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?

Rapid and sensitive but can yield false positives Signup and view all the answers

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

Nocturnal bone pain and radiologic abnormalities Signup and view all the answers

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

Lymphocytosis and pleocytosis Signup and view all the answers

Which clinical feature is typically NOT associated with general paresis?

Cranial nerve palsies Signup and view all the answers

What is the underlying mechanism that causes meningovascular syphilis?

Cerebrovascular thrombosis and infarction Signup and view all the answers

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

Syphilitic meningitis Signup and view all the answers

What neurological signs are characteristic of tabes dorsalis?

Loss of peripheral reflexes Signup and view all the answers

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

Aortic insufficiency Signup and view all the answers

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

Destructive changes in joints Signup and view all the answers

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

Late benign syphilis Signup and view all the answers

What distinguishes early latent syphilis from late latent syphilis?

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

What is a common characteristic of recurrent syphilitic skin lesions?

They are fewer in number and more firmly indurated than initial lesions. Signup and view all the answers

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

The patient may have latent syphilis, which can last a lifetime. Signup and view all the answers

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

Systemic lupus erythematosus Signup and view all the answers

Which of the following is characteristic of late benign syphilis?

It involves destructive lesions in skin, bone, and visceral organs. Signup and view all the answers

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

There is a risk of transmitting the infection to her fetus. Signup and view all the answers

Which option accurately describes the infectivity of late syphilis?

Late syphilis is mostly noninfectious, except in pregnant women. Signup and view all the answers

What presentation typically occurs in patients with secondary syphilis?

Confusion with infectious mononucleosis symptoms. Signup and view all the answers

What distinctive feature is associated with chancroid lesions?

Multiple shallow, ragged ulcers Signup and view all the answers

Which of the following microorganisms is primarily responsible for chancroid?

Haemophilus ducreyi Signup and view all the answers

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

Unilateral lymphadenopathy (bubo) Signup and view all the answers

What is the typical incubation period for chancroid?

3-5 days Signup and view all the answers

Which complication is associated with chancroid?

Phimosis and paraphimosis Signup and view all the answers

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

Chain-like configurations (school of fish) Signup and view all the answers

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

Amoxicillin 500mg three times daily for 7 days Signup and view all the answers

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

Phagedenic ulcer formation Signup and view all the answers

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

Single painless, clean-based indurated ulcer Signup and view all the answers

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

Diffuse non-pruritic indurated rash with superficial scales Signup and view all the answers

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

Painless chancre at the inoculation site Signup and view all the answers

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

Immune complex nephropathy with transient nephrotic syndrome Signup and view all the answers

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

Syphilis increases the risk of transmitting and contracting HIV Signup and view all the answers

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

9-90 days, usually around 21 days Signup and view all the answers

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

Raised, oval mucous patches covered by a grayish-white membrane Signup and view all the answers

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

Neurosyphilis with neurological complications Signup and view all the answers

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

Benzathine Penicillin G, 2.4 million units IM Signup and view all the answers

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

Doxycycline 100 mg orally twice daily for 28 days Signup and view all the answers

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

Aqueous crystalline penicillin G, 18-24 million units IV every 4 hours Signup and view all the answers

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

Aqueous crystalline penicillin G 100,000-150,000 units/kg/day Signup and view all the answers

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

Hutchison's teeth and rhagades around the mouth Signup and view all the answers

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

Increased risk for HIV acquisition by three to five times Signup and view all the answers

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

Ceftriaxone 2 gm daily IM/IV for 10-14 days Signup and view all the answers

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

At one week intervals for 3 doses Signup and view all the answers

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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Description

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.