Syphilis (aka Red Plague, the Great Pox)

  • Caused by Treponema pallidum
  • Primary stage of syphilis:  contact & dissemination of the disease
    • Chancre (painless papule) will appear 1-3 weeks after exposure.  It will heal in 4-6 weeks w/o trxt.
    • Regional lymphadenopathy.
  • Secondary stage of syphilis:  2-24 weeks after contact
    • Manifestations:  skin rashes (especially on the upper half of the body), general malaise, fever, weight loss, alopecia, erythematous plaques, HA, aseptic menigitis
    • Will resolve w/o trxt
  • Tertiary or Latent stage of syphilis:  10-25 years after initial contact
    • Manifestations:  neurosyphilis & CV (aortic aneurysm)syphilis, benign gumma (granulomatous lesion)
    • 35% incidence of untreated pts
  • Diagnosis:  darkfield microscopic exam of lesions, blood testing (FRA-abs, VDRL)
  • Treatment:
    • Benzathine-Penicillin G 2.4 Million units once
      • For latent syphilis trxt (> 1 year duration or unknown duration) use 2.4 million units weekly for 3 weeks
        • Alternative trxt for latent syphilis:  doxycycline 100 mg PO BID x 4 weeks
    • Alternative trxt:  doxycycline 100 mg PO BID x 14 days or erythromycin 500 mg PO QID x 14 days
    • Neuro/CV syphilis trxt:  AQUEOUS Penicillin G 3-4 million units IV Q 4 h x 10-14 days
      • Alternative trxt for CBV/CV syphilis:  procaine Penicillin G 2.4 million units IM daily + probenicid 500 mg PO x 10-14 days
    • Need to watch out for Jarisch-Herxheimer reaction (occurs in half of pts w/ secondary syphilis) which starts within 2-4 h after initiating trxt & subsides within 12-24 h.  Secondary to release of an endotoxin associated w/ spirochete death
      • Symptoms of J-H rx:  fever/chills, sore throat, diffuse myalgias, HA, tachycardia, hypotension
        • Trxt of J-H rx:  analgesics/antipyretics

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