181.2 📚 國考版

181.2.0.1 必背 — Stages

• 1° chancre painless indurated
• 2° rash palms/soles, condyloma lata, mucous patches
• Latent (early < 1 yr, late > 1 yr)
• 3° gummas, aortitis, late neurosyphilis

181.2.0.2 必背 — Neurosyphilis 5 forms

1. Acute meningitis
2. Meningovascular (stroke)
3. Tabes dorsalis (sensory ataxia, Argyll-Robertson, lightning pain)
4. General paresis (dementia, psychosis)
5. Otic / Ocular

181.2.0.3 必背 — Treatment

• Benzathine PCN G:
  • 1°/2°/early latent: 2.4M IM × 1
  • Late latent: 2.4M IM weekly × 3
• Neurosyphilis: Aqueous PCN G 18-24M IV × 10-14d
• Pregnancy: PCN only (desensitize)
• Doxycycline alt non-preg non-neuro

181.2.0.4 必背 — Jarisch-Herxheimer

• 6-24 hr after PCN
• Fever, chills, rash flare
• Toxin-like release; supportive, don’t stop

181.2.0.5 必背 — Serology

• Non-treponemal (RPR/VDRL) → titer for activity, 4-fold drop = response
• Treponemal (FTA-ABS, TP-PA, EIA) → lifelong +
• Reverse algorithm increasingly

181.2.0.6 必背 — Argyll-Robertson Pupil

• Tabes dorsalis classic
• “Accommodates but doesn’t react to light” (pupil constricts to near, not light)

---