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B - Gynaecology > Syphilis > Flashcards

Flashcards in Syphilis Deck (77)
1

What is syphilis?

An STI caused by Treponema pallidum

2

What type of organism is Treponema pallidum?

Spiochete gram-negative bacteria

3

How many cases of syphilis were diagnosed in the UK in 2015?

5,000

4

What is happening to the incidence of syphilis?

Increasing

5

What groups is incidence of syphilis markedly increasing in?

High risk groups e.g. MSM

6

What other conditions can be caused by other types of Treponemes?

- Bejel
- Yaws
- Pinta

7

What is Bejel?

A chronic skin and tissues disease

8

What is Yaws?

A disease of the bones and joints

9

What is Pinta?

A skin disease

10

How are other Treponeme diseases spread?

Any close contact but not mother to foetus

11

What does the increasing rates of syphilis in MSM suggest?

They still have high rates of condomless sex

12

How can syphilis be transmitted?

- Sexual transmission
- Mother to foetus via placenta
- Infected blood products

13

What is it called if a foetus gets syphilis across the placenta?

Congenital syphilis

14

How does Treponema pallidum enter the host?

Through breaks in the skin or intact mucous membranes

15

What forms at the site of contact in syphilis after an incubation period of 2-3 weeks?

Infectious hard ulcer (chancre)

16

What is the chancre in syphilis an indicator of?

The first stage of acquired symptomatic syphilis - Primary syphilis

17

What can happen if syphilis is left untreated?

T. pallidum can persist and cause systemic damage via obliterating arteritis

18

What is obliterating arteritis?

Where the endothelial cells of the vessels excessively proliferate causing lumen of the vessels to narrow

19

What can occur as a result of obliterating arteritis?

Ischaemia at the tissues supplied by the arteries which leads to symptoms associated with syphilis

20

What are the risk factors for syphilis?

- Unprotected sex
- Multiple partners
- MSM
- HIV infection

21

What are the two types of syphilis?

- Acquired
- Congenital

22

What are the forms of acquired syphilis?

- Asymptomatic (latent)
- Symptomatic

23

What are the stages of symptomatic syphilis?

- Primary
- Secondary
- Tertiary

24

What forms the basis of primary syphilis?

Chancre formation

25

How does the chancre form in primary syphilis?

A papule forms at the inoculation site which will ulcerate into a chancre

26

What is a chancre?

A painless ulcer that is usually singular, hard and non-itchy

27

When does a chancre develop after inoculation with syphilis?

9-90 days post infection

28

Where does the syphilis chancre present?

- Penis
- Scrotum
- Anus
- Rectum
- Labia
- Cervix

29

What is an atypical syphilis chancre?

- One that appears on unusual sites e.g. oral
- Multiple
- Painful

30

When do syphilis chancres typically heal?

Within 3-10 weeks with or without symptoms but can persist into secondary syphilis

31

When does secondary syphilis typically develop?

3 months post infection

32

What are the signs and symptoms of secondary syphilis?

- Skin rash
- Fever
- Malaise
- Arthralgia
- Headaches
- Condylomata lata
- Painless lymphadenopathy
- Silvery-grey mucous membrane lesions

33

What sort of skin rash develops in secondary syphilis?

Painless and non-itchy rash usually on the hands or soles of feet

34

What is condylomata lata?

Elevated plaque like warts on moist areas of the skin e.g. inner thighs, anogenital region and axillae

35

Where do secondary syphilis mucous membrane lesions form?

- Oral
- Pharyngeal
- Genital

36

What are some other manifestations of secondary syphilis?

Affecting kidneys or brain and many other sites

37

What happens after secondary syphilis?

The disease enters a latent asymptomatic phase

38

What is tertiary syphilis?

Syphilis that presents many years after the initial infection

39

How can tertiary syphilis be classified?

- Gummatous syphilis
- Neurosyphilis
- Cardiovascular syphilis

40

What happens in gummatous syphilis?

Granulomas can form in the bone, skin, mucous membranes of the upper respiratory tract, mouth and viscera or connective tissue

41

Are patients with gummatous syphilis infectious?

No

42

What can result from neurosyphilis?

- Tabes dorsalis
- Dementia
- Meningovascular complications
- Argyll Robertson pupil

43

What is tabes dorsalis?

- Ataxia
- Numb legs
- Absence of deep tendon reflexes
- Lightning pains
- Loss of pain and temperature sensation
- Skin and joint damage

44

What can be caused by syphilis dementia?

- Cognitive impairment
- Mood alterations
- Psychosis

45

What are the meningovascular complications of tertiary syphilis?

- Cranial nerve palsies
- Stroke
- Cerebral gummas

46

What is an Argyll Roberston pupil?

- Constricted
- Unreactive to light
- Reactive to accommodaiton

47

What can happen in cardiovascular syphilis?

- Aortic regurgitation
- Angina
- Dilation and calcification of the ascending aorta

48

What causes aortic regurgitation in cardiovascular syphilis?

Aortic vasculitis

49

What causes angina in cardiovascular syphilis?

Stenosis of the coronary ostia

50

What are the differentials for primary syphilis?

- Herpetic ulcers
- Chancroid
- Lymphogranuloma venereum
- Donovanosis

51

What are the differentials for the rash seen in secondary syphilis?

- Pityriasis rosea
- Viral exanthema

52

Why are the differentials for tertiary syphilis so variable?

The presentation is so variable

53

Who should tertiary syphilis be considered in?

Anyone with neurological or cardiac signs or symptoms

54

What tests are available for syphilis?

- Dark ground microscopy of chancre fluid
- PCR testing of swab from active lesion
- Serology
- Lumbar puncture

55

What does dark ground microscopy look for?

Spirochaete in primary syphilis

56

What serology tests can be used to look for syphilis?

- Treponemal tests
- Non-treponemal tests

57

What do treponemal serology tests do?

Assess for exposure to treponemes (not necessarily syphilis)

58

What are the treponemal tests used to look for syphilis?

- Treponemal ELISA
- TPPA or TPHA

59

What are the non-treponemal serology tests for syphilis?

RPR/VDRL

60

When are RPR/VDRL tests for syphilis highest?

In early disease

61

When can RPR/VDRL tests for syphilis results fall?

In successful treatment or advanced disease

62

When can false positive RPR/VDRL tests for syphilis results occur?

- Inflammatory diseases
- Pregnancy

63

Why may LP be useful for assessing for syphilis?

CSF antibodies are present in neurosyphilis

64

What drug is the treatment of choice for syphilis?

Penicillin

65

What should be considered in patients with syphilis and penicillin allergy?

Desensitisation

66

What is the first line regimen for early syphilis?

Benzathine penicillin 2.4 MU IM single dose

67

What is the first line regimen for late syphilis?

Benzathine penicillin 2.4 MU IM 3 doses at weekly intervals

68

How is neurosyphilis treated?

Procaine penicillin plus probenecid for 14 days

69

What additional management steps are required in syphilis?

- Advise to avoid any sex until treated
- Screen for other STIs
- Patient education
- Contact tracing
- Follow-up serology

70

What is the Jarisch Herxheimer reaction?

An inflammatory response to death of treponemes and results in a flu-like illness within 24 hours of treatment for syphilis

71

How is Jarisch Herxheimer reaction managed?

Supportive care and oral steroids in cardiovascular or neurosyphilis

72

How is syphilis detected in pregnancy?

Screening alongside HIV and Hep B at first antenatal appointment

73

Why is it important to screen for syphilis in pregnancy?

T. pallidum can cross the placenta or infect the baby during delivery

74

Why should women with syphilis in pregnancy be treated ASAP?

To reduce the risk of adverse outcomes

75

What are the risks of untreated syphilis in pregnancy?

- Miscarriage
- Stillbirth
- Pre-term labour
- Congenital syphilis

76

How severe is congenital?

Usually severe and debilitating

77

What can congenital syphilis present with?

- Saddle nose
- Rashes
- Fever
- Failure to gain weight