Editing Sexually Transmitted Infections (section)

===== Syphilis =====
* '''Caused by Treponema pallidum'''
* '''Primary syphilis'''
** '''Incubation period: typically 2-3 weeks''', can range from 9-90 days for the appearance of lesions after infection
** '''Lesion'''
*** '''Called “chancre”'''
*** Occurs at the initial site of infection
**** In male, lesions are typically on the glans, corona or perineal area
**** In females, lesions are typically on the labia or perianal area
*** '''Usually single and painless''' but can be multiple, and up to 25% of chancres can be painful
**** '''See Figure'''
** '''Local non-tender lymphadenopathy is common'''
** '''Untreated lesions heal spontaneously in 3-8 weeks'''
* '''Secondary syphilis'''
** '''T. pallidum eventually becomes a systemic infection with bacteremia'''.
** '''Appears 3-5 months after the initial infection'''
** '''Characterized by a maculopapular rash, which is often widespread and involves the scalp, palms, and soles of the feet.'''
*** '''The rash can ulcerate and lead to condyloma lata, which are wart-like lesions'''.
** Additional symptoms include fever, malaise, weight loss, patchy alopecia, and ocular inflammation
** A broad vasculitis occurs in ≈10% of patients and may lead to hepatitis, iritis, nephritis, and neurologic problems including headache and cranial nerve involvement, especially VIII (auditory).
** Relapses usually occur in the first year after infection and rarely after the second year. The infection then becomes latent and asymptomatic.
*** Latent syphilis is defined as seroreactivity with no clinical evidence of disease
* Tertiary or late syphilis
** ≈35% of individuals with late latent syphilis will develop the late manifestations of syphilis, which include  neurosyphilis, cardiovascular syphilis, and gummatous syphilis.
* '''Diagnosis and Evaluation'''
** '''Labs'''
*** '''Darkfield examination'''
**** '''Cultures of T. pallidum are not possible'''
**** '''Direct tests include identification of T. pallidum under a dark-ground microscope'''
*** '''Serology'''
**** '''Categories of tests (2):'''
****# '''Non-treponemal''' (directed against phospholipids)
****# '''Treponemal''' (directed against T. pallidum polypeptides)
**** '''Non-treponemal'''
***** '''Includes:'''
****** '''Rapid plasma reagin (RPR) test'''
****** '''Venereal Disease Research Laboratory (VDRL) test'''
****** '''Toluidine red unheated serum test (TRUST)'''
***** '''Need confirmation with a treponemal test because they can be positive in other conditions such as:'''
****** '''Viral infections'''
****** '''Pregnancy'''
****** '''Malignancies'''
****** '''Autoimmune disease'''
****** '''Advanced age'''
***** '''Used to monitor disease activity'''
**** '''Treponemal tests'''
***** Includes
****** '''FTA-ABS:''' fluorescent treponemal antibody absorption test
****** '''MHA-TP:''' microhemagglutination assay for T. pallidum
****** '''TP-HA:''' T. pallidum hemagglutination assay
****** '''TP-PA:''' T. pallidum particle agglutination test
*** All patients with syphilis should be tested for HIV
* '''Management'''
** '''Antibiotics'''
*** '''Standard treatment for all stages of syphilis is benzathine penicillin G'''
**** Stage and clinical manifestations of syphilis determine the preparation, dosage, and length of treatment
*** '''Jarisch-Herxheimer reaction'''
**** '''Not an allergic reaction to penicillin but occurs with treatment of the treponemes, and more commonly with treatment with penicillin and in early syphilis.'''
**** '''Consists of fever, malaise, nausea, and vomiting;''' may also be associated with chills and exacerbation of secondary rash.
**** '''Management'''
***** '''Bed rest and nonsteroidal anti-inflammatory medications.'''