#rpr

Trying to make it thru stormblood is painstaking... idk if I just haven't gotten to the good parts or what bc i am bored af...

Anti-cardioplipin = reagin. It's the Ab to cardiolipin (an Ag on syphilis, but also seen on human cells, so just because it's positive doesn't mean it's syphilis).

Tertiary syphilis = immune response over the course of years. Neurosyphilis - loss of sensation, Argyll Robertson pupil, syphilitic uveitis. Argyll Robertson (AR) pupils are small, irregular, bilateral pupils that exhibit "light-near dissociation"—constricting for near focus (accommodation) but not to bright light. Often called "prostitute's pupils" because they "accommodate but do not react," they are a classic, though rare, sign of neurosyphilis. Other causes include diabetes, MS, or midbrain lesions.

Congenital syphilis - hepatosplenomegaly, a copper-colored rash on palms/soles, "snuffles" (bloody nasal discharge), bone deformities, Hutchinson teeth.

Treponema pallidum needs to be in the cell to survive so it's hard to culture. Can be seen with dark field microscopy.

Non-treponemal test (RPR) detects any type of treponema, not just T. pallidum.

Treponemal tests = FTA-Ab, TPPA (cerobrospinal fluid), and EIA.

The reverse algorithm starts with the specific test first.

RPR tells you whether the body is responding to it now.

Tx of early syphilis = Penicillin (or doxycycline if PCN allergic). But most people don't truly have PCN allergy, so PCN is preferred.

Secondary syphilis treated with bicillin and then pt has reaction = Jerisch-Herxheimer reaction (tx with NSAIDs).

RPR goes from 1:8 to 1:2 = adequate tx. RPR goes from 1:8 to 1:16 = not adequate tx.

MA has the DPH clinic to keep track of syphilis records. Important to get a hx of prior treatments.

DoxyPEP = using doxycycline as post exposure prophylaxis. Doxycycline 200 mg once. If doxycycline PEP is used, doxycycline 200 mg is taken once orally, ideally within 24 hours but no later than 72 hours after condomless oral, anal, or vaginal sex, with a maximum dose of 200 mg each day. 

Do empiric tx for people with known exposure (i.e., slept with someone who is known to have it). Don't have to test. The RPR isn't even positive until secondary syphilis (a few weeks after infection).

Tertiary syphilis can present with:

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