1. what 2 ways can syphilis be transmitted?
    • sexually
    • vertically
  2. how long does syphilis last for?
    • chronic
    • potentially lifelong
  3. what is the pathogenesis of clinical manifestations of syphilis?
    • direct tissue invasion
    • vasculitis
  4. what causes syphilis?
    • treponema pallidum
    • spirochaete = coiled bacterium
    • parasite
  5. why is syphilis so important if it is curable?
    • facilitates HIV transmission
    • congenital syphilis - serious consequences
    • (so screen in ANC booking)
  6. what are the names of the 4 stages of syphilis?
    • primary
    • secondary
    • latent
    • tertiary
  7. what is the risk of transmission of untreated syphilis?
  8. how can you transmit syphilis?
    • from mucosal lesions
    • oral vaginal anal sex
    • even if condom used
  9. what is the main difference between primary and secondary syphilis?
    • primary = LOCAL
    • seconday = DISSEMINATED
  10. how soon after exposure does primary syphilis occur?
    2-3 weeks after exposure
  11. what are features of primary syphilis?
    • ulcer at site of exposure
    • painless
    • local lymphadenopathy
    • chancre= HARD ulcerating papule on genitalia
  12. what happens to ulcer in primary syphilis?
    resolves spontaneously over weeks-months
  13. how long after exposure does secondary syphilis occur?
    2-4 months after exposure
  14. 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
  15. describe rash in 2ry syphilis
    • macular
    • palm and soles
    • non itchy
    • generalised
  16. what are the 4 risks/complciations with congenital syphilis?
    • miscarriage
    • stillbirth
    • deafness
    • blindness
  17. how long after getting syphilis is mother able to pass it to baby if she gets pregnant?
    2 years
  18. what is mode of transmission for congenital syphilis?
    through placenta so babies get it EARLY
  19. what is way of preventing and treating congenital syphilis?
    • prevent: ANC screen
    • treat: treatment with penicillin
  20. when is someone NO longer infectious with syphilis?
    after 2 years
  21. what is the risk of progression to tertiary syphilis?
  22. what is early latent syphilis?
    when you have been infected with it for less than 2 years
  23. what are the 3 categories of tertiary syphilis?
    • neurosyphilis
    • cardiovascular
    • gummata - necrotic skin/bone lumps
  24. 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!
  25. what happens in cardiovascular syphilis?
    • heart failure
    • angina
    • aneurysm
    • very rare
  26. how does having both HIV and syphilis alter the symptoms of primary syphilis?
    primary: PAINFUL larger multiple ulcers
  27. how does having both HIV and syphilis alter the symptoms of secondary syphilis?
    get genital ulcers
  28. how does having both HIV and syphilis alter the symptoms of tertiary syphilis?
    get faster progression to neurosyphilis
  29. how often are HIV+ pts screened for syphilis
  30. 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
  31. what is used as a screening test for syphilis?
    • EIA (treponemal specific test)
    • form of serology
  32. if the screening test for syphilis is positive then what test is done?
    • TPPA
    • RPR - non treponemal test = monitoring test
  33. which is the monitoring test for syphilis?
    RPR: Ab to cardiolipin (not specific to syphilis, also raised in inflammation)
  34. which 2 tests are positive lifelong even after cured?
    • EIA
    • TPPA
  35. what happens to RPR levels after treatment?
    titre decreases
  36. why would RPR increase?
    if re-infection or false positive with other diseases (pregnancy, other infections, autoimmune)
  37. if there are any neurosyphilis signs, what needs to be done?
  38. how many days after infection does it take for EIA to become positive?
  39. how many days after infection does it take for TPPA to become positive?
  40. how many days after infection does it take for RPR to become positive?
    28 day
  41. why is PCR useful?
    can detect early syphilis, when EIA isn't positive yet eg before 14 days
  42. does EIA -ve and TPPA -ve exclude syphilis?
    • no
    • as may be very early eg before 14 days - so if ulcer do PCR
  43. what change in the RPR would suggest re-infection?
    4 fold increase
  44. 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
  45. 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
  46. what is treatment of late latent syphilis?
    • benzathine penicillin 2.4 mega units x 3
    • days 0, 7, 13
  47. if there is neurosyhplis, which drug to add?
  48. what is 2nd line Rx or if pen allergic for syphilis?
    doxycycline 100mg bd 14 days
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