Syphilis Overview and Stages

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Questions and Answers

Which of the following is a characteristic dental finding in congenital syphilis?

Enamel hypoplasia

Hutchinson's teeth (correct)

Pear-shaped incisors

Mottled teeth

Which imaging investigation is primarily used to confirm the diagnosis of syphilis in its infectious stages?

Ultrasound

MRI

Dark field microscopy (correct)

CT scan

Which non-treponemal test is commonly used for screening syphilis?

Venereal Disease Research Laboratory (VDRL) (correct)

Fluorescent treponemal antibody absorption (FTA/ABS)

Treponema pallidum agglutination test (TPPA)

Rapid plasma reagin (RPR)

What is the preferred treatment for early syphilis according to WHO recommendations?

Benzathine penicillin Signup and view all the answers

Which condition is NOT considered in the differential diagnosis of a Chancre?

Chlamydia Signup and view all the answers

Which of the following neurological symptoms is associated with congenital syphilis?

Eighth nerve deafness Signup and view all the answers

What is a common orthopedic manifestation of congenital syphilis?

Scaphoid scapula Signup and view all the answers

Which treatment option is recommended for individuals allergic to penicillin?

Long-term oral tetracycline Signup and view all the answers

What is the primary method of transmission for syphilis?

Sexual contact with an infected partner Signup and view all the answers

Under which conditions can Treponema pallidum be transmitted congruently?

Through transplacental route from mother to unborn child Signup and view all the answers

Which characteristic motion is typical of virulent Treponema pallidum observed under dark-field microscopy?

A rotatory motion with flexion and backward movement Signup and view all the answers

What describes a typical primary chancre associated with syphilis?

It is a painless ulcerated lesion up to 1 cm in diameter Signup and view all the answers

What is the typical appearance of skin eruptions in the secondary stage of syphilis?

Symmetrical macular lesions that later become papular Signup and view all the answers

Which feature is NOT typically associated with late syphilis skin lesions?

Macerated erythema around the lesions Signup and view all the answers

What is the incubation period for the primary stage of syphilis?

9-90 days Signup and view all the answers

Gummas in late syphilis are characterized by which of the following?

Granulomatous areas that lead to poorly healing ulcers Signup and view all the answers

Study Notes

Syphilis

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum.
It can be acquired through sexual contact, contaminated blood transfusions and congenital transmission.
The bacterium is a motile, corkscrew-shaped prokaryote with a flexible, helically coiled cell wall.
It is microscopically indistinguishable from other treponemes that cause pinta and yaws.
Syphilis is a major public health problem in many parts of the world.

Stages of Acquired Syphilis

Primary stage:
- After an incubation period of 9-90 days, a primary chancre develops at the site of inoculation.
- The chancre is an ulcerated, painless, button-like lesion up to 1 cm in diameter.
- It is often found in the genital area, but oral and anal chancres are also common.
- It is accompanied by local lymphadenopathy.
- The chancre lasts for about 6 weeks then heals leaving an inconspicuous scar.
Secondary stage:
- May occur while the chancre is still present or soon after it heals.
- Systemic symptoms and a generalized lymphadenopathy develop.
- Skin eruptions ranging from macular to papular appear, are symmetrical, and have a coppery-brown color.
- Lesions are often found on the palms and soles, with annular lesions also common.
- Moist papules known as condylomata lata may appear in the genital and anal areas.
- Other symptoms include moth-eaten alopecia and mucous patches in the mouth.
Late stage:
- Characterized by granulomatous areas called gummas.
- Gummas in the skin break down and leave punched-out ulcers that heal poorly, leaving papery white scars.

Stigmata of Congenital Syphilis

Hutchinson teeth
Gummas in nose or palate
Mulberry molars
High-arched palate
Saddle nose
Frontal bossing
Periostitis
Short maxilla
Dactylitis
Protuberant mandible
Clutton's joint
Saber shins
Scaphoid scapula
Thickened medial clavicle
Eighth nerve deafness
Neurosyphilis
Gummas
Hepatomegaly
Splenomegaly

Differential Diagnosis

Chancre:
- Chancroid (multiple and painful), herpes simplex, anal fissure, cervical erosions.
Secondary Syphilis:
- Measles, rubella, drug eruptions, pityriasis rosea, lichen planus, psoriasis.
- Condyloma lata: genital warts, haemorrhoids.
- Oral lesions: aphthous ulcers, candidiasis.
Late Syphilis:
- Bromide and iodide reactions, other granulomas, erythema induratum.

Investigations

Serological tests:
- Non-treponemal tests (VDRL) are used for screening and assessing treatment response.
- Treponemal tests (RPR, FTA-ABS) are specific and remain positive for life, so not useful for monitoring treatment.
Microscopy:
- Dark-field microscopy can be used to identify spirochetes in smears from chancres, oral lesions, or moist areas of a secondary eruption.

Treatment

Penicillin is the treatment of choice for syphilis, with long-term high-dose oral erythromycin and tetracycline being effective alternatives for those with penicillin allergies.
Treatment should follow current WHO recommendations.

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Description

This quiz covers essential information about syphilis, including its causative agent, transmission methods, and the stages of the disease. Learn about the primary and secondary stages of syphilis along with their symptoms and characteristics. Test your knowledge on this significant public health issue.