Syphilis

SEROLOGY

Non-Treponemal Tests (titers ↓ w/ Treatment):     RPR and VDRL
Treponemal Tests (remain “reactive” forever):    TP-PA and FTA-ABS
 

Early Syphilis

1° Syphilis:  Chancre
  • RPR Neg, TP-PA Neg
  • Dx clinically
  • Darkfield if available
2° Syphilis: Rash, myriad of Sx
  • RPR 100% Pos (plus additional biologic False-Pos)
  • TP-PA 100% Pos. (“confirms” RPR)
Early-Latent Syphilis
  • Same as 2° Syphilis
Early Neurosyphilis
  • RPR >95% sensitive

Late Syphilis

Late-Latent Syphilis:  A-Sx
  • RPR only ~75% Positive (approx. 25% False-Neg)
  • TP-PA ~100% Pos
3° Syphilis:  Neuro, C-V, Gumma
  • Same as Late-Latent
  • Early Neurosyphilis: RPR >95% sensitive
  • Late Neurosyphilis: RPR only 75% Pos
Late Neurosyphilis: CSF
  • VDRL 30-50% sensitive
  • FTA-ABS ~100 sensitive
  • ↑ lymphocytes & protein ~100% sensitive

 TIME LINE OF STAGES

Early Syphilis  (contagious)

1° Syphilis:  Chancre (at site of inoculation)
  • Appears 2-6 weeks after infection
  • Lasts 4-8 weeks
2° Syphilis: Rashes, constitutional Sx / adenopathy / diverse organs
  • Onset 6 wks – 4 mos. from infection
  • Lasts 2-6 weeks
  • Manifestations can relapse for up to 1 yr.
Early-Latent Syphilis:  Asymptomatic
  • Defined as 1 yr. from end of 2° symptoms
  • Rarely identified; important only for contact tracing

Late Syphilis (probably not contagious)

Late-Latent Syphilis:  Asymptomatic; Lasts Forever
  • Onset 1½ to 2 yrs. from infection
  • 1/3 of persons eventually develop 3° Syphilis
3° Syphilis:  Neuro, Cardiovascular, Gummas
  • Early Neuro (meningeal): Up to 5 yrs. from infection
  • Late Neurosyphilis: Onset 15-30 yrs. from infection
    • General Paresis of the Insane
    • Tabes Dorsalis
  • Cardiovascular & Gummas: >10-15 yrs. from infection

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