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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