Syphilis

Question 1

What type of organism causes syphilis?

Answer 1

Treponema pallidum

• it is a spirochete bacteria (spiral-shaped)
• it enters through skin / mucous membranes, replicates and then disseminates throughout the body

Question 2

What is the incubation period between initial infection and symptoms?

Answer 2

21 days

Question 3

How can syphilis be contracted?

Answer 3

• through oral, vaginal or anal sex
• vertical transmission from mother to baby during pregnancy
• intravenous drug use
• blood transfusions / organ transplants (rare due to screening of blood products)

Question 4

How can syphilis infection be divided into stages?

Answer 4

• primary syphilis
• secondary syphilis
• latent syphilis
• tertiary syphilis
• (neurosyphilis)

Question 5

What is primary syphilis?

Answer 5

• development of a painless ulcer (chancre) at the original site of infection
• there may be local lymphadenopathy
• the chancre resolves within 3-8 weeks without treatment

Question 6

When does secondary syphilis start?

Answer 6

• secondary syphilis begins after the chancre has healed
• typically involves systemic symptoms affecting the skin / mucous membranes
• symptoms resolve after 3-12 weeks

Question 7

What are common presentations of secondary syphilis?

Answer 7

• maculopapular rash (usually involving palms/soles)
• condylomata lata (grey wart-like lesions around the genitals / anus)
• low-grade fever
• oral lesions (“mucous patches”) that resemble snail tracks
• generalised lymphadenopathy
• alopecia (localised hair loss)

Question 8

What is meant by latent syphilis and when does this occur?

Answer 8

• following the secondary stage, the symptoms disappear and the patient becomes asymptomatic
• they are STILL infected
• early latent syphilis occurs within 2 years of initial infection
• late latent syphilis occurs from 2 years after initial infection onwards

Question 9

When does tertiary syphilis occur?

Answer 9

• this occurs many years after the initial infection
• symptoms depend on the internal organs affected

Question 10

What are the key features of neurosyphilis?

Answer 10

• gummatous lesions (gummas) that are granulomatous lesions affecting the skin, organs + bones
• aortic aneurysms / coronary arteritis
• neurosyphilis

Question 11

What is neurosyphilis?

Answer 11

• occurs if the infection involves the CNS
• it can occur at any stage of disease and presents with neurological symptoms

Question 12

What are the typical symptoms of neurosyphilis?

Answer 12

• headache
• altered behaviour
• dementia
• tabes dorsalis
  
  • demyelination affecting spinal cord posterior columns
  • causes pain / sensory deficits
• ocular syphilis
• paralysis
• sensory impairment

Question 13

What is Argyll-Robertson pupil?

Answer 13

• a constricted pupil that accommodates** when focussing on a nearby object but **DOES NOT react to light
• specific to neurosyphilis and often irregularly shaped
• called “prostitutes pupil” as it “accommodates but does not react”

Question 14

How is syphilis tested for?

Answer 14

a blood test to look for antibodies to the T. pallidum bacteria

Question 14

How is syphilis tested for?

Answer 14

a blood test to look for antibodies to the T. pallidum bacteria

Question 15

What are the rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) tests used for?

Answer 15

assessment of active syphilis infection

• they measure the quantity of antibodies being produced by the body to an infection with syphilis
• a higher number indicates a greater chance of active disease
• they are non-specific and often produce false positive results

Question 16

What is the treatment for syphilis?

Answer 16

a single deep intramuscular dose of benzathine benzylpenacillin

• ceftriaxone, amoxicillin + doxycycline are alternatives

Question 17

What other advice should be given to patients with syphilis infection?

Answer 17

• full screening for other STIs
• avoiding sexual activity until treatment is complete
• contact tracing
• prevention of future infections