Syphilis

Primary Syphilis 

Introduction 

Syphilis is a sexually transmitted, systemic disease caused by the spirochete Treponema pallidum 

-It occurs in multiple overlapping stages: Primary, Secondary, Tertiary, and Latent syphilis. 

-Neurosyphilis can occur at any stage.

-It is contracted through direct sexual contact with primary or secondary lesions 

-Congenital syphilis can be contracted across the placenta.

Symptoms & Signs 

Syphilis passes through 4 distinct clinical phases:

  • Primary stage: one or more, usually painless chancres 
  • Secondary stage: rash, condylomata lata, with or without lymphadenopathy, and organ disease
  • Latent syphilis: absence of signs or symptoms of disease, with only reactive serologic tests as evidence of infection
  • Tertiary stage: cutaneous, neurologic, or cardiovascular manifestations.

-Infectious lesions of syphilis can be present anywhere on the body but are typically located in or around the genital, anal, or oral area

-Chancre: Dusky red macule which evolves into a papule, then an ulcer 

Diagnosis 

A diagnosis of syphilis of any stage should be confirmed through the use of two-stage serologic tests

Serologic tests are either nontreponemal, which measure anticardiolipin antibodies, or treponemal , which measure antibodies to T. pallidum

Nontreponemal tests:

  • VDRL—Venereal Disease Research Laboratory.
  • RPR—Rapid plasma reagin.

Treponemal tests:

  • EIA—Enzyme immunoassay.
  • TP-PA—T. pallidum particle agglutination.
  • FTA-ABS—Fluorescent treponemal antibody absorption.
  • MHA-TP—Microhemagglutination assay for T. pallidum.

– Lyme disease may cause a false-positive treponemal test but rarely causes a false-positive nontreponemal test.

-Test all patients with syphilis for HIV.

-Traditionally, a diagnosis of syphilis of any stage should be confirmed through the use of two-stage serologic tests.

-Dark-field microscopy is useful in evaluating moist cutaneous lesions

Treatment 

-Treatment of choice for all stages of syphilis: Benzathine penicillin

-The dose and duration depend on the stage 

-Penicillin allergy: Doxycycline, Ceftriaxone, Azithromycin

-Counsel patients to abstain from sexual activity for 7–10 days after treatment-The Jarisch–Herxheimer reaction: Fever and aggravation of the existing clinical picture in the hours following treatment. The reaction resolves spontaneously within 24 hours

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