Guideline for self-study of students for practical lesson. Module I. Dermatology and Venereology

Guideline for self-study of students for practical lesson

Module I. Dermatology and Venereology

Thematic module 8. Venereal Diseases

LESSON 22

Laboratory diagnostics of venereal diseases. Treatment of syphilis

Theme urgency

Diagnosis cannot be based on clinical presentation alone, and unfortunately, T. pallidum cannot be cultured.

Serological tests for syphilis detect antibodies that develop during the course of syphilis and other treponematoses. Two types of tests are available: non-treponemal tests (reaginic tests) and treponemal tests.

Non-treponemal tests are good screening tests because they are sensitive but since there is a chance of false positives these tests are not very specific.

Treponemal tests are more specific than nontreponemal tests but once these tests become positive, they remain so for a lifetime. Treponemal tests detect antibody IgM and IgG directed against T. pallidum. Standard tests include the immunofluorescence test (IFT), the T. pallidum immobilization test (TPI). They are considered specific for T. pallidum, although dependent on serum dilution and adsorption. Biological false positives occur, although rarely. Treponemal tests generally remain reactive for life after adequate therapy, and should not be used to assess response to treatment.

Agents used in treating syphilitic patients are called specific, antisyphilitic. They are prescribed after the diagnosis has been made or as a measure for preventing the development of the disease. They are also used in ex juvantibus therapy as an aid in the diagnosis of doubtful cases (it is most frequently applied when syphilis of the internal organs or nervous system is suspected). Once the diagnosis of syphilis has been made, treatment should be started as soon as possible (within the first 24 hours in active forms). The earlier the treatment is begun, the better the prognosis and the more effective the treatment. According to order issued by Ukraine Ministry of Health and endorsed on June 06, 2004, besides antisyphilitic agents producing a direct effect on T. pallidum (mainly in the period of active reproduction), non-specific agents are widely used to produce a general invigorating effect and help the body to overcome the infection. Non-specific therapy is applied at the same time as the specific antisyphilitic agents. The later the treatment begins, the longer the causative agent remains in the patient's body, the more non-specific therapy is substantiated.

Concrete Objectives:

Students must know:

1. Difference between nontreponemal and treponemal tests, as well as their value for diagnosis in the different stages of syphilis and their use for follow-up.

2. Choose the appropriate treatment for each stage of syphilis and describe proper post treatment follow-up.

3. Evaluation of treatment and follow-up of syphilis in pregnant women.

4. Management of sexual partners of persons infected with syphilis

Students should be able to:

1. To prescribe the laboratory tests for confirming syphilitic infection.

2. To estimate the laboratory tests of syphilis.

3. To prescribe the syphilis therapy.

4. To estimate the criteria of complete cure from syphilis.

SEROLOGICAL REACTIONS AND TESTS IN SYPHILIS

Literature.

The basic:

1. Lecture on the theme.

2. Guideline for self-study of students by preparation for practical lesson 22.

3. Yu. K.Skripkin and M.V. Milich. Skin and Venereal Diseases, English translation, Mir Publishers, 1981, p.496-508.

The additional:

1. Fitzpatrick et al. Dermatology in General Medicine, 4th ed. New York, McGraw-Hill, 1993.
2. Fitzpatrick. Color Atlas and Synopsis of Clinical Dermatology, 3rd Edition, 1997.
3. P.N Behl, A. Aggarwal, Govind Srivastava. Practice of Dermatology, 9th Edition, 2002, p. 50-51, 242-243.

Guideline for self-study of students for practical lesson

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