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31 Cards in this Set
- Front
- Back
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What are the 3 genera under the order of Spirochaetales?
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Leptospira, Treponema, Borrelia
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FACT: No one knows why syphilis evolves in the fashion that it does
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FACT: trepnomea pallidum is tranferred ONLY human to human (we're the only source)
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Does syphilis have flagella? Where?
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Yes, they are under the outer membrane, moves around looking like someone in a potato sac, so it does not swim gracefully
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What does a VDRL stand for? What does this test reflect?
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Venerial Disease Research Laboratory [of CDC] or otherwise known as an RPR (rapid plasma reagen test). It reflects antibody to cardiolipin (phosphatidylcholine)
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How does treponema get their cardiolipin?
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They don't make it, yet its an important part of their constituents. They incorporate it from mamallian tissue and alters it slightly as it does it. Therefore, when we make antibody to this its like we're making autoantibody.
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What other disease will have a positive VDRL test? (a positive antibody to cardiolipin)
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SLE (systemic lupus erethymatous), as reflected by the autoimmune response to make antibodies to the body's own cardiolipin
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FACT: appearance where things were inocculated during sexual intercourse appears as a nodular thing, starting to break down in the center,
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FACT: one case of syphilis implies there is at least one more case out there (because it doesn't come from nowhere)
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Describe the syphilitic lesion (chancre)
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Syphilitic lesion (chancre) is painless, raised border, quite clean, well-demarcated
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How would you detect primary lesion in women of syphilis?
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It almost is NEVER detected unless by public health measure means (when you call in all sexual contacts of a person who has been found to have it, to then get them checked out)
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From the time of inocculation to the appearance of the primary lesion of syphilis is how long?
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2-3 weeks, because treponema pallidum is very slowly dividing (24 hours)
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FACT: you can find these primary syphilitic lesions in any errogenous zone
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FACT: During the primary lesion phase, the treponema starts to spread hematogenously everywhere, then the entire thing comes under control.
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In what cases may the primary lesion of syphilis be hidden?
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In women (vagina, labia) and in bisexual men (in the anus), and is generally then not diagnosed at this stage
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Why don't the secondary lesions open up an ulcerate like the first one?
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Because there is some degree of immunity at this point. All these skin lesions in secondary syphilis are like modified chancres because you have some degree of immunity, so these ones won't open up and ulcerate
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Describe onset of secondary lesion as compared to disappearance of first lesion...
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Primary lesions tend to go away from 3-4 weeks, whereas secondary lesion appears over a period of 4-6 weeks (so, you can have a period of no lesion whatsoever, or you can have both on their at the same time as to say your secondary lesions can come up while your primary is still there, most of them don't happen this way)...a range of things
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Secondary lesions main lesions recognized are in the ______
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skin
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What is the BEST way to diagnose syphilis?
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Dark field microscopy
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FACT: Think about secondary syphilis as disseminated disease, clinical manifestations are generally the skin
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FACT: syphilis also causes allopecia (secondary, disseminated stages)
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Where do the older clinicians automatically look if they suspect someone with syphilis? Why?
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to the palms of hands and soles of feet, because syphilis is one of the few diseases which will have lesions in these places
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FACT: secondary syphilis may cause syphilitic arthritis, and most importantly these organisms go into the CNS
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FACT: Your control of your primary lesion obviously wasn't very good since it progressed onto secondary
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What happens to secondary syphilis in the absence of treatment?
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Under a period of 3-4-5 weeks, that comes under control and goes away. Secondary syphilis always comes under cure, this is called LATENT SYPHILIS AT THIS POINT (called latent because it WILL come back as tertiary syphilis).
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What is the rule of thirds? When does it apply?
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This applies once latency is reached. 1/3 will progress to form tertiary disease, 1/3 eradicate the disease alltogethe, and the other 1/3 keep the positive antibody tests (suggest disease is just smoldering along...latent syphilis)
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So, with tertiary disease, in the absence of treatment, late recurrence in 1/3 of patients, 6 to 40 years after initial infection. What is the exception to this?
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In HIV/AIDS patients! They develop EARLY neuro-syphilis
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What are the three types of Tertiary disease of syphilis?
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1) Benign (not really seen), 2) cardiovascular (not really seen), 3) neurologic (IS SEEN!)
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How do you diagnose primary syphilis?
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Dark field microscopy!
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What is a gumma? When is it seen?
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A gumma s a large, immunologically mediated, granolomatous lesion of skin, liver, testis, hard palate (large collection of lymphocytes and macrophages) seen in the benign form of tertiary syphilis
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What antibody does the VDRL (aka RPR) detect?
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antibody to cardiolipin, called a non-treponemal test even though this is FALSE (this is treponemal, because the organism made the cardiolipin a part of its own!)
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FACT: Presence of antibody to cardiolipin (+ RPR) indicates activity (as you can imagine this subsides during the quiescent phases of the disease)
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UNDERSTAND THE JARISCH HERXHEIMER REACTION
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WHY IS MHA-TP antibody test not useful diagnostically?
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Because it remains positive for life!!!! Not helpful to make a diagnosis, only helpful to exclude syphilis. Therefore, you use the RPR and MHA-TP TOGETHER!
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Interpret a + RPR, but a negative MHA-TP for a secondary lesion like person
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ITS SOMETHING ELSE (because both tests are 100% at this point in secondary), if it were primary lesions and you got these results, well it could still be syphilis (because 85% for RPR, 90% + for persons with primary syphilis in the MHA-TP)
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What is used to treat syphilis?
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Penicillin
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What happens in Jeresch Herxheimer reaction?
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4 hours after giving penicillin, they start an enormous febrile reaction (up to like 104), got chills, sweats, headaches, and his lesions flare up all over. During the 4-12 hours after you take the antibiotic, there is a tremendous reaction to it. Thought to be that you are lysing treponemas throughout the body, releasing treponemal constituents and your body is producing reactions to it
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