Syphilis

http://embryology.med.unsw.edu.au/Defect/syphilis.htm
 Syphilis
A sexually transmitted disease caused by the
spirochetal bacterium Treponema pallidum

http://www.hpa.org.uk/cdr/archives/2004/sti_3104.pd
 Primary Syphilis

●
Acquired by direct sexual contact with infectious
lesions.
●
10-90 days (21) skin lesion occurs (at point of
contact)
●
Papule appears first and develops into chancre
(usually single, clear base, indurated margin and
painless)
●
Heals spontaneously (4-6 weeks)
●
Ipsilateral lymphadenopathy
●
Asymptomatic
 Primary Syphilis

http://webpages.shepherd.edu/AKAETZ01/syphilis_picture_primary_46.jpg
 Secondary Syphilis
●
Once primary lesion is healed, secondary lesions
occur
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4-10 weeks after primary infection
●
Primarily on palms of hands and soles of feet
●
Symmetrical reddish pink rash on trunk and legs
●
Non-pruritic
●
Condylomata lata – large raised lesions in moist
areas
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Non specific: Sore throat, headache, fever
●
If left untreated lesions will heal → Latent
 Secondary Syphilis

http://health.allrefer.com/health/syphilis-secondary-syphilis-secondary-on-the-palms.html
http://missinglink.ucsf.edu/lm/DermatologyGlossary/syphilis.html
 Latent Syphilis

●
Early Latent: 6 months to 2 years
●
Secondary symptoms may reoccur in 25% of
patients
●
Generally asymptomatic
●
Treatment sometimes not sought
●
Late Latent: greater than 2 years without
symptoms
●
Distinction is important for treatment
(Early: single im injection, Late: 3xweekly
injections)
 Tertiary Syphilis
●
1-10 years after initial infection, up to 50 years
●
Gummas form, harmful ulcers or granulomas, on any
part of body.
●
Chronic, due to inability of immune system to
remove organism
●
Cardiovascular Syphilis: Rare, 10% of patients
untreated for 10-40 years.
●
Damage to heart and major blood vessels
●
Often fatal
●
Neurosyphilis: <10% of untreated patients, CNS
affected with paralysis and/or paresis
●
(Asymptomatic neurosyphilis, meningovascular
syphilis, general paresis, tabes dorsalis)
 Tertiary Syphilis

http://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/Syphilis-and-trachoma.htm
http://www.pathology.vcu.edu/education/dental2/lab6.htmll
 Diagnosis
●
Clinical picture
●
Find Treponemes
●
Darkground
●
Rapid Plasma Reagin (RPR) and Venereal
Disease Research Laboratory (VDRL), but not
specific – Cardiolipin ab.
●
Treponema pallidum hemagglutination assay
(TPHA) and Fluorescent Treponemal Antibody
Absorption (FTA-ABS) are more specific –
treponeme specific ab.
●
Neurosyphilis: high numbers of leukocytes in
CSF
 Treatment
●
First choice penicillin G.
●
Early syphilis, one dose is effective
●
Allergy: Doxycycline/Tetracycline
●
Late Latent: penicillin G weekly dose for 3 weeks
●
Neurosyphilis: aqueous crystalline penicillin G i.v.
every 4 hours, or continuously for 10-14 days
●
Procaine penicillin is an alternative (painful
injections)
+3 weekly doses of benzathine penicillin G after
the completion of a 14-day course of aqueous
crystalline or aqueous procaine penicillin G