Syphilis and Its Complications Quiz
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Questions and Answers

What is a notable complication of gummas related to facial structures?

  • Septal perforations and disfiguring facial lesions (correct)
  • Increased risk of skin cancer
  • Hearing impairment
  • Loss of vision

Which of the following tests is most specific for confirming syphilis?

  • Direct Fluorescent Antibody (DFA)
  • FTA-ABS (correct)
  • RPR
  • VDRL

In which stage of syphilis is Dark Field Microscopy primarily utilized?

  • Secondary syphilis
  • Primary syphilis (correct)
  • Congenital syphilis
  • Late syphilis

Which of the following best describes non-treponemal tests like VDRL and RPR?

<p>Rapid and sensitive but can yield false positives (B)</p> Signup and view all the answers

What characterizes the bone involvement in late benign syphilis (gummas)?

<p>Nocturnal bone pain and radiologic abnormalities (B)</p> Signup and view all the answers

What is the characteristic cerebrospinal fluid (CSF) finding in asymptomatic neurosyphilis?

<p>Lymphocytosis and pleocytosis (B)</p> Signup and view all the answers

Which clinical feature is typically NOT associated with general paresis?

<p>Cranial nerve palsies (C)</p> Signup and view all the answers

What is the underlying mechanism that causes meningovascular syphilis?

<p>Cerebrovascular thrombosis and infarction (C)</p> Signup and view all the answers

In which condition does the cerebrospinal fluid typically show lymphocytic pleocytosis and elevated protein with normal glucose concentrations?

<p>Syphilitic meningitis (D)</p> Signup and view all the answers

What neurological signs are characteristic of tabes dorsalis?

<p>Loss of peripheral reflexes (A)</p> Signup and view all the answers

Which of the following is a primary complication of cardiovascular syphilis?

<p>Aortic insufficiency (C)</p> Signup and view all the answers

What is a common outcome in advanced cases of tabes dorsalis?

<p>Destructive changes in joints (A)</p> Signup and view all the answers

What type of syphilis is characterized by the formation of gummas?

<p>Late benign syphilis (B)</p> Signup and view all the answers

What distinguishes early latent syphilis from late latent syphilis?

<p>Early latent occurs within the first year post-primary or secondary lesions, while late latent does not have a time frame. (D)</p> Signup and view all the answers

What is a common characteristic of recurrent syphilitic skin lesions?

<p>They are fewer in number and more firmly indurated than initial lesions. (B)</p> Signup and view all the answers

What is the implication of a positive syphilis serology without clinical signs?

<p>The patient may have latent syphilis, which can last a lifetime. (C)</p> Signup and view all the answers

Which disease can occasionally cause false-positive results in nontreponemal tests for syphilis?

<p>Systemic lupus erythematosus (B)</p> Signup and view all the answers

Which of the following is characteristic of late benign syphilis?

<p>It involves destructive lesions in skin, bone, and visceral organs. (B)</p> Signup and view all the answers

What complication is most likely if a pregnant woman has late latent syphilis?

<p>There is a risk of transmitting the infection to her fetus. (D)</p> Signup and view all the answers

Which option accurately describes the infectivity of late syphilis?

<p>Late syphilis is mostly noninfectious, except in pregnant women. (D)</p> Signup and view all the answers

What presentation typically occurs in patients with secondary syphilis?

<p>Confusion with infectious mononucleosis symptoms. (C)</p> Signup and view all the answers

What distinctive feature is associated with chancroid lesions?

<p>Multiple shallow, ragged ulcers (B)</p> Signup and view all the answers

Which of the following microorganisms is primarily responsible for chancroid?

<p>Haemophilus ducreyi (B)</p> Signup and view all the answers

Which clinical manifestation is commonly observed in lymphogranuloma venereum during its secondary stage?

<p>Unilateral lymphadenopathy (bubo) (A)</p> Signup and view all the answers

What is the typical incubation period for chancroid?

<p>3-5 days (C)</p> Signup and view all the answers

Which complication is associated with chancroid?

<p>Phimosis and paraphimosis (D)</p> Signup and view all the answers

What is the appearance of the Gram stain for chancroid when examined under microscopy?

<p>Chain-like configurations (school of fish) (C)</p> Signup and view all the answers

Which of the following is NOT a treatment option for chancroid?

<p>Amoxicillin 500mg three times daily for 7 days (A)</p> Signup and view all the answers

What is a potential consequence of associated Vincent organism in chancroid patients?

<p>Phagedenic ulcer formation (B)</p> Signup and view all the answers

What is the characteristic appearance of a primary chancre in syphilis?

<p>Single painless, clean-based indurated ulcer (C)</p> Signup and view all the answers

Which of the following best describes the rash seen in secondary syphilis?

<p>Diffuse non-pruritic indurated rash with superficial scales (D)</p> Signup and view all the answers

Which of the following symptoms is NOT typically associated with secondary syphilis?

<p>Painless chancre at the inoculation site (A)</p> Signup and view all the answers

What complication may arise from untreated secondary syphilis involving the kidneys?

<p>Immune complex nephropathy with transient nephrotic syndrome (D)</p> Signup and view all the answers

What is the significance of performing HIV testing in patients with syphilis?

<p>Syphilis increases the risk of transmitting and contracting HIV (C)</p> Signup and view all the answers

What period range is considered as the incubation period for primary syphilis?

<p>9-90 days, usually around 21 days (D)</p> Signup and view all the answers

Which type of lesion may occur in approximately 30% of secondary syphilis patients?

<p>Raised, oval mucous patches covered by a grayish-white membrane (A)</p> Signup and view all the answers

Which of the following abnormalities is seen in late or tertiary syphilis?

<p>Neurosyphilis with neurological complications (B)</p> Signup and view all the answers

What is the recommended regimen for treating early latent syphilis in a patient without a penicillin allergy?

<p>Benzathine Penicillin G, 2.4 million units IM (B)</p> Signup and view all the answers

Which treatment regimen is recommended for latent syphilis in a patient allergic to penicillin?

<p>Doxycycline 100 mg orally twice daily for 28 days (C), Tetracycline 500 mg orally four times daily for 28 days (D)</p> Signup and view all the answers

What is the preferred regimen for treating neurosyphilis in a patient with no penicillin allergy?

<p>Aqueous crystalline penicillin G, 18-24 million units IV every 4 hours (D)</p> Signup and view all the answers

In cases of congenital syphilis, what is a recognized treatment regimen for proven disease?

<p>Aqueous crystalline penicillin G 100,000-150,000 units/kg/day (B), Procaine penicillin G 50,000 units/kg/dose IM for 10 days (D)</p> Signup and view all the answers

What are some well-known clinical manifestations of late congenital syphilis?

<p>Hutchison's teeth and rhagades around the mouth (B), Nerve deafness and interstitial keratitis (D)</p> Signup and view all the answers

What complication is associated with the presence of syphilis in patients who are HIV positive?

<p>Increased risk for HIV acquisition by three to five times (B)</p> Signup and view all the answers

Which alternative regimen should be considered for a patient with neurosyphilis who has a penicillin allergy?

<p>Ceftriaxone 2 gm daily IM/IV for 10-14 days (C)</p> Signup and view all the answers

Which duration is recommended for treating latent syphilis with Benzathine penicillin G?

<p>At one week intervals for 3 doses (D)</p> Signup and view all the answers

Flashcards

Primary Syphilis

A sexually transmitted infection characterized by a painless chancre at the site of infection, followed by a rash, fever, and swollen lymph nodes.

Secondary Syphilis

The second stage of syphilis, which occurs weeks or months after primary syphilis. It is characterized by a widespread rash, fever, sore throat, swollen lymph nodes, and hair loss.

Recurrent Syphilis

Recurrent skin lesions that reappear after the resolution of primary or secondary syphilis, though they may be fewer and more indurated.

Latent Syphilis

A stage of syphilis where the infection is present but no symptoms are evident, often lasting for years.

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Early Latent Syphilis

An early form of latent syphilis that occurs within the first year after the resolution of primary or secondary syphilis.

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Late Latent Syphilis

A later form of latent syphilis that occurs after the first year after the resolution of primary or secondary syphilis. It is usually not infectious, except for pregnant women.

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Tertiary Syphilis

The destructive phase of syphilis, characterized by lesions in the skin, bone, and internal organs.

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Neurosyphilis

A type of Tertiary Syphilis, affecting the cardiovascular system and the nervous system.

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Primary Syphilis Chancre

A painless, indurated ulcer that develops at the site of infection with Treponema pallidum. It typically appears 9-90 days after exposure.

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Condylomata Lata

Large, flat-topped papules that form in warm, moist areas like the perineum. These lesions are highly infectious.

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Mucous Patch

A slightly raised, oval area covered with a grayish white membrane, with a pink base. This lesion can be found in the mouth in patients with secondary syphilis.

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Syphilis

An infection with Treponema pallidum that can be transmitted sexually, from mother to baby, or rarely by other means. Syphilis increases the risk of getting HIV and spreading it.

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Late Benign Syphilis (Gumma)

Late stage syphilis characterized by the appearance of rubbery tumors (gummas) in various organs, including the respiratory, gastrointestinal, bones, larynx, lung, liver, and skin.

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Gumma's effect on the nose and palate

Gummas can cause septal perforations and disfiguring facial lesions when they affect the nose and palate.

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Bone involvement in Late Benign Syphilis

Involvement of the bones can lead to chronic bone pain, particularly at night.

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Radiological findings of Late Benign Syphilis

Radiological tests may reveal signs of periostitis, and lytic or sclerotic, destructive osteitis.

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Dark Field Microscopy for Syphilis

This test involves using a dark-field microscope to examine a sample from a syphilis chancre for the presence of Treponema pallidum.

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Asymptomatic Neurosyphilis

Neurosyphilis without any apparent symptoms, detectable through cerebrospinal fluid (CSF) abnormalities.

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Syphilitic Meningitis

An inflammation of the membranes surrounding the brain and spinal cord, caused by syphilis; can lead to cranial nerve palsies.

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Meningovascular Syphilis

Neurosyphilis involving blood vessels, leading to strokes (CVAs) due to inflammation and blockage of blood vessels.

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General Paresis

A chronic, progressive neurodegenerative disease caused by syphilis, affecting the brain and leading to mental decline, personality changes, and cognitive impairment.

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Tabes Dorsalis

A form of neurosyphilis affecting the posterior columns of the spinal cord, leading to loss of reflexes, impaired sensation, and ataxia (lack of coordination).

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Cardiovascular Syphilis

Syphilis affecting the heart, primarily causing aortic valve problems and aneurysm of the ascending aorta.

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What is the recommended treatment for early syphilis?

Penicillin G, the gold standard treatment, given intramuscularly in a single dose for early syphilis.

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What is the alternative treatment for early syphilis if the patient is allergic to penicillin?

Doxycycline, a tetracycline-class antibiotic, is used if the patient has a penicillin allergy. It is administered orally twice daily for 14 days.

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How is latent syphilis treated?

Three doses of benzathine penicillin G, given intramuscularly at one-week intervals.

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How is neurosyphilis treated?

Aqueous crystalline penicillin G intravenously every four hours for 10-14 days. This is given for more severe cases of neurosyphilis where the infection has reached the central nervous system.

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What is the alternative treatment for neurosyphilis in patients with penicillin allergy?

Ceftriaxone, a cephalosporin antibiotic, is given intravenously daily for 10-14 days. This is used for neurosyphilis in patients with penicillin allergy.

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How is congenital syphilis treated in infants?

Aqueous crystalline penicillin G, 100,000-150,000 units/kg/day, given intravenously every 12 hours for the first 7 days and then every 8 hours for 10 days.

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How does syphilis affect HIV risk?

Syphilis infection can increase the risk of acquiring HIV by three to five times.

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What is the connection between neurosyphilis and HIV?

Neurosyphilis, a serious complication of syphilis where the infection affects the central nervous system, is more common in individuals who are also HIV positive.

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What causes Chancroid?

Chancroid, a common genital ulcer, is caused by Haemophilus ducreyi, a small G-negative bacterium known for its characteristic shape resembling a "school of fish".

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What is the incubation period for Chancroid?

The incubation period for Chancroid is typically 3 to 5 days, meaning it takes that long for symptoms to appear after exposure.

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Describe the characteristic appearance of Chancroid ulcers.

Chancroid presents as multiple, painful ulcers with ragged edges, a soft base, and a tendency to bleed easily. These ulcers often ooze pus with a foul odor.

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What is a common complication of Chancroid?

A common complication of Chancroid is lymphadenopathy, where the lymph nodes in the groin area become inflamed and painful. These swollen nodes can even form pus-filled abscesses (buboes).

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How is Chancroid diagnosed?

Chancroid can be diagnosed by examining a smear of the ulcer under a microscope for the characteristic "school of fish" appearance of the bacteria.

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How is Chancroid treated?

Treatment for Chancroid typically involves antibiotics such as azithromycin, ceftriaxone, ciprofloxacin, or erythromycin.

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What causes Lymphogranuloma venereum?

Lymphogranuloma venereum (LGV), a sexually transmitted infection, is caused by a specific strain of Chlamydia trachomatis, particularly L1, L2, and L3.

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Describe the stages of LGV infection.

LGV infection manifests in three stages, beginning with a painless papule or ulcer at the site of inoculation, followed by painful, swollen lymph nodes in the groin area (buboes).

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Study Notes

Syphilis

  • Caused by Treponema pallidum.
  • Transmission routes include sexual contact, mother-to-child transmission (vertical), and rarely, other means.
  • Syphilis increases the risk of HIV transmission and acquisition.
  • HIV testing should be performed on all syphilis patients.

Taxonomy

  • Domain: Bacteria
  • Phylum: Spirochaetes
  • Order: Spirochetales
  • Family: Spirochaetaceae
  • Genus: Treponema
  • Species: pallidum

Stages of Syphilis

  • Primary Syphilis

    • Incubation period: 9-90 days, typically 21 days.
    • Develops at the site of infection.
    • Classically presents as a single, painless, clean-based, indurated ulcer with a firm, raised border.
    • Commonly found on anogenital areas, but can occur on other sites (tongue, pharynx, lips, fingers, nipples).
    • Non-tender regional adenopathy is common.
    • Darkfield microscopy is positive, but serology may still be negative.
    • Untreated, it heals in weeks, leaving a faint scar.

  • Secondary Syphilis

    • Occurs 6 weeks to 6 months after the primary chancre.
    • Characterized by a diffuse, non-pruritic, indurated rash, including palms and soles.
    • Can cause additional symptoms including fever, malaise, headache, sore throat, myalgia, arthralgia and generalized lymphadenopathy.
    • Can affect various organ systems (e.g., hepatitis, immune complex-mediated nephropathy, iritis/uveitis, periostitis).
    • Usually highly infectious.
    • Serological tests are positive in almost all cases.

  • Latent Syphilis

    • Marked by a positive serology but no visible signs.
    • Occurs after secondary syphilis resolves.
    • Divided into early and late latency periods.
      • Early: Within the first year following the resolution of secondary syphilis, or with a serological change from negative to positive during this period.
      • Late: After the first year is usually non-infectious unless the patient is pregnant.

  • Tertiary Syphilis

    • The destructive stage of syphilis, and it occurs after years of untreated initial stages.
    • Lesions develop in skin, bones, and visceral organs.
    • Types of lesions include gummas (nodules), neurosyphilis (affecting the central nervous system), and cardiovascular syphilis(affecting the heart).
    • Very infectious like other stages.

Neurosyphilis

  • Divided into five overlapping groups:
    • Asymptomatic neurosyphilis (CSF abnormalities)
    • Syphilitic meningitis ('aseptic meningitis') with CSF changes like lymphocytic pleocytosis, elevated protein, and normal glucose
    • Meningovascular syphilis (caused by vascular inflammation)
    • General paresis (chronic meningoencephalitis, causing altered mental status)
    • Tabes dorsalis (slowly progressive degenerative disease affecting posterior spinal columns)

Cardiovascular Syphilis

  • Primarily causes aortic insufficiency and ascending aorta aneurysm.
  • Due to obliterative endarteritis of the vasa vasorum.

Late Benign Syphilis (Gummas)

  • The most prevalent complication of late syphilis involving various body parts.
  • Present as superficial nodules or deep lesions that can form punched-out ulcers.

Tests for Syphilis

  • Darkfield Microscopy (primary syphilis)
  • VDRL, RPR (nontreponemal tests)
  • FTA-ABS, TPHA (treponemal tests)
  • Direct Fluorescent Antibody (DFA)

HIV/Syphilis Interactions

  • Syphilis increases the risk of HIV transmission and acquisition by three-to-five times.
  • Neurosyphilis may be more frequent in people with HIV.
  • Treatment failure may be more common in people with both illnesses.

Treatment

  • Benzathine penicillin G (usually administered as a single dose for primary, secondary, and early latent syphilis).
  • Doxycycline
  • Ceftriaxone
  • Azithromycin

Congenital Syphilis

  • Transmitted from mother to child.
  • Classified into early stage (within 2-8 weeks of birth) and late stage (onset at/near puberty). Early stage symptoms are similar to secondary syphilis (failure to thrive, lesions, skin rash, and lymphadenopathy). Late stage symptoms include nerve deafness, interstitial keratitis, and characteristic dental abnormalities (Hutchinson's teeth), bone abnormalities and perforations.

Chancroid

  • Caused by Haemophilus ducreyi.
  • Characterized by multiple, painful, shallow genital ulcers with ragged undermined edges, a soft base, and a tendency to bleed easily and ooze foul-smelling seropus.
  • Often associated with inguinal lymphadenopathy which may develop to suppuration (bubo) and give rise to sinuses.

Herpes Genitalis

Caused by HSV-2(90%). Mostly presents as recurrent, painful, erythematous, closely grouped vesicles which subsequently rupture to form polycyclic erosion.

Lymphogranuloma Venereum(LGV)

  • Caused by certain serovars of Chlamydia trachomatis.
  • Three clinical stages characterized by gradual progression.
  • First stage : Painless transient papules or ulcers at the site of inoculation
  • Second stage : Unilateral, painful enlargement of lymph nodes.
  • Third stage : Chronic inflammation, tissue destruction, and lymphatic obstruction.

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Test your knowledge on syphilis, including its stages, tests, and associated complications. This quiz covers key concepts like gummas, meningovascular syphilis, and cerebrospinal fluid findings. Perfect for medical students and healthcare professionals wishing to review their understanding of syphilis-related conditions.

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