01b: Syphilis

Question 1

T. pallidum stains as gram (pos/neg).

Answer 1

Neither (though may stain as weak gram-neg)

Question 2

List the modes of transmission of T. pallidum.

Answer 2

1. Sex contact
2. Transplacental
3. Blood contact

Question 3

Primary syphilis emerges within (X) days of acquisition and the classic finding is (Y).

Answer 3

X = 10-90
Y = chancre (painless, indurated, usually solitary lesion at site of inoculation)

Question 4

T/F: Syphilis is almost always sexually transmitted.

Answer 4

True

Question 5

Spirochetes have unique ability to penetrate (X).

Answer 5

X = blood vessels

Question 6

T/F: There has been a recent rapid decline in syphilis cases.

Answer 6

False - increase

Question 7

Key clinical picture of primary syphilis.

Answer 7

1. Painless ulcer/chancre at inoculation site (heaped borders, clean base)
2. Painless bilateral lymphadenopathy

Question 8

T/F: Primary syphilis symptoms resolve within few weeks, even without treatment.

Answer 8

True - but spirochetes disseminate

Question 9

Key clinical picture of secondary syphilis.

Answer 9

1. Low-grade fever, malaise, sore throat, lymphadenopathy
2. RASH (including palms/soles)
3. Condyloma lata (wart-like lesions in moist areas)

Question 10

T/F: Secondary syphilis symptoms resolve within few weeks, even without treatment.

Answer 10

True

Question 11

Rash in (primary/secondary/tertiary) syphilis is (macular/pustular/plaque/scaling) and often confused with:

Answer 11

Secondary;
Can be any of those;

Drug eruption

Question 12

Symptoms of early neurosyphilis occurs in about (X) time after infection. It presents as (Y) disease.

Answer 12

X = within 1 year
Y = meningitis (headache, photophobia, CN abnormalities)

Question 13

Symptoms of late neurosyphilis usually occurs in about (X) time after infection. They fall into which two categories?

Answer 13

X = 10 years

1. Meningovascular
2. Parenchymatous

Question 14

T/F: Both secondary and tertiary stages of syphilis represent reactivation of latent syphilis.

Answer 14

False - tertiary stage

Question 15

Typical clinical manifestations of meningovascular symptoms of late neurosyphilis.

Answer 15

STROKES and seizures

Question 16

Typical clinical manifestations of parenchymatous symptoms of late neurosyphilis.

Answer 16

1. Tabes Dorsalis (shooting pains, ataxia)
2. General paresis (dementia, psychosis, slurry speech)
3. Argyll Robertson pupil

Question 17

Argyll Robertson pupil is symptom of (X). Describe it.

Answer 17

X = late neurosyphilis

Bilateral small pupils that constrict to accommodation, but not light

Question 18

List the three general presentations of tertiary syphilis.

Answer 18

1. Late neurosyphilis
2. CV syphilis
3. Late benign syphilis

Question 19

Symptoms of CV syphilis, which occurs more often in (M/F).

Answer 19

M (3x)

AAA, aortic insufficiency, coronary artery stenosis, myocarditis

Question 20

“Gummas” are seen in which infectious disease? Briefly describe these.

Answer 20

Late stage of syphilis;

Granulomatous process (involving skin, cartilage, bone)

Question 21

T/F: Syphilis in pregnancy increases risk for many adverse effects on child.

Answer 21

True - miscarriage/stillbirth, premature delivery, low weight, hydrops fetalis, congenital infection

Question 22

Incidence of congenital syphilis is clearly related to:

Answer 22

Socioeconomic factors and availability/use of pre-natal care

Question 23

T/F: Most syphilitic infants lack manifestations at birth.

Answer 23

True - typically takes 3 weeks to 3 months

Question 24

Classic findings of congenital syphilis.

Answer 24

1. Rhinitis
2. Skin eruptions
3. Hepatomegaly, anemia, lymphadenopathy

Question 25

Failure to treat congenital syphilis can lead to which malformations?

Answer 25

1. Dental abnormalities 2. Eye damage 3. Saddle-nose deformity 4. Neurosyphilis

Question 26

T/F: T. pallidum is large enough to be seen in light microscope.

Answer 26

False - too thin

Question 27

(X) microscopy used to see T. pallidum. Best to isolate from (primary/secondary/tertiary) lesion.

Answer 27

X = dark-field or phase-contrast Primary or secondary

Question 28

In most cases, how is syphilis diagnosed?

Answer 28

1. Hx and physical exams | 2. Serological tests

Question 29

Non-treponemal tests are used to diagnose (X). What do they detect?

Answer 29

X = syphilis Ab against host antigens (cardiolipin), released from cells damaged during spirochete dissemination

Question 30

(Non-treponemal/Treponemal) tests used as screening test for (X). What are some risks for false positive?

Answer 30

Non-treponemal X = syphilis Advanced age, pregnancy, autoimmune diseases, viral infections

Question 31

Prozone effect can produce false (pos/neg) on (Non-treponemal/Treponemal) test. Describe this phenomenon.

Answer 31

False neg; Non-treponemal Too many Ab interferes with proper formation of antigen-antibody lattice

Question 32

Which value of (non-treponemal/treponemal) test is used to indicate of cure from (X) infection?

Answer 32

Non-treponemal; X = syphilis 4-fold decline after treatment (independent of end titer)

Question 33

Treponemal tests are used to diagnose (X). What do they detect?

Answer 33

X = syphilis IgG (and maybe IgM) against treponemal agents

Question 34

T/F: A positive treponemal test usually means it'll be positive for life.

Answer 34

True

Question 35

It takes (X) days/weeks/months after infection for VDRL/RPR, aka (treponemal/non-treponemal) tests to come back positive if (Y) infection present.

Answer 35

X = 4-6 weeks Non-treponemal Y = syphilis

Question 36

T/F: In late syphilis, most untreated patients have negative non-treponemal tests.

Answer 36

False - 25%

Question 37

The gold standard for neurosyphilis diagnosis is:

Answer 37

None

Question 38

T/F: All treatment regimens for syphilis involve penicillin.

Answer 38

True

Question 39

When should pregnant women be screened for syphilis?

Answer 39

First prenatal visit And if high risk, twice more in 3rd trimester (one at time of delivery)

Question 40

The Jarisch-Herxheimer reaction occurs after (X) treatment in some patients. What are the symptoms?

Answer 40

X = syphilis (with penicillin) Similar to allergic reaction, but endotoxin-related (fever, chills, headaches, joint pain

Question 41

T/F: All patients with syphilis should be evaluated for other sexually transmitted infections.

Answer 41

True

Question 42

What's the etiologic agent in Chancroid? It's a gram (pos/neg) (aerobe/anaerobe).

Answer 42

Haemophilus ducreyi; Gram-negative; Facultative anaerobe

Question 43

"School of fish" pattern in gram staining should make you think of which infective organism? What's responsible for this pattern?

Answer 43

Haemophilus ducreyi (Chancroids); agglutination properties that lead to clumping of organisms

Question 44

Describe the classic hallmark of Chancroid.

Answer 44

PAINFUL, ragged, NON-INDURATED, sharply demarcated ulcer which often has a necrotic, friable (crumbly) base

Question 45

Diagnosis of chancroid is almost always via (X).

Answer 45

X = history and physical exam

Question 46

Top two preferable treatments for Chancroid are:

Answer 46

1. Azithromycin | 2. Ceftriaxone