- What is syphilis?
- A sexually transmitted infection (STI) caused by Treponema pallidum.
- Rationale: T. pallidum is a spirochete that spreads via direct contact with infectious lesions.
- 2. What are the stages of syphilis?
- Primary: Chancre (painless ulcer), lymphadenopathy.
- Secondary: Rash (palms/soles), mucocutaneous lesions, fever, lymphadenopathy.
- Latent: Asymptomatic, seropositive.
- Tertiary: Neurosyphilis, cardiovascular, gummatous disease.
- Rationale: Stages reflect systemic progression; tertiary involves irreversible damage.
- 3. How is syphilis diagnosed?
- Non-treponemal tests: RPR/VDRL (titers correlate with disease activity).
- Treponemal tests: FTA-ABS, TP-PA (confirmatory, remain positive lifelong).
- Rationale: Non-treponemal tests used for screening; treponemal for confirmation.
- 4. What is the treatment for primary/secondary syphilis?
- Benzathine penicillin G (2.4 million units IM × 1 dose).
- Rationale: Penicillin is the gold standard; alternatives (doxycycline) for penicillin-allergic patients.
- 5. How is latent syphilis treated?
- Early latent: Benzathine penicillin G (2.4 million units IM × 1 dose).
- Late latent: Benzathine penicillin G (2.4 million units IM × 3 doses, weekly).
- Rationale: Duration depends on risk of neurosyphilis; late latent requires prolonged therapy.
- 6. What is the treatment for neurosyphilis?
- Aqueous crystalline penicillin G (3–4 million units IV every 4 hours × 10–14 days).
- Rationale: High-dose IV penicillin ensures CNS penetration.
- 7. How is syphilis in pregnancy managed?
- Benzathine penicillin G (2.4 million units IM × 1 dose for early syphilis; 3 doses for late).
- Rationale: Prevents congenital syphilis; penicillin is safe in pregnancy.
- 8. What is the follow-up after treatment?
- Non-treponemal titers should decline 4-fold (or to normal) at 6/12/24 months.
- Rationale: Titers indicate treatment response; persistent elevation suggests failure.
- 9. Can syphilis be cured without treatment?
- No. Untreated syphilis progresses to severe complications (neurosyphilis, cardiovascular disease).
- Rationale: T. pallidum persists without treatment; no spontaneous cure.
- 10. What is the Jarisch-Herxheimer reaction?
- Acute febrile reaction (fever, myalgia, headache) within 24 hours of treatment.
- Rationale: Caused by endotoxin release from dying spirochetes; self-limited.
- 11. How is syphilis transmitted?
- Sexual contact, congenital (vertical transmission), blood transfusion (rare).
- Rationale: Primarily sexual; congenital syphilis is preventable with prenatal screening.
- 12. What is the role of HIV in syphilis?
- HIV co-infection may cause:
- Higher RPR/VDRL titers.
- Faster progression to neurosyphilis.
- False-negative treponemal tests (rare).
- Rationale: HIV alters immune response, complicating diagnosis and management.
- 13. Can syphilis be reinfection or relapse?
- Reinfection: New exposure, higher RPR titer.
- Relapse: Treatment failure, same or lower RPR titer.
- Rationale: Distinguishing requires clinical judgment and lumbar puncture if needed.
- 14. What is the role of lumbar puncture in syphilis?
- Indicated for:
- HIV co-infection.
- Persistent high titers after treatment.
- Neurological symptoms.
- Rationale: Rules out neurosyphilis, which requires longer treatment.
- 15. What are the challenges in syphilis diagnosis in HIV patients?
- False negatives: Prozone effect (excess antibodies inhibit detection).
- False positives: Autoimmune conditions, other infections.
- Rationale: HIV may suppress immune response, leading to atypical serology.
- Key Reference: CDC Guidelines for Sexually Transmitted Infections (2021).
- Rationale: CDC provides evidence-based recommendations for diagnosis and treatment.