1 / 13

SYPHILIS

SYPHILIS. Why syphilis?. B ACKGROUND. Treponema pallidum (spiralled spirochaete ) First epidemic in Europe in 15 century Incubation – 10-90 days (average 21 days) Recent outbreaks in MSM communities in Manchester and London (sauna + cruising) Often associated with HIV infection.

trisha
Download Presentation

SYPHILIS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SYPHILIS

  2. Why syphilis?

  3. BACKGROUND • Treponemapallidum (spiralled spirochaete) • First epidemic in Europe in 15 century • Incubation – 10-90 days (average 21 days) • Recent outbreaks in MSM communities in Manchester and London (sauna + cruising) • Often associated with HIV infection

  4. Transmission • Sexual – (primary) 30-50% infection rate • Accidental inoculation • Blood-borne – needle sharing, blood transfusion rare (screened, organisms die 90-120 hours at 4 degrees) • Transpacental (from 9/40) – more common in early syphilis

  5. Classification Acquired Congenital Early - <2 years Late - >2 years • Early - <2 years Primary, secondary and early latent • Late - >2 years Late latent and tertiary

  6. Classification • Primary – anogenital ulcer is syphilitic until proven otherwise (chancre) • Secondary – multisystem involvement within 2 years of infection • Early latent - <2 years. Positive serology with no clinical evidence • Late latent - >2 years. Positive serology with no clinical evidence • Tertiary – neurosyphilis, cardiovascular syphilis, gummatous syphilis

  7. Classification • Neurosyphilis – dorsal column loss (tabesdorsalis), dementia (general paralysis of the insane) or meningovascular involvement. • Cardiovascular – aortic regurgitation, aortic aneurism and angina • Gummatous– inflammatory nodules/ plaques that may be locally destructive

  8. DIAGNOSIS TPPA RPR EIA IgM/IgG PCR CLINICAL DIAGNOSIS ELISA

  9. DIAGNOSIS • Dark ground – for suspicious ulcers where empirical treatment not given – dark ground for 3 consecutive days • PCR – of swab if chancre in oropharynx or where dark ground unsuccessful • ELISA (IgG/IgM/IgA) – if positive then further testing needed • TPPA - specific treponal test to confirm ELISA • RPR – non specific test to aid staging of infection + monitor response to treatment • If suspect recent infection – ELISA IgM positive in those previously uneffected • Does not differentiate between other treponemal infection • Repeat all tests a week following positive results

  10. DIAGNOSIS

  11. TREATMENT • Benzathine penicillin 2.4 MU IM x 1 STAT • Amoxicillin 500mg TDS + Probenecid 500mg QDS PO for 14/7 • Penicillin allergy! Consider desensitisation Doxycycline 100mg BD x 21/7

  12. Partner notification • Primary – partners within last 3/12 • Secondary – partners within last 6/12 • Early latent – partners within last 2 years • Late – as many as you can remember! • Epidemiological treatments – all primary, secondary and early latent contacts. Serological testing at initial visit, 6/52 and 3/12

  13. BASICALLY, IT’S COMPLICATED DON’T BE AFRAID TO CONTACT YOUR FRIENDLY LOCAL GUM CONSULTANT

More Related