Syphlis
Syphilis
Sexually transmitted disease
4 types
Primary syphilis
Firm and painless chancre/lesion on the penis
Inguinal lymphadenopathy- Non-suppurating generally
Usually resolves in 4 weeks even if untreated
This may progress to latent syphilis
Secondary syphilis
Fever
Headache
Aches and pain
Eczema looking rash or coppery rash maculopapular eruption on face, trunk, palm and soles. The rash is general, not itchy or painful
Patchy alopecia- scalp and outer 3rd of eyebrow
Condylomata lata- warty growth in skinfolds
Painless lymphadenopathy (Preauricular, Occipital, posterior cervical, axillary, inguinal)
Oral/ pharyngeal and genital ulcers
Snail track ulcer
Latent syphilis
Asymptomatic
Commonest presentation in Australia
Late syphilis
Granulomatous lesion- Gummas in any organ mainly cardiovascular and CNS
Complications
Gummas
Neurosyphilis (Cranial nerve palsy, tabes dorsalis, Dementia)
Aortic aneurysm
Increased risk of HIV infection
Dementia
Diagnosis
Nontreponemal (or nonspecific) serological tests for syphilis
Rapid plasma reagin (RPR) test
Venereal disease research laboratory (VDRL) test
This test is non-specific and could be falsely positive in conditions such as pregnancy and autoimmune diseases
The titre of a nontreponemal test provides an index of the activity of syphilis infection and is used to monitor response to treatment. The RPR titre should be repeated at 3, 6, and 12 months after treatment. A fourfold drop in titre 6 months following treatment is indicative of an adequate response to treatment.
Treponemal (or specific) serological tests for syphilis include:
- pallidum particle agglutination (TPPA)
- pallidum haemagglutination (TPHA)
Fluorescent treponemal antibody absorbed (FTA-ABS) test, and • enzyme immunoassay (EIA
The above test confirms the diagnosis.
Note: Syphilis serology be done as part of the routine STI screening in MSM (Men having sex with Man) and also needs to be considered in the Aboriginal community
Management
Primary, secondary or early latent syphilis
Benzathine penicillin 1.8 g (2.4 mU) IM as a single dose
OR
Procaine penicillin 1.0 g IM daily for 10 days
If penicillin allergic and not pregnant then,
Doxycycline 100 mg orally twice daily for 14 days†
Late latent or syphilis of unknown duration
Benzathine penicillin 1.8 g (2.4 mU) IM once weekly for three doses
OR
Procaine penicillin 1.0 g IM daily for 15 days
If penicillin allergic then
Doxycycline 100 mg orally twice daily for 28 days
Note:
Immediate treatment should be offered for sexual contacts of syphilis without waiting for the results of serology if sexual contact with a person with infectious syphilis occurred less than 90 days ago, as syphilis serology may still be negative. Contacts should be offered a single dose of intramuscular benzathine penicillin,
Contact tracing
Disease notification
