Communicable Diseases Deren > Syphilis > Flashcards

Syphilis Flashcards

(39 cards)

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1
Q

Is syphilis nationally notifiable?

A

Yes

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2
Q

What organism causes syphilis?

A

Treponema pallidum (spirochete bacterium)

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3
Q

How is syphilis transmitted?

A

Sexual, vertical

Direct contact with skin lesions/mucous membranes during vaginal, oral, anal sex

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4
Q

What are the clinical features of syphilis?

A

Complex and highly variable
Primary, secondary, tertiary, congenital syphilis

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5
Q

What are the features of primary syphilis?

A

Chancre - indurated, painless ulcer
Regional LA

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6
Q

What are the features of secondary syphilis?

A

4-10 weeks following primary
HA, fever, LA, sore throat, rash, mucocutaneous lesions

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7
Q

What is early latent syphilis?

A

Infectious - ASx, evidence of < 2 years duration

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8
Q

What is late latent syphylis?

A

ASx, > 2 years duration, unlikely infectious

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9
Q

What are the features of tertiary syphilis?

A

25-30% of untreated syphilis
Bone, VC, neurosyphilis

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10
Q

What are the features of syphilis in pregnant women?

A

Miscarriage
Foetal death in utero (FDIU)
Stillbirth
Prematurity

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11
Q

What are the features of congenital syphilis?

A

Hydrops
Ascites
Hepatomegaly
Anaemia at birth

OR

Initially ASx progressing to FTT, pneumonia within 3months

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12
Q

What are the 3 broad case definitions for syphilis?

A

Infectious - < 2yr duration (conf/prob)
Syphilis - > 2yr duration (conf only)
Congenital - both conf / prob

Clinical, lab, epi criteria

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13
Q

How is syphilis diagnosed?

A
  • Hx and Ex
  • PCR
  • Serology - treponemal (TPPA / TPHA); non-treponemal (RPR, VDRC)
    RPR = marker of disease activity / hx of response
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14
Q

What is the incubation period for syphilis?

A

10-90 days
(median 3 weeks to primary syphilis)

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15
Q

What is the infectious period for syphilis?

A

First 2 years of infection if untreated
Most infectious in primary and secondary phase, including for vertical transmission (risk close to 100%)

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16
Q

Who are at high risk of syphilis?

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A

MSM
Female partners of MSM
FNs
Unprotected sex in high prevalence countries (sex workers)
Prisons

17
Q

How is the incidence of syphilis in Australia changing?

18
Q

What is the current epi of syphilis in Australia?

Study These Flashcards
A

MJOB - ATSI in regional / remote areas since 2011
Many cases of congenital syphilis

19
Q

How can syphilis be prevented?

Study These Flashcards
A

Safe sex, early detection and treatment are key

Multiple coordinated activities for prevention required

  • Health promotion campaigns - awareness, safe sex, regular testing
  • Prioritise high-risk groups - MSM, FNs, sex workers, prison
  • Culturally safe and appropriate approach
  • Routine screening in pregnancy ( X 3 - 1st appt, 24-26wk, 34-36wk) - some recommend more in higher risk groups
  • STI screening - all sexually active, yearly but more frequently if multiple partners, 3/12 for MSM (STIGMA guidelines), opportunistic testing
  • Adequate availability of sexual health services - trained workforce to facility testing, treating, contact tracing
  • Reduce stigma / discrimination
20
Q

How can syphilis be prevented?

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A

Primordial - education, income, SES, social gradient
Primary - health promotion - safe sex, awareness, education, condoms, culturally safe
Secondary - screening and testing - antenatal, high-risk groups, opportunistic testing
Tertiary - early treatment - availability of health services, sexual health, trained workforce for testing, Tx, contact tracing

21
Q

What resources are available for public health management of syphilis?

Study These Flashcards
A

SoNG, DH protocol

22
Q

Who are key stakeholders?

Study These Flashcards
A

Treating clinician
Sexual health services and physicians

23
Q

Which cases should receive high priority?

Study These Flashcards
A

Urgent - pregnant with infectious syphilis
Very high - congenital
High - women of child bearing age (WCBA), FNs, partners of pregnant
Routine - male, women > 50, non-infectious

24
Q

What should be confirmed immediately in cases who are women of child bearing age?

Study These Flashcards
A

Pregnancy status

25
What information should be asked of cases?
Symptom onset Test results (including previous) Details of previous infection and treatment Apply case definitions
26
How should cases be managed?
**T** - clinician, test for other STIs, penicillin (IM Benzathine P) **I** - abstain from sexual activity until 5 days post Tx and Sx resolved **E** - transmission, Sx, prevention, contact tracing, F/U
27
How should contacts be identified?
Clinician, LPHU Risk exposures and contacts - partners, sex workers Sensitivity, collaboration, privacy
28
How should cases of pregnant syphilis be managed?
Examination and F/U with specialist, especially if treatment not adequate (30d before delivery, 4 x drop in RPR)
29
What is RPR?
Reactive plasma reagin Detects antibodies in response to infection. Not specific >> FPs
30
What is sensitivity?
True positives - the proportion of people with the disease who test positive. SnOUT - high sensitivity means low FNs therefore negative test rules out disease
31
What is specificity?
True negatives - the proportion of people with a negative test who test negative SpIN - high Sp means low FPs therefore positive test rules in the disease
32
What is required when investigating cases of congenital syphilis?
Investigate to identify factors for improvement Escalate for DPH Sexual health involvement IMT
33
What is required for First Nations cases?
Culturally safe support services Links to culturally safe services and care especially for contact tracing
34
What are contact definitions for syphilis?
All sexual contacts Primary - duration of illness + 3mo prior Secondary - duration of illness + 6mo prior Early latent - previous 12mo Late latent / tertiary - current partners **Different case definitions require different periods of contact tracing.**
35
Who does contact tracing?
Clinician / case LPHU can assist If patient led, F/U to ensure done / offer to assist
36
How are contacts managed?
**T** - clinical review, testing (incl for other STIs), repeat testing, presumptive treatment - 1, 2, early latent if contact within 3mo **I** - abstain from sex for 5 days after Tx **E** - transmission, symptoms, monitoring, safe sex
37
What has been the response to the current outbreak?
CDNA - MJOI since 2015 Nationally coordianted response - AHPC, CDNA, BBVSS National strategic approach - enhanced response
38
What has the national strategic approach been?
Enhanced response for disproportionately high rates of STI / BBV in First Nations people Obectives: 1. Control OB 2. Undertake opportunistic control efforts 3. Consider sustainable response
39
How is syphilis monitored?
National syphilis surveillance and monitoring plan, surveillance reports
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