NU 545 Exam -QUESTIONS WITH ALL
CORRECT ANSWERS!!
Know all STIS: pathophysiology, etiology, clinical manifestations, diagnostic tests,
treatment, and complications. How is each transmitted during pregnancy to the fetus?
Know the different stages of syphilis; what organism causes each STI and is it viral,
bacterial etc.?
Do you treat both partners and why? What age group has the greatest risk of STIs and
why? What causes cervical cancer
FOUR STAGES OF SYPHILLIS
Primary Syphilis (incubation period ranges from 12 days to 12 weeks average of three weeks):
Local bacterial invasion: multiplies in epithelium and produces a granulomatous
tissue (chancre) at the
site > Consider syphilis with any open lesion
• Chancre (eroded, painless, firm and indurated ulcer <2cm in diameter)
• Some microorganisms drain with lymph into adjacent lymph nodes.
• Cell-mediated and humoral immune responses are stimulated within the nodes and at the site of
the chancre.
o If left untreated, heals in 2-8 weeks, disappears with no scar
Secondary Syphilis (usually 6 weeks after first appearance of chancre – may overlap with
primary stage):
,Systemic > blood borne bacteria is spread to all major organ systems.
• Followed by a period during which the immune system is able to suppress infection.
• Even without treatment, spontaneous resolution of the skin lesions occurs > individual enters
latent stage of infection (relapses may occur for several years)
• Typically, this stage presents with low-grade fever, malaise, sore
throat, hoarseness, anorexia, generalized adenopathy, headache, joint
paint, lymphadenopathy, pruritus, and skin or mucous membrane lesions or
rashes (e.g., condylomata lata).
Women > appear in perineum, vulva, inner thigh, anal area & groin
Men > inner thigh and anal area
Latent Syphilis (may be as short as 1 year or as long as a lifetime):
Subdivided into early and late stages even though no criteria to delineate one from the
other.
• Silent infection: medical history and serologic studies show that syphilis is present, but the
individual has no clinical manifestations
• Transmission of infection is possible during both late and early latent stages
Tertiary Syphilis rare as antibiotics cure syphilis:
Most severe stage, involving significant morbidity and mortality (non-infectious disease)
,• Destructive skin, bone, and soft skin lesions called gummas develop, which result from a
severe hypersensitivity reaction to the microorganism.
• Cardiovascular complications > aneurysms, heart valve insufficiencies, and heart failure.
• CNS > possible manifestations of neurosyphilis may develop (this may occur at any stage
of syphilis infection).
EVALUATION
Early diagnosis depends on darkfield microcopy of specimen from infected site. If initial
result negative, test is repeated on 2 successive days
2 categories of serologic testing exist:
1. nontreponemal antigen > show presence of reagin (a group of antibodies present in
syphilis) in serum > provide indirect evidence of infection
a. VDRL antigen / RPR test – Yield positive results in >50% individuals with primary &
100% in secondary > useful in screening/assessing treatment response > high rates of false
positives
2. treponemal antibody
a. done if VDRL antigen (RPR test is positive)
b. used to assess for antibody response to T. pallidum
c. include enzyme immunoassays (EIAs) FTA-AB test & TP-PA assay
• During latent phase – patients can have positive serologic evidence, but confirmation
must include presence of treponemata in cerebrospinal fluid to confirm.
, Preferred treatment for all stages is parenteral injection of benzathine PCN G. – no other
types of
penicillin are effective
TREATMENT:
If <1 year infected > 1 IM dose is appropriate
If >1 year infected; asymptomatic and assumed to be in late stage > treatment is 3 weekly
injections
Penicillin is okay for pregnant women (prevent vertical transmission to baby)
• Non-pregnant women who are allergic to PCN receive Doxycycline 100mg BID x14 days
Pregnant women with PCN allergy should be desensitized then treated with PCN G since
tetracycline causes permanent, lifelong discoloration of fetus teeth.
Repeated assessment of VDRL and RPR titers = determine effectiveness of treatment >
titers should
decrease 4-fold
Sexual partners are examined and treated and use of condoms recommended until
treatment
If infants require treatment, PCN is drug of choice.
• Infants are given serologic tests for syphilis every 2-3 months until test becomes
nonreactive or titer has decreased 4-fold.
CORRECT ANSWERS!!
Know all STIS: pathophysiology, etiology, clinical manifestations, diagnostic tests,
treatment, and complications. How is each transmitted during pregnancy to the fetus?
Know the different stages of syphilis; what organism causes each STI and is it viral,
bacterial etc.?
Do you treat both partners and why? What age group has the greatest risk of STIs and
why? What causes cervical cancer
FOUR STAGES OF SYPHILLIS
Primary Syphilis (incubation period ranges from 12 days to 12 weeks average of three weeks):
Local bacterial invasion: multiplies in epithelium and produces a granulomatous
tissue (chancre) at the
site > Consider syphilis with any open lesion
• Chancre (eroded, painless, firm and indurated ulcer <2cm in diameter)
• Some microorganisms drain with lymph into adjacent lymph nodes.
• Cell-mediated and humoral immune responses are stimulated within the nodes and at the site of
the chancre.
o If left untreated, heals in 2-8 weeks, disappears with no scar
Secondary Syphilis (usually 6 weeks after first appearance of chancre – may overlap with
primary stage):
,Systemic > blood borne bacteria is spread to all major organ systems.
• Followed by a period during which the immune system is able to suppress infection.
• Even without treatment, spontaneous resolution of the skin lesions occurs > individual enters
latent stage of infection (relapses may occur for several years)
• Typically, this stage presents with low-grade fever, malaise, sore
throat, hoarseness, anorexia, generalized adenopathy, headache, joint
paint, lymphadenopathy, pruritus, and skin or mucous membrane lesions or
rashes (e.g., condylomata lata).
Women > appear in perineum, vulva, inner thigh, anal area & groin
Men > inner thigh and anal area
Latent Syphilis (may be as short as 1 year or as long as a lifetime):
Subdivided into early and late stages even though no criteria to delineate one from the
other.
• Silent infection: medical history and serologic studies show that syphilis is present, but the
individual has no clinical manifestations
• Transmission of infection is possible during both late and early latent stages
Tertiary Syphilis rare as antibiotics cure syphilis:
Most severe stage, involving significant morbidity and mortality (non-infectious disease)
,• Destructive skin, bone, and soft skin lesions called gummas develop, which result from a
severe hypersensitivity reaction to the microorganism.
• Cardiovascular complications > aneurysms, heart valve insufficiencies, and heart failure.
• CNS > possible manifestations of neurosyphilis may develop (this may occur at any stage
of syphilis infection).
EVALUATION
Early diagnosis depends on darkfield microcopy of specimen from infected site. If initial
result negative, test is repeated on 2 successive days
2 categories of serologic testing exist:
1. nontreponemal antigen > show presence of reagin (a group of antibodies present in
syphilis) in serum > provide indirect evidence of infection
a. VDRL antigen / RPR test – Yield positive results in >50% individuals with primary &
100% in secondary > useful in screening/assessing treatment response > high rates of false
positives
2. treponemal antibody
a. done if VDRL antigen (RPR test is positive)
b. used to assess for antibody response to T. pallidum
c. include enzyme immunoassays (EIAs) FTA-AB test & TP-PA assay
• During latent phase – patients can have positive serologic evidence, but confirmation
must include presence of treponemata in cerebrospinal fluid to confirm.
, Preferred treatment for all stages is parenteral injection of benzathine PCN G. – no other
types of
penicillin are effective
TREATMENT:
If <1 year infected > 1 IM dose is appropriate
If >1 year infected; asymptomatic and assumed to be in late stage > treatment is 3 weekly
injections
Penicillin is okay for pregnant women (prevent vertical transmission to baby)
• Non-pregnant women who are allergic to PCN receive Doxycycline 100mg BID x14 days
Pregnant women with PCN allergy should be desensitized then treated with PCN G since
tetracycline causes permanent, lifelong discoloration of fetus teeth.
Repeated assessment of VDRL and RPR titers = determine effectiveness of treatment >
titers should
decrease 4-fold
Sexual partners are examined and treated and use of condoms recommended until
treatment
If infants require treatment, PCN is drug of choice.
• Infants are given serologic tests for syphilis every 2-3 months until test becomes
nonreactive or titer has decreased 4-fold.
