Dr. Russell Waddell of Royal Adelaide Hospital discusses the clinical presentation and treatment of syphilis in people with HIV. This presentation was given at AFAO's syphilis forum in May 2009.

1. Sexually Transmitted Diseases Services Dr. Russell Waddell Internal Medicine Service Royal Adelaide Hospital Syphilis Presentation Manifestations PLHIV Treatment

2. How Syphilis Causes Disease (Pathophysiology) Treponema pallidum penetrates intact mucous membranes or microscopic dermal abrasions and within hours enters lymphatics and blood to spread throughout the body. It attaches to the endothelial lining of blood vessels causing inflammation - endarteritis. Later there can be a hyper-sensitivity response to the organism resulting in gummatous lesions and necrosis

4. Primary Syphilis Chancre Source : Florida STD/HIV Prevention Training Center

7. Secondary Syphilis Rash Source : Florida STD/HIV Prevention Training Center

8. Secondary Syphilis Source : Diepgen TL, Yihune G et al. Dermatology Online Atlas

9. Secondary Syphilis – Condylomata Lata Source : Florida STD/HIV Prevention Training Center

12. Clinical History of Syphilis 1 o 1- 6 weeks 2 o weeks to months 3 y Early latent Early latent Late latent 2 years Incubation 9 – 90 days Neuro syphilis Gumma Cardiovascular

27. Syphilis the great mimic You cannot keep a good disease down

33. Causes of False Positives Source: Syphilis Reference Guide, CDC/National Center for Infectious Diseases, 2002 *May cause increase in titer in women previously successfully treated for syphilis TP-PA FTA-ABS RPR/VDRL Disease Yes -- Yes No Yes No Possibly Yes Yes Yes Yes Yes STD other than Syphilis -- Yes Recent Immunizations Yes* Pregnancy Yes Yes Pinta, Yaws Yes Malaria Lyme disease -- Yes Leprosy Glucosamine/chondroitin sulfate Yes Febrile Illness Yes Drug Abuse -- Yes Dermatologic Diseases Yes Cardiovascular Disease Yes Autoimmune Diseases Age

34. Serological Tests in Untreated Syphilis *FTA-ABS and TP-PA are generally considered equally sensitive in the primary stage of disease. 100 100 93 EIA 73 98 (95-100) 100 86 (77-99) RPR 94 97 (97-100) 100 76 (69-90) TPPA* 96 100 100 84 (70-100) FTA-ABS* 71 (37-94) 95 (88-100) 100 78 (74-87) VDRL Tertiary Latent Secondary Primary Test Stage of Disease (Percent Positive [Range])