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Participant information

initials:
email address:
date of birth: (mm/dd/yyyy)
residence county:
zip code:
homeless: Yes No

1. Syphilis is a bacterial sexually transmitted disease which can be passed between people by the following sexual activities:

Anal Sex
Oral Sex
Footage (rubbing skin on skin)
Anal and Oral Sex
All of The Above

2. A characteristic symptom of primary (1st stage) syphilis can be:

Chancre (paneless lesion) appearing in a sexually exposed area.
Rash on hands or feet or trunk of the body
Arthritis
Chancre and Rash
None of the above

3. Syphilis can be treated and eliminated from the body by using penicilin:

True
False

4. Being infected with syphilis puts an individual at greater risk for acquiring HIV:

True
False

5. Syphilis can only be transmitted during the "active" stages, when symptoms are present, such as a chancre on the penis, a rash on the hands, feet, trunk, etc.:

True
False

6. Left untreated, syphilis can infect the central nervous system. If untreated, syphilis can progress to tertiary and include the presence of neurosyphilis. Which of the following conditions can present themselves in individuals with syphilis:

Dementia
Kidney disorders
Arthritis
Heart problems
Dementia and Heart Problems
All of The Above

7. Once you've been infected with and been treated for syphilis, you can never get it again:

True
False

8. Tertiary syphilis (third stage) can surface twenty or more years after untreated second stage syphilis:

True
False

9. After being exposed to syphilis, the usual incubation period for infection is:

48 hours
1 year
3 weeks
6 months
25 years

10. In some cases, individuals with HIV and syphilis co-infection have been found to progress through the stages to tertiary syphilis in a matter of months instead of years.

True
False


















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