Syphilis

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Syphilis is caused by which type of bacteria? what is its shape?
Treponema Pallidum Subspecies Pallidum
Very thin spirochaete (spiral shaped)
Gram negative but difficult to see on stain as it is so thin
What is the timing of onset, and classical signs and symptoms of primary syphilis?
3-90 days (ave 21 days) post contact
Single or multiple painless non pruritic genital "chancres" +/- unilateral inguinal lymphadenopathy
When does secondary syphilis present and what is its classical presentation
21-90 days, widespread maculopapular erythematous rash particularly affecting palms, soles of feed and dorsum of hands, condyloma lata (wartlike genital lesions), malaise, fever, lympadenopathy, hepatitis, tonsillitis,
What are the three types of tertiary syphilis
1. Cardiovascular eg aortitis
2. Gummatous - visceral mass lesions or dermal ulcers
3. Neurological - Tabes Dorsalis or General Paresis of the Insane
When does neurosyphilis occur?
It can occur at any time, as demonstrated by clinical or serological evidence of neurological involvement
What 2 types of blood tests should you do to investigate syphilis (with an example of each) and which is better for monitoring response to treatment?
One of both
1. Non Treponemal - eg Rapid Plasma Reagin RPR or Venereal Disease Reference Laboratory VDRL
2. Treponemal eg Enzyme Immunoassay EIA or Fluorescent Treponemal Antibody absorption tests FTA-ABS
Non treponemal tests like RPR are quantitative, they give a titration, and therefore can be repeated to monitor response to treatment with a 4 fold decrease suggesting success. (treponemal antibody tests are either reactive or non reactive and also tend to persist post treatment
What are the possible CSF results suggesting neurosyphilis
Protein >0.45
Lymphocytosis >5
Any positive serological test
1. Non treponemal - eg RPR, VDRL
2. Treponemal eg EIA, FTA-ABS
What are the 3 respective treatments for early syphilis, late syphilis, and neurosyphilis
Early syphilis - 1 * IM Benzathine
Late syphilis - 3 * weekly IM Benzathine
Neurosyphilis - 4 hourly IV benzylpenicillin for 14 days
Can you be reinfected with syphilis after succesful treatment?
Yes,
The RPR or VDRL would be particularly useful to monitor changing titres in the event of reinfection or treatment failure
Syphilis was unleashed upon the world due to the wrath of which Olympian god?
Apollo, as detailed in "Syphilis Sive Morbus Gallicus" by Dr Girolamo Fractostoro in 1530