Syphilis

Question 1

What bacteria causes Syphilis?

Answer 1

Treponema pallidum

Question 2

How is syphilis spread?

Answer 2

1. Direct contact with infected secretions

2. Transplacental passage of bacteria during pregnancy

Question 3

What happens in primary syphilis?

Answer 3

1. In earliest stages, the initial manifestation is the ‘chancre’
2. Chancre is a single, painless genital lesion
3. Regional lymphadenopathy is present

Question 4

What happens in secondary syphilis?

Answer 4

‘Desseminated disease’
1. Wide spread erythematous rash

2. Oral / genital mucous lesions named ‘conddylomata lata’ in the anogenital region

Question 5

What happens in tertiary syphilis?

Answer 5

‘Complications’
1. Gummatous lesions - granulomatous locally destructive lesions affecting skin and bone.

2. Cardiovascular involvement - aortitis, valvular abnormalities
3. Neurological involvement - meningitis. 8th nerve palsy, deafness

Question 6

Dx of syphilis

Answer 6

1. PCR

2. Serological tests looking for antibodies and specific tests

Question 7

Syphilis specific investigations (2)

Answer 7

1. Rapid plasma reagin

2. T. pallidum particleor haemogglutination assays ( TPPA)

Question 8

Faetal complications of syphillis

Answer 8

A
B 
C
D
E
S

Question 9

What does a high Rapid plasma regain mean?

Answer 9

1. Usually high RPR means active infection

2. RPR and/or TPPA will be positive long term, even after successful treatment.

Question 10

What indicates successful treatment of syphillis

Answer 10

4 fold drop in RPR indicates successful treatment.

Question 11

Tx of syphyllis

Answer 11

Penicillin – Benzathine penicillin

• Others – Doxycycline, Erythromycin, Azithromycin, Amoxycillin, Ceftriaxone

Question 12

Complication with Tx of syphillis

Answer 12

Jarisch-herxheimer reaction. – Acute febrile illness with treatment of syphilis.

Steroids are given in some instances prior to syphilis treatment, to prevent worsening of local infection (eg in eye and aorta involvement).

Question 13

What are the follow ups required for syphilis?

Answer 13

Sexual contacts should be traced and followed up

• Window period of 12 weeks
• Follow up post treatment until RPR is dropped by at least four fold and stable.