Syphilis MCQs

Secondary syphilis presents with a variety of symptoms. The cutaneous manifestations are also varied A diffuse mucocutaneous rash (generally coppery red, non-pruritic and bilaterally symmetrical), coppery brown scaly macules on palms and soles are seen. Most often, the lesions are macular, discrete, reddish brown, and 5 mm or smaller in diameter; however, they can be pustular, annular, or scaling. Vesicular rash is typically absent. Generalized non-tender lymphadenopathy is typical, especially epitrochlear LN. Mucosal - condyloma lata, mucous patches, snail track ulcers - they contain a high load of spirochetes, these lesions are highly contagious. Hair - patchy non-scarring alopecia (Moth-eaten alopecia) Reference: Rooks textbook of dermatology, 9 th edition, chapter 29, page 12

Hutchinson's triad : Common pattern of presentation for congenital syphilis Triad: Interstitial keratitis, Hutchinson incisors, and Eighth nerve deafness Reference: Rooks textbook of dermatology, 9 th edition, chapter 29, page 31

Late syphilis not infective are Gumma, neurosyphilis, cardiovascular syphilis. Reference: Rooks textbook of dermatology, 9 th edition, chapter 29, page 28

Buttonhole sign In type 1 neurofibromatosis (Von-Recklinghausen's disease), neurofibromas can be invaginated with the tip of index finger back into the subcutis and again reappear after release of pressure. Reference: Rooks textbook of Dermatology, 9 th edition, Chapter 80, page 3

Jarisch Herxheimer reaction (JHR) is a transient clinical phenomenon that occurs in patients infected by spirochetes who undergo antibiotic treatment. It is a type 3 hypersensitivity reaction to breakdown products of the spirochete after the use of antibiotics The symptoms usually begin 2 hours from the administration of the antibiotic and resolve within 24 hours Along with systemic symptoms - body aches, fevers, nausea and vomiting, and flushing, exacerbation of skin lesions is seen Mild reactions are self-limiting and often resolve spontaneously within 24 hours. The patient should be treated for symptoms with antipyretics and kept under observation. More severe cases may need steroids Reference: Rooks textbook of dermatology, 9 th edition, chapter 29, page 26

Syphilis is a bacterial infection caused by the spirochete Treponema pallidum . Due to its many protean clinical manifestations, it has been named the "great imitator and mimicker." T. pallidum is the only treponemal agent that causes venereal disease. Primary syphilis appears 10 to 90 days after exposure to the infection and comprises a painless, indurated ulcer (chancre) at the site of inoculation with the T. pallidum . Regional lymphadenopathy is common and consists of rubbery lymph nodes. The chancre oozes serum, which is teeming with treponema Reference: Rooks textbook of dermatology, 9 th edition, chapter 29, page 8.

First described by Abraham Buschke and Helene Ollendorff Curth, this sign was named after their observation of slight tenderness on applying pressure with a dull probe on papular lesions of palms in secondary syphilis and is due to cutaneous vasculitis. Necrotic keratinocytes are one of the characteristics of secondary syphilis along with plasma cell infiltrate and obliterative end-arteritis are seen. Further, treponema are also present in the dermis. Reference: Rooks textbook of dermatology, 9 th edition, chapter 29, page 13

Latent syphilis is a stage at which the features of secondary syphilis have resolved, though patients remain seroreactive They are asymptomatic during the latent phase, and the disease is detected only by serologic tests Latent syphilis is divided into early latent and late latent. The distinction is important because treatment for each is different. The early latent period is the first year after the resolution of primary or secondary syphilis. Late latency syphilis is not infectious About one third of untreated latent syphilis patients go on to develop tertiary syphilis, whereas the rest remain asymptomatic Reference: Rooks textbook of dermatology, 9 th edition, chapter 29, page 13