CC Sept 2015 Latent and Tertiary Syphilis

echoecho's version from 2015-11-04 03:07


Question Answer
Syphilis, or infection with the spirochete Treponema pallidum may manifest itself in a number of ____?stages
How is primary syphilis characterized? Comment on serological testing early in the course of the disease?by the appearance of a painless ulcer (chancre) where the organism first entered the body (difficult to dx). Serological testing may be negative early in the course of the disease.
Comment on the rash that may occur in secondary syphilis?It is a non-pruritic, highly variable rash affecting the palms and soles, torso and face (occurs when the primary chancre is healing or when it has disappeared completely).
List constitutional symptoms?1) fever 2) LAD 3) weight loss 4) patchy hair loss 5) fatigue
Why is syphilis called the "great masquerader"?because of the broad range of clinical manifestations of syphilis and difficulty in establishing a clinical dx
If untreated, the symptoms of syphilis will eventually resolve, but the infection can then progress to what stages?latent and/or tertiary stages
Define latent syphilis?as serological evidence of infection without any other evidence of disease
Define early latent syphilis?if the primary infection occurred within the past year
An early latent syphilis diagnosis is made, if during the year prior to diagnosis, there was what 3 criteria?1) documented seroconversion or sustained (>2 weeks) 4 fold or greater increase in nontreponemal titer 2) unequivocal symptoms of primary or secondary infection 3) a sexual partner diagnosed with primary, secondary or early latent syphilis
Define late latent syphilis?characterized by an infection > 1 year prior to diagnosis
In late latent syphilis, seroconversion is defined by a > 4 fold increase in the titer of a nontreponemal test, give examples of a nontreponemal test?RPR or VDRL
*** Although the titers are typically ______ (lower vs. higher) in early latent than late latent syphilis, the levels themselves can't be used to distinguish between early and late syphilis?increase
Because of the frequency of co-infection, all pts with latent syphilis should be tested for what?HIV
Can patients with latent syphilis transmit the infection sexually? Why is treatment mandated?1) no 2) to prevent complications
What is the recommended treatment of latent syphilis?Penicillin (patients who are IgE-mediated penicillin-allergic should be desensitized and then treated with penicillin)
What are the options of treatment for pregnant women, individuals with congenital syphilis and neurosyphilis?Penicillin administration after appropriate allergic testing and desensitization is the only option
While alternative antibiotic regimens for primary, secondary and early latent syphilis have been used, data are lacking and no alternatives are recommended. Of these alternatives, the most established option in order of preference (with dosages) are?1) doxycycline (Doryx) 100 mg BID x 14 days 2) Tetracycline 500 mg QID x 14 days 3) Ceftriaxone (Rocephin) with no established optimal dose or duration of treatment
Why should Azithromycin (Zithromax) be avoided?because documented resistance has been identified in certain portions of the USA
What is the recommended treatment for early latent syphilis?Benzathine penicillin G (Bicillin LA) 2.4 million units IM in a single dose
What is the recommended treatment for late latent syphilis?Benzathine penicillin G 7.2 million units total, administered as three 2.4 million unit doses IM once weekly x 3 weeks
Patients with latent syphilis should have a CSF evaluation if any of what 3 conditions are present?1) neurological symptoms 2) evidence of active tertiary disease 3) serological treatment failure (persistent 4-fold elevation of tnon-treponemal serology despite adequate treatment program)
Follow up non-treponemal testing should be done at ___, ___, and ___ months?6, 12, 24
If the titers fail to decrease by 4-fold from baseline, what should be repeated?treatment
It is estimated that 1/3 of pts w/ untreated syphilis will progress to tertiary syphilis, true or false?true
In tertiary syphilis, why does a markedly inflammatory and destructive immune response occur?due to a persistent low level of T. pallidum
List the manifestations that tertiary syphilis can take?1) dermatological lesions (violaceous annular plaques similar in appearance to psoriatic plaques and/or destructive, granulomatous ulcers {gumma} 2) infection of the great vessels (typically the ascneding aorta along with aortic valve regurgitation. 3) invasion of the nervous system (neurosyphilis
List the symptoms of neurosyphilis?1) cognitive dysfunction 2) stroke 3) poor vision 4) personality changes 5) symptoms suggestive of meningitis
Later findings of neurosyphilis include?1) general paresis 2) tabes dorsalis (locomotor ataxia)
Can neurosyphilis occur at any stage of syphilis infection? Is neurosyphilis in itself diagnostic of tertiary syphilis?yes; no
All pts w/ tertiary syphilis should have what done to r/o neurological involvement?CSF exam
What is the treatment for tertiary syphilis that does not involve the CNS?Benzathine penicillin G 7.2 million units total, administered as 2.4 million units IM ONCE WEEKLY x 3 weeks
What is the treatment for neurosyphilis?Aqueous crystalline penicillin G 18-24 million units daily (administered as 3-4 million units) IV every 4 hours x 10-14 days
***True or false, there is limited information available about the most appropriate serologic and clinical f/u for pts dxed w/ tertiary syphilis?true
Consultation with what subspecialist is recommended if teritary syphilis suspected?infectious disease
*** SUMMARY = Latent syphilis is defined as?serological evidence of infection w/o any other evidence of disease
*** SUMMARY = Non-treponemal titers _____ (can vs. can't) be used to differentiate early and late latent syphilis?can't
*** SUMMARY = Individuals with latent syphilis _____ (can't vs can) transmit the disease sexually?can't
*** SUMMARY = Why is tertiary syphilis a markedly inflammatory and destructive immune response??a markedly inflammatory and destructive immune response due to a persistent low level of Treponema pallidum