence
- i

“I got Chancre?? its** R**eally Crazy but im Not Gonna Cry” ez dab

Cardiovascular tertiary syphilis will reappear in CVS pathology. Very important to know that tertiary syphilis is associateed with aortic aneurysm, valve incompetence, aortitis and coronary artery narrowing!!!

Question 6

What is the ROT of Treponema pallidum? (IMPT!!)

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Hence, how do we detect/prevent syphilis?

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Answer 6

What is the ROT of Treponema pallidum? (IMPT!!)

BY BLOOD
- STD
- verticle transmission
- blood transfusion
- transplants

Hence, how do we detect/prevent syphilis?

• Screening of all STD clinic patients
• Contact tracing
• Antenatal screening
• Screening of all blood used for transfusion
• Education

Question 7

What is the treatment of syphilis?

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Answer 7

What is the treatment of syphilis?

• Benzathine Pen G (IM)
• For neurosyphilis: Aq Pen G (IV)
• Watch out for Jarisch-Herxheimer reaction
• Follow-up
• Contact tracing

“Jarisch–Herxheimer reaction is a reaction to endotoxin-like products released by the death of harmful microorganisms within the body during antibiotic treatment.”