Practice Questions: Spirochetes

Table of Contents
1. Spirochetes - Practice Questions for Nursing Competitive Exams
2. Type 1: Direct Factual Questions
3. Type 2: Clinical Scenario / Case-Based Questions
4. Type 3: Drug / Pharmacology Questions
5. Type 4: Procedure-Based Questions
6. Type 5: Priority Questions
7. Type 6: Community Health & Public Health Questions
8. Type 7: Concept-Based / Application Questions
9. Quick Revision Summary
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Spirochetes - Practice Questions for Nursing Competitive Exams

Subject: Microbiology | Chapter: Spirochetes | Total Questions: 45 | Level: Nursing Competitive Exams

Type 1: Direct Factual Questions

Q1: Which of the following is the causative agent of syphilis?
(a) Treponema pallidum
(b) Borrelia recurrentis
(c) Leptospira interrogans
(d) Treponema pertenue

Ans: (a)
Explanation: Treponema pallidum is the causative agent of syphilis, a sexually transmitted infection. Borrelia recurrentis causes relapsing fever, Leptospira interrogans causes leptospirosis, and Treponema pertenue causes yaws. Understanding these distinctions is essential for diagnosis and management.

Q2: Spirochetes are characterized by which of the following structural features?
(a) Rigid cell wall with flagella at both ends
(b) Helical shape with axial filaments
(c) Coccoid shape with pili
(d) Rod-shaped with external flagella

Ans: (b)
Explanation: Spirochetes are characterized by their helical or spiral shape and possess axial filaments (also called endoflagella) located between the outer sheath and cell wall. These filaments enable their unique corkscrew motility. This structural feature distinguishes them from other bacterial groups.

Q3: Which staining technique is best suited for visualizing spirochetes?
(a) Gram staining
(b) Ziehl-Neelsen staining
(c) Dark-field microscopy
(d) Albert staining

Ans: (c)
Explanation: Dark-field microscopy is the preferred method for visualizing spirochetes as they are too thin to be seen clearly with conventional bright-field microscopy. Spirochetes appear as bright, motile organisms against a dark background. Gram staining is generally ineffective due to their thin walls.

Q4: The primary stage of syphilis is characterized by:
(a) Diffuse maculopapular rash
(b) Painless ulcer called chancre
(c) Gummatous lesions
(d) Neurosyphilis

Ans: (b)
Explanation: The primary stage of syphilis presents with a painless ulcer called a chancre at the site of inoculation, appearing 10-90 days post-infection. Maculopapular rash occurs in secondary syphilis, gummatous lesions in tertiary syphilis, and neurosyphilis is a complication of untreated disease.

Q5: Which genus of spirochetes is responsible for Lyme disease?
(a) Treponema
(b) Borrelia
(c) Leptospira
(d) Spirillum

Ans: (b)
Explanation: Borrelia burgdorferi (genus Borrelia) is the causative agent of Lyme disease, transmitted by Ixodes ticks. The disease is characterized by erythema migrans, arthritis, and neurological complications. Treponema causes syphilis and yaws, Leptospira causes leptospirosis.

Q6: The Jarisch-Herxheimer reaction is most commonly associated with treatment of which infection?
(a) Tuberculosis
(b) Syphilis
(c) Typhoid fever
(d) Diphtheria

Ans: (b)
Explanation: The Jarisch-Herxheimer reaction is an acute febrile response occurring within 24 hours of antibiotic treatment for syphilis and other spirochetal infections. It results from the release of endotoxins from dying spirochetes, causing fever, chills, and worsening of skin lesions. It is self-limiting.

Q7: Which serological test is used as a screening test for syphilis?
(a) VDRL (Venereal Disease Research Laboratory)
(b) FTA-ABS (Fluorescent Treponemal Antibody Absorption)
(c) Weil-Felix test
(d) Widal test

Ans: (a)
Explanation: VDRL and RPR (Rapid Plasma Reagin) are non-treponemal tests used for screening syphilis. FTA-ABS is a specific treponemal test used for confirmation. Weil-Felix tests for rickettsial diseases, and Widal tests for typhoid fever.

Q8: Leptospirosis is primarily transmitted through:
(a) Sexual contact
(b) Contaminated water with animal urine
(c) Tick bite
(d) Respiratory droplets

Ans: (b)
Explanation: Leptospirosis is transmitted through contact with water or soil contaminated with urine of infected animals (mainly rodents). The spirochete Leptospira interrogans enters through mucous membranes or skin abrasions. Occupational exposure is common among sewage workers and farmers.

Q9: The causative agent of relapsing fever is:
(a) Treponema pallidum
(b) Borrelia recurrentis
(c) Leptospira icterohaemorrhagiae
(d) Treponema carateum

Ans: (b)
Explanation: Borrelia recurrentis causes epidemic relapsing fever (louse-borne), while other Borrelia species cause endemic relapsing fever (tick-borne). The disease is characterized by recurring episodes of fever separated by afebrile periods due to antigenic variation of the organism.

Q10: Which clinical manifestation is characteristic of secondary syphilis?
(a) Chancre
(b) Condyloma lata and generalized rash
(c) Aortic aneurysm
(d) Tabes dorsalis

Ans: (b)
Explanation: Secondary syphilis presents with generalized maculopapular rash (including palms and soles), condyloma lata (broad-based wart-like lesions), lymphadenopathy, and fever. Chancre is primary, aortic aneurysm and tabes dorsalis are tertiary manifestations.

Type 2: Clinical Scenario / Case-Based Questions

Q11: A 28-year-old man presents with a painless genital ulcer that appeared 3 weeks ago. Dark-field microscopy shows motile spirochetes. What is the most likely diagnosis?
(a) Chancroid
(b) Herpes genitalis
(c) Primary syphilis
(d) Lymphogranuloma venereum

Ans: (c)
Explanation: The presence of a painless genital ulcer (chancre) and motile spirochetes on dark-field microscopy confirms primary syphilis caused by Treponema pallidum. Chancroid presents with painful ulcers, herpes with vesicles, and lymphogranuloma venereum with suppurative lymphadenopathy.

Q12: A farmer presents with high fever, jaundice, and conjunctival suffusion after working in flooded fields. Which infection should be suspected?
(a) Viral hepatitis
(b) Leptospirosis
(c) Malaria
(d) Typhoid fever

Ans: (b)
Explanation: Leptospirosis (Weil's disease) classically presents with fever, jaundice, conjunctival suffusion, and renal involvement following exposure to contaminated water. The occupational history (farmer in flooded fields) and triad of symptoms strongly suggest leptospirosis caused by Leptospira interrogans.

Q13: A patient treated for syphilis develops fever, headache, and worsening of skin lesions 6 hours after the first dose of penicillin. What is the most likely cause?
(a) Allergic reaction to penicillin
(b) Jarisch-Herxheimer reaction
(c) Secondary infection
(d) Drug resistance

Ans: (b)
Explanation: The Jarisch-Herxheimer reaction occurs within hours of treatment of spirochetal infections, caused by endotoxin release from dying organisms. It presents with fever, chills, headache, and temporary worsening of lesions. Management is supportive; the reaction is self-limiting and does not require stopping antibiotics.

Q14: A woman in her third trimester is diagnosed with syphilis. What complication is the fetus most at risk for?
(a) Neural tube defects
(b) Congenital syphilis
(c) Down syndrome
(d) Cystic fibrosis

Ans: (b)
Explanation: Untreated maternal syphilis can lead to congenital syphilis, causing stillbirth, prematurity, or neonatal manifestations like snuffles, hepatosplenomegaly, rash, and bone abnormalities. VDRL/RPR screening is mandatory during pregnancy, and treatment with penicillin prevents transmission.

Q15: A patient presents with a bull's eye rash (erythema migrans) after a camping trip. Which infection is most likely?
(a) Syphilis
(b) Lyme disease
(c) Leptospirosis
(d) Relapsing fever

Ans: (b)
Explanation: Erythema migrans (a bull's eye rash) is the pathognomonic sign of Lyme disease, caused by Borrelia burgdorferi and transmitted by Ixodes ticks. History of outdoor exposure and the characteristic rash confirm the diagnosis. Early treatment with doxycycline or amoxicillin is effective.

Q16: A patient with untreated syphilis for 20 years develops dementia and ataxia. Which stage of syphilis is this?
(a) Primary syphilis
(b) Secondary syphilis
(c) Latent syphilis
(d) Tertiary syphilis

Ans: (d)
Explanation: Neurosyphilis (with dementia, tabes dorsalis, ataxia) is a manifestation of tertiary syphilis, occurring years after untreated infection. Other tertiary features include gummatous lesions and cardiovascular syphilis (aortic aneurysm). CSF analysis and treponemal tests confirm diagnosis.

Q17: A sewage worker develops fever, myalgia, and renal failure. Blood culture shows spirochetes. What is the diagnosis?
(a) Typhoid fever
(b) Leptospirosis
(c) Brucellosis
(d) Tuberculosis

Ans: (b)
Explanation: Leptospirosis is common in sewage workers due to exposure to rat urine-contaminated water. Clinical features include fever, myalgia, jaundice, and renal failure. Blood or urine culture may reveal Leptospira, and treatment is with penicillin or doxycycline.

Q18: A neonate born to an untreated syphilitic mother presents with snuffles and a diffuse rash. What is the appropriate nursing action?
(a) Administer oral erythromycin
(b) Isolate the infant and start IV penicillin
(c) Provide phototherapy
(d) Administer hepatitis B vaccine

Ans: (b)
Explanation: The infant has congenital syphilis with classic features like snuffles (nasal discharge) and rash. Immediate treatment with IV aqueous penicillin G is required. The infant should be isolated to prevent nosocomial transmission, and thorough evaluation including CSF analysis should be performed.

Q19: A patient presents with recurrent episodes of fever, each lasting 3 days and separated by afebrile periods. Blood smear shows spirochetes. What is the diagnosis?
(a) Malaria
(b) Relapsing fever
(c) Typhoid fever
(d) Dengue fever

Ans: (b)
Explanation: Relapsing fever, caused by Borrelia recurrentis (louse-borne) or other Borrelia species (tick-borne), presents with recurrent febrile episodes due to antigenic variation. Blood smear during fever shows spirochetes. Treatment is with tetracycline or penicillin.

Q20: A patient with tertiary syphilis develops an aortic aneurysm. Which part of the cardiovascular system is most commonly affected?
(a) Mitral valve
(b) Ascending aorta
(c) Descending aorta
(d) Pulmonary artery

Ans: (b)
Explanation: Cardiovascular syphilis in tertiary stage most commonly affects the ascending aorta, causing aortitis, aortic aneurysm, and aortic valve insufficiency. This results from obliterative endarteritis of the vasa vasorum. Surgical intervention may be needed for large aneurysms.

Type 3: Drug / Pharmacology Questions

Q21: What is the drug of choice for treating primary syphilis?
(a) Doxycycline
(b) Benzathine penicillin G
(c) Ciprofloxacin
(d) Metronidazole

Ans: (b)
Explanation: Benzathine penicillin G (2.4 million units IM single dose) is the drug of choice for primary, secondary, and early latent syphilis. It provides sustained levels of penicillin. Doxycycline is an alternative for penicillin-allergic patients. Treponema pallidum remains sensitive to penicillin.

Q22: Which antibiotic is preferred for treating Lyme disease in early stages?
(a) Doxycycline
(b) Vancomycin
(c) Chloramphenicol
(d) Metronidazole

Ans: (a)
Explanation: Doxycycline (100 mg twice daily for 14-21 days) is the first-line treatment for early Lyme disease in adults. Alternatives include amoxicillin or cefuroxime. For late Lyme disease with neurological or cardiac involvement, IV ceftriaxone is preferred.

Q23: Which drug is used for treating leptospirosis?
(a) Penicillin or doxycycline
(b) Isoniazid
(c) Fluconazole
(d) Acyclovir

Ans: (a)
Explanation: Mild leptospirosis is treated with doxycycline or amoxicillin, while severe cases (Weil's disease) require IV penicillin or ceftriaxone. Early initiation of antibiotics reduces severity and duration. Supportive care including dialysis may be needed for renal failure.

Q24: In a patient allergic to penicillin, which alternative can be used for treating syphilis?
(a) Doxycycline
(b) Gentamicin
(c) Clindamycin
(d) Rifampicin

Ans: (a)
Explanation: Doxycycline (100 mg twice daily for 14-28 days depending on stage) is the preferred alternative for non-pregnant patients with penicillin allergy. Ceftriaxone may also be used. However, pregnant women must undergo desensitization and receive penicillin as it is the only proven treatment to prevent congenital syphilis.

Q25: What is the prophylactic antibiotic for Lyme disease after a tick bite in endemic areas?
(a) Single dose doxycycline 200 mg
(b) Amoxicillin for 7 days
(c) Azithromycin for 3 days
(d) Ciprofloxacin for 5 days

Ans: (a)
Explanation: A single 200 mg dose of doxycycline within 72 hours of tick removal can prevent Lyme disease in endemic areas if the tick was attached for ≥36 hours. This prophylaxis is not routinely recommended but considered in high-risk situations. Observation is appropriate in most cases.

Type 4: Procedure-Based Questions

Q26: Which specimen is best for diagnosing primary syphilis using dark-field microscopy?
(a) Blood sample
(b) Serum for serology
(c) Exudate from chancre
(d) Urine sample

Ans: (c)
Explanation: Exudate from the chancre is examined under dark-field microscopy to visualize motile Treponema pallidum. This is the most specific method for diagnosing primary syphilis before antibodies develop. Serological tests may be negative in early primary syphilis.

Q27: Which technique is used to culture Leptospira?
(a) Blood agar
(b) Lowenstein-Jensen medium
(c) Fletcher's medium
(d) MacConkey agar

Ans: (c)
Explanation: Leptospira is cultured using Fletcher's medium or EMJH medium (Ellinghausen-McCullough-Johnson-Harris). Growth is slow, taking 2-4 weeks. Blood or urine from the first week of illness is used. Culture is not routinely done; diagnosis is mainly serological.

Q28: What is the confirmatory serological test for syphilis?
(a) VDRL
(b) RPR
(c) FTA-ABS
(d) Weil-Felix

Ans: (c)
Explanation: FTA-ABS (Fluorescent Treponemal Antibody Absorption) is a specific treponemal test used to confirm syphilis after a positive screening test (VDRL/RPR). Other confirmatory tests include TP-PA (Treponema pallidum Particle Agglutination). These remain positive for life.

Q29: Which body fluid is examined for diagnosing neurosyphilis?
(a) Blood
(b) Urine
(c) Cerebrospinal fluid
(d) Saliva

Ans: (c)
Explanation: Cerebrospinal fluid (CSF) analysis is essential for diagnosing neurosyphilis. CSF shows increased protein, lymphocytic pleocytosis, and positive VDRL (high specificity). CSF FTA-ABS has high sensitivity. Neuroimaging and clinical correlation are also important.

Q30: What is the gold standard method for diagnosing Lyme disease?
(a) Blood culture
(b) Dark-field microscopy
(c) Two-tier serological testing (ELISA followed by Western blot)
(d) PCR of skin biopsy

Ans: (c)
Explanation: The two-tier approach involves screening with ELISA for antibodies to Borrelia burgdorferi, followed by confirmatory Western blot (IgM and IgG). Culture is difficult and slow. Clinical diagnosis is often based on erythema migrans without serological confirmation.

Type 5: Priority Questions

Q31: A patient with suspected leptospirosis presents with oliguria and rising creatinine. What is the FIRST priority nursing action?
(a) Administer IV antibiotics
(b) Assess airway and breathing
(c) Insert urinary catheter and monitor urine output
(d) Prepare for dialysis

Ans: (b)
Explanation: Following the ABC (Airway, Breathing, Circulation) priority framework, the nurse must first assess and secure the airway and breathing. Once stable, address renal failure with fluid management, antibiotics, and consider dialysis if indicated. Prioritization ensures life-threatening issues are managed first.

Q32: A pregnant woman is diagnosed with syphilis in the second trimester. What is the priority intervention to prevent congenital syphilis?
(a) Schedule cesarean delivery
(b) Administer benzathine penicillin G immediately
(c) Counsel for termination of pregnancy
(d) Start doxycycline therapy

Ans: (b)
Explanation: Immediate administration of benzathine penicillin G is the priority to treat maternal syphilis and prevent congenital syphilis. Penicillin is the only proven effective treatment in pregnancy. Doxycycline is contraindicated in pregnancy. Early treatment reduces transmission risk significantly.

Q33: A patient receiving treatment for relapsing fever develops a high fever and rigors 2 hours after the first antibiotic dose. What should the nurse do FIRST?
(a) Stop the antibiotic immediately
(b) Monitor vital signs and provide supportive care
(c) Administer corticosteroids
(d) Prepare for intubation

Ans: (b)
Explanation: This is likely a Jarisch-Herxheimer reaction, common in spirochetal infections. The nurse should monitor vital signs closely and provide supportive care (antipyretics, fluids). The reaction is self-limiting and resolves in 24 hours. Do not stop antibiotics; continue treatment as planned.

Q34: In a community outbreak of leptospirosis following floods, what is the FIRST public health measure?
(a) Mass vaccination campaign
(b) Chemoprophylaxis with doxycycline
(c) Health education on avoiding contaminated water
(d) Distribution of antimalarials

Ans: (c)
Explanation: The priority is health education about avoiding contact with contaminated water, using protective gear, and proper sanitation. Chemoprophylaxis (doxycycline 200 mg weekly) may be considered for high-risk groups. No vaccine is routinely available for human leptospirosis.

Type 6: Community Health & Public Health Questions

Q35: What is the strategy for control of syphilis in the community?
(a) Mass vaccination
(b) Early detection, treatment of cases and contact tracing
(c) Vector control
(d) Water purification

Ans: (b)
Explanation: Control of syphilis involves early detection and treatment, contact tracing and treatment, health education on safe sex, and antenatal screening. There is no vaccine for syphilis. Condom use and awareness campaigns reduce transmission. VDRL screening during pregnancy is mandatory.

Q36: Which occupational group is at highest risk for leptospirosis?
(a) Healthcare workers
(b) Office workers
(c) Farmers, sewage workers, and veterinarians
(d) Teachers

Ans: (c)
Explanation: Farmers, sewage workers, veterinarians, abattoir workers, and those exposed to contaminated water are at high risk for leptospirosis due to contact with animal urine. Preventive measures include using protective clothing, boots, and chemoprophylaxis (doxycycline) in outbreak settings.

Q37: Screening for syphilis during pregnancy is done to prevent:
(a) Neonatal jaundice
(b) Congenital syphilis
(c) Preeclampsia
(d) Gestational diabetes

Ans: (b)
Explanation: Mandatory VDRL/RPR screening during pregnancy (ideally in first and third trimesters) aims to detect and treat maternal syphilis early, preventing congenital syphilis, which can cause stillbirth, prematurity, and severe neonatal disease. Treatment with penicillin is highly effective.

Q38: Which vector transmits Lyme disease?
(a) Anopheles mosquito
(b) Ixodes tick
(c) Body louse
(d) Rat flea

Ans: (b)
Explanation: Lyme disease is transmitted by Ixodes ticks (deer ticks). The tick must be attached for at least 36-48 hours for transmission of Borrelia burgdorferi. Prevention includes using insect repellents, wearing protective clothing, and prompt tick removal.

Q39: What is the role of rodent control in preventing leptospirosis?
(a) Rodents are the intermediate host
(b) Rodents are the primary reservoir and contaminate water with infected urine
(c) Rodents act as vectors
(d) Rodents have no role

Ans: (b)
Explanation: Rodents (especially rats) are the primary reservoir of Leptospira. They shed the organism in urine, contaminating water and soil. Rodent control, proper waste disposal, and environmental sanitation are key preventive measures. Rodents are not vectors; transmission is through environmental contamination.

Q40: Which public health measure is most effective in preventing relapsing fever?
(a) Vaccination
(b) Control of lice and ticks
(c) Water chlorination
(d) Hand hygiene

Ans: (b)
Explanation: Relapsing fever is transmitted by body lice (epidemic) or ticks (endemic). Prevention focuses on vector control: improving hygiene, delousing, using insect repellents, and proper clothing. There is no vaccine. Treatment of infected individuals and contacts is important.

Type 7: Concept-Based / Application Questions

Q41: Why are spirochetes difficult to visualize using Gram staining?
(a) They do not have a cell wall
(b) They are too thin (0.1-0.5 µm diameter)
(c) They are acid-fast
(d) They lack peptidoglycan

Ans: (b)
Explanation: Spirochetes are extremely thin (0.1-0.5 µm in diameter), making them difficult to visualize with conventional Gram staining. Special techniques like dark-field microscopy, silver staining (Fontana stain), or immunofluorescence are used. They do have a cell wall with peptidoglycan.

Q42: What is the significance of antigenic variation in relapsing fever?
(a) It allows the organism to evade immune response, causing recurrent fevers
(b) It makes the organism resistant to antibiotics
(c) It increases virulence
(d) It facilitates transmission

Ans: (a)
Explanation: Borrelia undergoes antigenic variation by changing its surface proteins, allowing it to evade the host immune response. Each relapse corresponds to emergence of a new antigenic variant. This leads to the characteristic pattern of recurrent fevers separated by afebrile periods.

Q43: The chancre of primary syphilis is painless because:
(a) The organism produces local anesthetic
(b) There is minimal inflammatory response due to immunosuppression by the organism
(c) Nerve endings are destroyed
(d) The lesion is superficial

Ans: (b)
Explanation: Treponema pallidum induces a minimal acute inflammatory response and primarily elicits a mononuclear infiltrate. The organism may modulate the local immune response, resulting in a painless chancre. This contrasts with other sexually transmitted infections like chancroid, which causes painful ulcers.

Q44: What is the mechanism of motility in spirochetes?
(a) External flagella
(b) Axial filaments (endoflagella) causing corkscrew movement
(c) Pseudopodia
(d) Pili

Ans: (b)
Explanation: Spirochetes possess axial filaments (endoflagella) located in the periplasmic space between the outer membrane and cell wall. Rotation of these filaments produces a corkscrew or helical movement, enabling penetration through viscous media. This unique motility aids tissue invasion.

Q45: Why is penicillin ineffective against latent syphilis in a single dose?
(a) Treponema pallidum divides slowly, requiring prolonged antibiotic exposure
(b) The organism is dormant and not replicating
(c) The organism is intracellular
(d) There is antibiotic resistance

Ans: (a)
Explanation: Treponema pallidum has a very slow replication time (30 hours), and penicillin (a cell wall synthesis inhibitor) is only effective during active division. Latent syphilis requires prolonged treatment (e.g., three doses of benzathine penicillin G weekly for late latent) to ensure eradication.

Quick Revision Summary

• Spirochetes: Helical bacteria with axial filaments (endoflagella) causing corkscrew motility; include Treponema, Borrelia, Leptospira
• Treponema pallidum: Causes syphilis (STI); visualized by dark-field microscopy; cannot be cultured; treated with benzathine penicillin G
• Syphilis stages:
  • Primary: Painless chancre
  • Secondary: Rash (palms/soles), condyloma lata, lymphadenopathy
  • Tertiary: Gummas, cardiovascular (aortic aneurysm), neurosyphilis (tabes dorsalis, dementia)
• Congenital syphilis: Transmitted transplacentally; causes snuffles, rash, hepatosplenomegaly, bone abnormalities; prevented by antenatal screening and penicillin treatment
• Serological tests for syphilis:
  • Screening (non-treponemal): VDRL, RPR
  • Confirmatory (treponemal): FTA-ABS, TP-PA (remain positive lifelong)
• Jarisch-Herxheimer reaction: Acute febrile response within 24 hours of treating spirochetal infections; caused by endotoxin release; self-limiting; manage supportively
• Borrelia burgdorferi: Causes Lyme disease; transmitted by Ixodes ticks; characteristic erythema migrans (bull's eye rash); treated with doxycycline or amoxicillin
• Borrelia recurrentis: Causes relapsing fever (epidemic-louse-borne, endemic-tick-borne); recurrent fevers due to antigenic variation
• Leptospira interrogans: Causes leptospirosis (Weil's disease); transmitted via water/soil contaminated with animal (rat) urine; presents with fever, jaundice, conjunctival suffusion, renal failure; occupational disease (farmers, sewage workers); treated with penicillin or doxycycline
• Prevention of leptospirosis: Rodent control, protective clothing, boots, avoiding contaminated water; chemoprophylaxis with doxycycline 200 mg weekly in high-risk settings
• Dark-field microscopy: Gold standard for diagnosing primary syphilis from chancre exudate
• Culture media: Leptospira grows on Fletcher's medium or EMJH medium (slow growth, 2-4 weeks)
• Penicillin: Drug of choice for syphilis; doxycycline for penicillin allergy (except pregnancy-requires desensitization)
• Lyme disease prophylaxis: Single dose doxycycline 200 mg within 72 hours of tick bite (if attached ≥36 hours) in endemic areas
• Neurosyphilis diagnosis: CSF analysis (increased protein, lymphocytosis, positive VDRL)
• Public health measures: Antenatal screening for syphilis (VDRL), contact tracing, safe sex education, rodent control (leptospirosis), vector control (Lyme disease, relapsing fever)
• Mnemonic for tertiary syphilis: GCN - Gummas, Cardiovascular (aortic aneurysm), Neurosyphilis