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what 2 ways can syphilis be transmitted?
how long does syphilis last for?
- potentially lifelong
what is the pathogenesis of clinical manifestations of syphilis?
- direct tissue invasion
what causes syphilis?
- treponema pallidum
- spirochaete = coiled bacterium
why is syphilis so important if it is curable?
- facilitates HIV transmission
- congenital syphilis - serious consequences
- (so screen in ANC booking)
what are the names of the 4 stages of syphilis?
what is the risk of transmission of untreated syphilis?
how can you transmit syphilis?
- from mucosal lesions
- oral vaginal anal sex
- even if condom used
what is the main difference between primary and secondary syphilis?
- primary = LOCAL
- seconday = DISSEMINATED
how soon after exposure does primary syphilis occur?
2-3 weeks after exposure
what are features of primary syphilis?
- ulcer at site of exposure
- local lymphadenopathy
- chancre= HARD ulcerating papule on genitalia
what happens to ulcer in primary syphilis?
resolves spontaneously over weeks-months
how long after exposure does secondary syphilis occur?
2-4 months after exposure
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
describe rash in 2ry syphilis
- palm and soles
- non itchy
what are the 4 risks/complciations with congenital syphilis?
how long after getting syphilis is mother able to pass it to baby if she gets pregnant?
what is mode of transmission for congenital syphilis?
through placenta so babies get it EARLY
what is way of preventing and treating congenital syphilis?
- prevent: ANC screen
- treat: treatment with penicillin
when is someone NO longer infectious with syphilis?
after 2 years
what is the risk of progression to tertiary syphilis?
what is early latent syphilis?
when you have been infected with it for less than 2 years
what are the 3 categories of tertiary syphilis?
- gummata - necrotic skin/bone lumps
what happens in neurosyphilis?
- spinal cord - DC loss
- pupils: argyll robertson (can accommodate but not react to light) - so will be dilated!
what happens in cardiovascular syphilis?
- heart failure
- very rare
how does having both HIV and syphilis alter the symptoms of primary syphilis?
primary: PAINFUL larger multiple ulcers
how does having both HIV and syphilis alter the symptoms of secondary syphilis?
get genital ulcers
how does having both HIV and syphilis alter the symptoms of tertiary syphilis?
get faster progression to neurosyphilis
how often are HIV+ pts screened for syphilis
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
what is used as a screening test for syphilis?
- EIA (treponemal specific test)
- form of serology
if the screening test for syphilis is positive then what test is done?
- RPR - non treponemal test = monitoring test
which is the monitoring test for syphilis?
RPR: Ab to cardiolipin (not specific to syphilis, also raised in inflammation)
which 2 tests are positive lifelong even after cured?
what happens to RPR levels after treatment?
why would RPR increase?
if re-infection or false positive with other diseases (pregnancy, other infections, autoimmune)
if there are any neurosyphilis signs, what needs to be done?
how many days after infection does it take for EIA to become positive?
how many days after infection does it take for TPPA to become positive?
how many days after infection does it take for RPR to become positive?
why is PCR useful?
can detect early syphilis, when EIA isn't positive yet eg before 14 days
does EIA -ve and TPPA -ve exclude syphilis?
- as may be very early eg before 14 days - so if ulcer do PCR
what change in the RPR would suggest re-infection?
4 fold increase
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
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
what is treatment of late latent syphilis?
- benzathine penicillin 2.4 mega units x 3
- days 0, 7, 13
if there is neurosyhplis, which drug to add?
what is 2nd line Rx or if pen allergic for syphilis?
doxycycline 100mg bd 14 days