CMN 572 ACTUAL COMPREHENSIVE QUESTIONS
AND ANSWERS SET A+
✔✔primary syphillis - ✔✔Primary lesion or "chancre" develops at the site of inoculation.
Chancre
Progresses from macule(flat) to papule (raised) to ulcer;
Typically painless, indurated, and has a clean base;
Highly infectious;
Heals spontaneously within 3 to 6 weeks; and
Multiple lesions can occur.
Regional lymphadenopathy: classically rubbery, painless, bilateral
Serologic tests for syphilis may not be positive during early primary syphilis.
✔✔Secondary syphilis - ✔✔Secondary lesions occur several weeks after the primary
chancre appears; and may persist for weeks to months.
Primary and secondary stages may overlap
Mucocutaneous lesions most common
Clinical Manifestations:
Rash (75%-100%)
Lymphadenopathy (50%-86%)
Malaise
Mucous patches (6%-30%)
Condylomata lata (10%-20%)
Alopecia (5%)
Liver and kidney involvement can occur
Splenomegaly is occasionally present
Serologic tests are usually highest in titer during this stage.
,✔✔latent syphilis - ✔✔Host suppresses infection, but no lesions are clinically apparent
Only evidence is a positive serologic test
leads to cardiovasuclar syphlis & gummatous lesions
Early latent: <1 year duration
Late latent: >1 year duration
✔✔Neurosyphilis - ✔✔Occurs when T. pallidum invades the central nevous system
(CNS)
May occur at any stage of syphilis-Can be asymptomatic
Clinical manifestations:acute syphilitic meningitis, meningovascular syphilis, and ocular
involvement
Clinical manifestations can include general paresis, tabes dorsalis, and ocular
involvement
Ocular involvement can occur in early or late neurosyphilis
✔✔congenital syphilis risks to newborn, transmission, severity - ✔✔May lead to
stillbirth, neonatal death, and infant disorders such as deafness, neurologic impairment,
and bone deformities
Transmission can occur during any stage of syphilis; risk is much higher during primary
and secondary syphilis
Fetal infection can occur during any trimester of pregnancy
Wide spectrum of severity exists; only severe cases are clinically apparent at birth [perf
palate, hutchinsons teeth (indent on biting suface), mucous patches]
Early lesions (most common): Infants <2 years old; usually inflammatory
Late lesions: Children >2 years old; tend to be immunologic and destructive
✔✔diagnostic labs to confirm syphilis - ✔✔Identification of Treponema pallidum in lesion
exudate or tissue:
Darkfield microscopyor serologic tests:
Serologic tests to allow a presumptive diagnosis
Nontreponemal tests
Treponemal tests
, Titers usually correlate with disease activity and results are reported quantitatively-
Titers should not be used to assess treatment response
✔✔indications of CSF exam from syphilis - ✔✔Neurologic or ophthalmic signs or
symptoms
Evidence of active tertiary syphilis (e.g., gummatous lesions)
Treatment failure
HIV infection with a CD4 count ≤350
✔✔diagnosis of neurosyphilis - ✔✔Reactive serologic test results
Abnormalities of CSF cell count or protein
A reactive VDRL-CSF with or without clinical manifestations-gold standard
✔✔treatment for primary, secondary, early laten syphilis: - ✔✔Benzathine penicillin
intramuscularly in a single dose
If penicillin allergic (non-pregnant):
Doxycycline or Tetracycline
pregnancy- treat with penicillin according to stage of disease
*higher doses & frequency for treatment of late latent syphilis
✔✔Jarisch-Herxheimer Reaction - ✔✔Fever, malaise, nausea/vomiting; may be
associated with chills and exacerbation of secondary rash-Occurs within 24 hours after
therapy
Not an allergic reaction to penicillin
Antipyretics can be used to manage symptoms
Pregnant women should be informed of this possible reaction, that it may precipitate
early labor, and to call obstetrician if problems develop
✔✔Syphilis: Follow-up titers - ✔✔Follow-up titers should be compared to the
nontreponemal titer obtained on day of treatment.
Primary, secondary, and early latent syphilis require quantitative VDRL or RPR at six
and 12 months.
✔✔pregnancy screening recommendations for syphilis - ✔✔Screen pregnant women at
least at first prenatal visit, high prevalence communities, or patients at risk
Test twice during the third trimester, at 28 weeks, and at delivery, in addition to routine
early screening.
Any woman who delivers a stillborn infant after 20 weeks gestation should be tested for
syphilis.
AND ANSWERS SET A+
✔✔primary syphillis - ✔✔Primary lesion or "chancre" develops at the site of inoculation.
Chancre
Progresses from macule(flat) to papule (raised) to ulcer;
Typically painless, indurated, and has a clean base;
Highly infectious;
Heals spontaneously within 3 to 6 weeks; and
Multiple lesions can occur.
Regional lymphadenopathy: classically rubbery, painless, bilateral
Serologic tests for syphilis may not be positive during early primary syphilis.
✔✔Secondary syphilis - ✔✔Secondary lesions occur several weeks after the primary
chancre appears; and may persist for weeks to months.
Primary and secondary stages may overlap
Mucocutaneous lesions most common
Clinical Manifestations:
Rash (75%-100%)
Lymphadenopathy (50%-86%)
Malaise
Mucous patches (6%-30%)
Condylomata lata (10%-20%)
Alopecia (5%)
Liver and kidney involvement can occur
Splenomegaly is occasionally present
Serologic tests are usually highest in titer during this stage.
,✔✔latent syphilis - ✔✔Host suppresses infection, but no lesions are clinically apparent
Only evidence is a positive serologic test
leads to cardiovasuclar syphlis & gummatous lesions
Early latent: <1 year duration
Late latent: >1 year duration
✔✔Neurosyphilis - ✔✔Occurs when T. pallidum invades the central nevous system
(CNS)
May occur at any stage of syphilis-Can be asymptomatic
Clinical manifestations:acute syphilitic meningitis, meningovascular syphilis, and ocular
involvement
Clinical manifestations can include general paresis, tabes dorsalis, and ocular
involvement
Ocular involvement can occur in early or late neurosyphilis
✔✔congenital syphilis risks to newborn, transmission, severity - ✔✔May lead to
stillbirth, neonatal death, and infant disorders such as deafness, neurologic impairment,
and bone deformities
Transmission can occur during any stage of syphilis; risk is much higher during primary
and secondary syphilis
Fetal infection can occur during any trimester of pregnancy
Wide spectrum of severity exists; only severe cases are clinically apparent at birth [perf
palate, hutchinsons teeth (indent on biting suface), mucous patches]
Early lesions (most common): Infants <2 years old; usually inflammatory
Late lesions: Children >2 years old; tend to be immunologic and destructive
✔✔diagnostic labs to confirm syphilis - ✔✔Identification of Treponema pallidum in lesion
exudate or tissue:
Darkfield microscopyor serologic tests:
Serologic tests to allow a presumptive diagnosis
Nontreponemal tests
Treponemal tests
, Titers usually correlate with disease activity and results are reported quantitatively-
Titers should not be used to assess treatment response
✔✔indications of CSF exam from syphilis - ✔✔Neurologic or ophthalmic signs or
symptoms
Evidence of active tertiary syphilis (e.g., gummatous lesions)
Treatment failure
HIV infection with a CD4 count ≤350
✔✔diagnosis of neurosyphilis - ✔✔Reactive serologic test results
Abnormalities of CSF cell count or protein
A reactive VDRL-CSF with or without clinical manifestations-gold standard
✔✔treatment for primary, secondary, early laten syphilis: - ✔✔Benzathine penicillin
intramuscularly in a single dose
If penicillin allergic (non-pregnant):
Doxycycline or Tetracycline
pregnancy- treat with penicillin according to stage of disease
*higher doses & frequency for treatment of late latent syphilis
✔✔Jarisch-Herxheimer Reaction - ✔✔Fever, malaise, nausea/vomiting; may be
associated with chills and exacerbation of secondary rash-Occurs within 24 hours after
therapy
Not an allergic reaction to penicillin
Antipyretics can be used to manage symptoms
Pregnant women should be informed of this possible reaction, that it may precipitate
early labor, and to call obstetrician if problems develop
✔✔Syphilis: Follow-up titers - ✔✔Follow-up titers should be compared to the
nontreponemal titer obtained on day of treatment.
Primary, secondary, and early latent syphilis require quantitative VDRL or RPR at six
and 12 months.
✔✔pregnancy screening recommendations for syphilis - ✔✔Screen pregnant women at
least at first prenatal visit, high prevalence communities, or patients at risk
Test twice during the third trimester, at 28 weeks, and at delivery, in addition to routine
early screening.
Any woman who delivers a stillborn infant after 20 weeks gestation should be tested for
syphilis.
