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38 Cards in this Set

  • Front
  • Back
Treponema Pallidum, motile spirochete
(replicates q30min)
enters through breaks in skin or mucous membranes
Syphilis risk of acquisition of syphilis
from an infected 30-60%
Primary Syphilis
first sign occurs 10-90days after exposure (average 21 days)
Secondary Syphilis
begins 3wks to 6mo after primary inoculation
Primary Syphilis
clinical manifestations
painless papule appears at site of inoculation
incase to 0.5-1.5cm and ulcerates into a chancre (indurated and firm), no exudate seen
Secondary Syphilis
clinical manifestations
system involvement-
flulike symptoms
highly variable rash
generalized lymphadenopaty,
Condyloma lata lesions
Condyloma lata
large rasised whitish or gray lesions,
commonly seen in are adjacent to primary chancre,
loaded with spirochetes
Early latent syphilis
less than 1 yr duration,
usually asymptomatic
potentially infectious for 4 yrs
need documented seroconversion or hs or unequivocal signs of primary or secondary syphilis
Late latent syphilis
greater than 1 yr duration, or duration unknown; if asymptomatic and lesion-free, not infections
Tertiary syphilis
15-30yrs after initial infection,
neurosyphilis, gumma formation, cardiovascular diseease,
Gumma formation
in syphilis: subcuatenous process of chronic and progressive inflammation.
granulomatous lesion, most commonly involves skin and bones
Primary syphilis
darkfield exam (characteristic corkscrew organism with spiraling motion that undulates about midpoint)-obtain specimen from chancre
need 3 neg exams to be negative
Non-treponemal test
eg. four-fold change in titer to a change of two doubling dilutions 1:8 to 1:32
*primary s. have high viral loads 1:256 reactic serofast reaction
False negative non-treponal tests
leprosy, malaria,lupus, vaccines,pregnancy, narcotic addiction
False positive
occur 1-2%, provider needs to prove patient doesn't have syphilis
Treponemal tests
FTA-ABS 90-95% sensitive
and MHA-TP 80-85% sensitive
tests indicate present or past infection
When to screen for syphilis
Suspicious lesion,
suspicious rash, pregnant women, presence of other STI, risk factors for syphilis
Syphilis, Primary&Secondary
Benzathine PCN G 2.4 millin units IM in single dose;
mayse use doxyciline for 14 days in non-pregnant PCN sensitive patients
Syphilis, Latent
early latent: Benzathine PCN G 2.4 million units IM x1;
late latent: Benzathine PCN G 2.4 million units IM 1/week x3weeks
Syphilis-treat presumptively?
presumptively treat if exposed within 90 days, even is serologic testing is neg.
Patient Education
avoid safe until both pt and partner have completed treatment; HIV testing; follow-up
Jarisch-Herxheimer Reaction
can occur after treatment of syphilis;
occurse several hrs after treatment
symptoms last 24-48hrs: fever,malaise, HA, myalgia, nausea, tachycardia, chancre may swell or develop sympotoms of disease for first time
cause: rapid relase of treponemal antigens
(endotoxin reaction)
clinical and serologic testing at 3 and 6 mo.
need to see 4fold decrease at 6 mo.-
if not HIV test/CSF test +retreat
repeat CSF examination q6mo until titer is normal
if not decreased by 6mo. or nl at 2 years--retreat
Syphilis and HIV disease
repeat nontreponemal testing at 1,2,3, 6, 9 and 12 mo.
CSF eval 6mo after treatment or if you don't see 4-fold decrease by 3 months
Congenital syphilis
most infants borth to women with primary or secondary syphilis;
manifest 10-14 days after birth, rash copious nasal DC,
small slowly growing double DNA virus can infect epithilial surface and mucous membranes,
HPV "high risk types"
contain genome sequence with oncogenic activity
(16 and 18)
Can HPV vaccine be give with an abornmal PAP?
Can HPV vaccine be give with visible warts?
Can HPV vaccine be give with breastfeeding?
Can HPV vaccine be given in pregnancy?
Not recommended
HPV vaccine dosing
3 doses
2nd dose 2 months after 1st,
3rd dose 6 months afer 1st
What strains of HPV does Gardisil prevent?
HPV 6, 11,16, and 18
What ages is HPV vaccine recommended for?
Treatment options for HPV
cryotherapy, laser therapy, surgery,
Podofilix (self-treatment),
Imiquimod (cream self-treatment)
Tricholoracetic acid (TCA only treatment available for pregnancy)
Treatment options for HPV in pregnancy
Tricholoracetic acid (TCA only treatment available for pregnancy)
Note: never podophyllin or 5FU