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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.

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SYPHILIS

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  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

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