syphilis
| Headline | |
|---|---|
| Etiology | Etio: Treponema pallidum, horizontal/vert transmission (via placenta). |
| Epidemiology | Men who have sex with men aged 25–34, 40% have HIV-1 co-infection (BASHH) |
| Clinical presentation | Incubation: 21d (9-90) → 4-10w to secondary infection. solitary painless chancre = local infection. Secondary: rash PCDS, lymphadenopathy, condylomata lata secondary: B s/s, vision changes; tertiary: cognitive ↓; sensory ataxia, Charcot joint, Argyll-Robertson pupil (tabes dorsalis); vasculitis Ddx: |
| Pathogenesis | |
| Diagnostic investigations | EIA: +ve = active/past infection (non-specific) ➥ TPPA: confirms T. pallidum ➥ RPR: measure of disease activity (↓ with treatment; ↑ with re-infection; serofast rxn = persistent +ve titre) ➥ Exclude herpes simplex, STI screen ➥ Dark ground microscopy: 3 –ve ⇒ cleared infection. Not routine. |
| Management | (in secondary care) ➥ Early (within 2y): benzathine penicillin 2.4 MU IM – 1 dose only ➥ Late: 1x/week, 3 doses ⚠ Jarisch-Heixheimer reaction within hours (endotoxin-like products released by bacterial lysis) – mx: paracet ➥ Allergic: doxy, macrolides ➥ ↑ risk HIV transmission ➥ Contact notification required: all partners since last –ve notif Complications: |
| Prevention |