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what 2 ways can syphilis be transmitted?
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how long does syphilis last for?
- chronic
- potentially lifelong
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what is the pathogenesis of clinical manifestations of syphilis?
- direct tissue invasion
- vasculitis
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what causes syphilis?
- treponema pallidum
- spirochaete = coiled bacterium
- parasite
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why is syphilis so important if it is curable?
- facilitates HIV transmission
- congenital syphilis - serious consequences
- (so screen in ANC booking)
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what are the names of the 4 stages of syphilis?
- primary
- secondary
- latent
- tertiary
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what is the risk of transmission of untreated syphilis?
30-50%
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how can you transmit syphilis?
- from mucosal lesions
- oral vaginal anal sex
- even if condom used
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what is the main difference between primary and secondary syphilis?
- primary = LOCAL
- seconday = DISSEMINATED
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how soon after exposure does primary syphilis occur?
2-3 weeks after exposure
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what are features of primary syphilis?
- ulcer at site of exposure
- painless
- local lymphadenopathy
- chancre= HARD ulcerating papule on genitalia
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what happens to ulcer in primary syphilis?
resolves spontaneously over weeks-months
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how long after exposure does secondary syphilis occur?
2-4 months after exposure
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what are the symptoms of secondary syphilis?
- rash: macular on palms and soles, non itchy
- flu like - fever, myalgia, sweat
- mucosal ULCERS
- GENERALISED lymphadenopathy (compare to primary only local)
- condylomata lata
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describe rash in 2ry syphilis
- macular
- palm and soles
- non itchy
- generalised
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what are the 4 risks/complciations with congenital syphilis?
- miscarriage
- stillbirth
- deafness
- blindness
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how long after getting syphilis is mother able to pass it to baby if she gets pregnant?
2 years
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what is mode of transmission for congenital syphilis?
through placenta so babies get it EARLY
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what is way of preventing and treating congenital syphilis?
- prevent: ANC screen
- treat: treatment with penicillin
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when is someone NO longer infectious with syphilis?
after 2 years
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what is the risk of progression to tertiary syphilis?
20-40%
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what is early latent syphilis?
when you have been infected with it for less than 2 years
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what are the 3 categories of tertiary syphilis?
- neurosyphilis
- cardiovascular
- gummata - necrotic skin/bone lumps
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what happens in neurosyphilis?
- dementia
- stroke
- spinal cord - DC loss
- rare
- pupils: argyll robertson (can accommodate but not react to light) - so will be dilated!
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what happens in cardiovascular syphilis?
- heart failure
- angina
- aneurysm
- very rare
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how does having both HIV and syphilis alter the symptoms of primary syphilis?
primary: PAINFUL larger multiple ulcers
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how does having both HIV and syphilis alter the symptoms of secondary syphilis?
get genital ulcers
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how does having both HIV and syphilis alter the symptoms of tertiary syphilis?
get faster progression to neurosyphilis
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how often are HIV+ pts screened for syphilis
yearly
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what are the direct tests for syphilis?
- PCR: very sensitive and specific
- dark ground microscopy: if ulcer present, can only use in infectious lesions, not latent, poor sensitivity, too observer dependent
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what is used as a screening test for syphilis?
- EIA (treponemal specific test)
- form of serology
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if the screening test for syphilis is positive then what test is done?
- TPPA
- RPR - non treponemal test = monitoring test
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which is the monitoring test for syphilis?
RPR: Ab to cardiolipin (not specific to syphilis, also raised in inflammation)
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which 2 tests are positive lifelong even after cured?
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what happens to RPR levels after treatment?
titre decreases
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why would RPR increase?
if re-infection or false positive with other diseases (pregnancy, other infections, autoimmune)
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if there are any neurosyphilis signs, what needs to be done?
LP
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how many days after infection does it take for EIA to become positive?
14-21
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how many days after infection does it take for TPPA to become positive?
21-42
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how many days after infection does it take for RPR to become positive?
28 day
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why is PCR useful?
can detect early syphilis, when EIA isn't positive yet eg before 14 days
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does EIA -ve and TPPA -ve exclude syphilis?
- no
- as may be very early eg before 14 days - so if ulcer do PCR
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what change in the RPR would suggest re-infection?
4 fold increase
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what are the 3 main actions to be done if syphilis is diagnosed or suspected?
- further investigations
- STI, HIV screen
- partner notification - v.imp even asymp partners
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what is 1st line treatment for primary or secondary syphilis?
- benzathine penicillin 2.4 mega units x 1
- followed by 3 weeks of no sex
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what is treatment of late latent syphilis?
- benzathine penicillin 2.4 mega units x 3
- days 0, 7, 13
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if there is neurosyhplis, which drug to add?
probenecid
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what is 2nd line Rx or if pen allergic for syphilis?
doxycycline 100mg bd 14 days
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