Do you want to buy antibiotics online without prescription? http://buyantibiotics24h.com/ - This is pharmacy online for you!

Publichealthworks.ca

Syphilis – A Review
Barbara Romanowski MD, FRCPC
Clinical Professor
Faculty of Medicine & Dentistry
University of Alberta
September 16, 2008
Association Between Genital Ulcers
Any genital ulceration is associated with
an increased risk of HIV acquisition and
transmission

HIV can be cultured from lesion exudate
Therefore, HIV serology for all patients
with genital ulcers and vice versa
Reported Infectious Syphilis Rates in
Alberta and Canada, 1994 to 2007
Note: National rates for 2006 and 2007 are preliminary.
Source: Surveillance and Epidemiology Section, Centre for Communicable Disease and Infection Control, Public
Health Agency of Canada 2008; http://www.phac-aspc.gc.ca/std-mts/stdcases casmts/index.html) and Alberta
Health and Wellness Communicable Disease Reporting System: Notifiable Diseases and Sexually Transmitted
Infections Databases as of June 11, 2008
Infectious and Congenital Syphilis Cases
in Alberta 2007 (n=255)
* 4 of the 7 symptomatic CNS cases were ocular Source: Alberta Health and Wellness Communicable Disease Reporting System: Notifiable Diseases and Sexually Transmitted Infections Databases as of June 11, 2008 Gender-Specific Age Distribution of Infectious Syphilis
Cases in Alberta, 2007
Age (yrs)
Source: Alberta Health and Wellness Communicable Disease Reporting System: Notifiable Diseases and Sexually Transmitted Infections Databases as of June 11, 2008 Male Infectious Syphilis Cases in Alberta
by Sexual Preference, 2003-2007
Source: Alberta Health and Wellness Communicable Disease Reporting System: Notifiable Diseases and Sexually Transmitted Infections Databases as of June 11, 2008 Infectious Syphilis – HIV Status in Regions 3 and 6, Alberta, 2007
Calgary Health (Region 3)
Capital Health (Region 6)
n=100 cases
n=106 cases
Unknown,
Unknown, 16,
Positive, 9,
Positive,
24, 24%

Negative,
Negative, 81,
Note: In 2007, there was one HIV positive infectious syphilis case outside of Capital and Calgary Health Region.
Source: Alberta Health and Wellness Communicable Disease Reporting System: Notifiable Diseases and Sexually Transmitted Infections Databases as of June 11, 2008 Sexual Contact
3-4 weeks
Infectious
Primary Syphilis
6-8 weeks
Secondary Syphilis
lymphadenopathy
Latent Syphilis
Early <2 years
Late > 2 years
Spontaneous Cure
Tertiary
Static positive serology
Primary Syphilis
Incubation 9-90 days (average
Chancre
Regional lymphadenopathy
Secondary Syphilis
Mucocutaneous eruption
Generalized
lymphadenopathy
Constitutional symptoms
Latent Syphilis
asymptomatic
positive serology
< 2 years – early latent
infectious
25% relapse to secondary

> 2 years – late latent
non-infectious
Tertiary Syphilis
3-30 years after primary infection
Non-infectious
Types late benign – skin,
bone, viscera
Cardiovascular –
aorta, heart
Neurosyphilis –
meninges, brain

Outcome of Pregnancy in Relation to
Stage of Untreated Maternal Syphilis
Primary or
Late Normal
Secondary
Prematurity
Perinatal death
Congenital syphilis
Healthy child
Congenital Syphilis
Early < 2 years of age
Late > 2 years of age
mucocutaneous &
interstitial keratitis
bony lesions
mulberry molars
hepatosplenomegaly
Hutchinson’s teeth
meningitis
saddle nose
perforation of hard
Summary of Congenital Syphilis Cases,
Alberta, 2005 to 2007
All 14 cases were born in Edmonton to 13 mothers (1 set
of twins)

5 neonatal deaths
Ethnicity: 8 First Nations, 4 Caucasian, 1 Asian
Marital status: 6 married/common-law
5 sex trade workers
8 mothers did not access antenatal care and were not
tested for syphilis until delivery; 1 mother was tested in the
second trimester but could not be located and the
remaining 4 tested negative for syphilis early in pregnancy

Source: Communicable Disease Reporting System: Notifiable Diseases and Sexually
Transmitted Infections Databases as of June 11, 2008

Diagnosis of Syphilis
1. History
2. Physical Examination
3. Laboratory Investigations
A) Darkfield examination / DFA
B) Serology

Serologic Tests for Syphilis
Non-treponemal test
ƒ RPR
ƒ VDRL
ƒ ART
ƒ EIA
ƒ RST
Treponemal test
ƒ MHA-TP / TP-PA
ƒ FTA-Abs
Serologic Tests for Syphilis
EIA – treponema specific test – detects
improved sensitivity / specificity
has replaced RPR, TPPA, FTA-Abs
cannot differentiate venereal from non-
venereal treponemal infection i.e. yaws /
pinta

INNO-LIA®
measures antibodies to T pallidum
antigens
will remain positive for life
will be only run initially to confirm EIA
Interpretation of Syphilis EIA
EIA -ve - no syphilis or incubating.
Consider repeating in 2 – 4 weeks
EIA +ve - syphilis. RPR will be done to
determine titres
EIA +ve / RPR –ve / LIA +ve – syphilis
False Positive Reactions
NON-TREPONEMAL
TREPONEMAL
viral infections
autoimmune
pregnancy
malaria
genital herpes
leprosy
elderly
pinta
injection drug abuse
cirrhosis
autoimmune
Indications for CSF Examination
any neurological abnormalities
before re-treatment of patients
who have had a relapse
in all infants
in the investigation of patients
with late latent syphilis and an
RPR ≥ 16
Diagnosis of Congenital Syphilis
physical examination
serology
ƒ if maternal transfer – titre should
gradually decrease & disappear by 6-12
months.

ƒ if congenital infection – titre will increase
CSF examination
long bone x-rays
Treatment of Syphilis
“A night on Venus, but a month on Mercury”
Primary, secondary, early latent
Benzathine penicillin 2.4 mu IM STAT
Doxycycline 100 mg bid x 14 days
Latent > 1 year duration
Benzathine penicillin 2.4 mu IM weekly for 3
successive weeks
Doxycycline 100 mg bid x 28 days
Treatment of Syphilis in Pregnancy
All women not previously treated should receive
penicillin appropriate to their stage of disease
Some experts suggest that pregnant women with
early syphilis received 4.8 mu benzathine
penicillin
Retreatment during pregnancy is unnecessary
unless there is clinical or serologic evidence of
new infection
When penicillin allergy is reported,
desensitization should be attempted
Syphilis Screening during Pregnancy
All pregnant women should have
syphilis serology undertaken at their 1st
pre-natal visit

Serology should be repeated at 28 – 32
weeks gestation
For “high-risk’ women serology should
again be repeated at term
Congenital Syphilis
Neonates should be treated at birth if:
They demonstrate symptoms/signs of
congenital syphilis
Maternal treatment was inadequate
Maternal treatment is unknown
Maternal treatment was with drugs other
than penicillin
RPR Titre Decrease After Treatment of
Infectious Syphilis
PRIMARY
ƒ 2 tube decrease at 6 months
ƒ 3 and 4 tube decrease at 12 and 24 months
SECONDARY
ƒ 3 and 4 tube decrease at 6 and 12 months
EARLY LATENT
ƒ 2 tube decrease at 12 months
Source: Romanowski B. Annals Int Med 1991;114:1005

Source: http://www.publichealthworks.ca/archive/2008/2008_09_Romanowski_Syphylis.pdf

frontagelab.com.cn

China’s Hisun Files IND For Cholesterol-lowering Drug In U.S. Hisun, best known for a proposed JV with Pfizer on branded generics, is looking to move up the value chain into R&D. SHANGHAI – One of China’s leading active pharma-latory consulting for the IND preparation (CMC, phar-ceutical ingredient and finished product manufacturers macology/toxicology and clinical development plan/

Ldr abcd rosiglitazone.qxp

The Association for British Clinical Diabetologists: recommendations following suspension of rosiglitazone (Avandia) On 23 September 2010, the European Medicine’sAgency (EMA) Committee on Medicinal Products forHuman Use (CHMP) recommended the suspension ofmarketing authorisation for Avandia (rosiglitazone)• For all new prescriptions of thiazolidinediones, and Avandamet (rosiglitazone

Copyright © 2010-2014 Medical Pdf Finder