SYPHILISSYPHILIS

SYPHILIS IS :SYPHILIS IS : a sexual transmitted disease caused a sexual transmitted disease caused by spirochetal bacterium Treponema by spirochetal bacterium Treponema pallidum , pallidum , a motile anaerobic a motile anaerobic

Transmission of syphilis is almost always through

sexual contact or congenitally through the placenta to a fetus or at birth from an infected mother.

Different manifestations

occur depending on the stage of the

disease

• Primary Syphilis: it’s the first stage after infection

1.painless & localized ulcer with rolled edge (chancres).

2.single or multiple.3.appear 2-3 weeks after contact.4.most common site are cervix ,

vagina , vulva , anus and mouth.5.regional L.N become enlarged.

.

PRIMARY SYPHILISPRIMARY SYPHILIS(The Chancre)(The Chancre) Incubation period 9-90 days, usually ~21

days. Develops at site of contact/inoculation.Classically: single, painless, clean-based,

indurated ulcer, with firm, raised borders. Atypical presentations may occur.

Mostly anogenital, but may occur at any site (tongue, pharynx, lips, fingers, nipples, etc...)

Non-tender regional adenopathy Very infectious.May be darkfield positive but serologically

negative. Untreated, heals in several weeks, leaving a faint scar.

SECONDARY SYPHILISSECONDARY SYPHILIS(Cont.)(Cont.) The skin rash:

◦ Diffuse,◦ often with a superficial scale (papulosquamous). ◦ May leave residual pigmentation or depigmentation.

Condylomata Lata:◦ Formed by coalescence of large, pale, flat-topped

papules.◦ Occur in warm, moist areas such as the perineum.◦ Highly infectious.

Mucosal lesions: ~ 30% of secondary syphilis patients develop mucous

patch (slightly raised, oval area covered by a grayish white membrane, with a pink base that does not bleed).

◦ Highly infectious

Secondary Syphilis: 1.Systemic2.1-6 months after contact3.fever, malaise, general adenopathy

and non-itchy maculopapular skin rash “money spot” .

4.involve the palms of the hands and the soles of the feet.

5.Mucous patches and linear (snail track) ulcers are seen on the mucosal surfaces.

SECONDARY SYPHILISSECONDARY SYPHILISSeen 6 wks to 6 mos after primary chancreUsually w diffuse non-pruritic, indurated rash,

including palms & soles.May also cause:

◦ Fever, malaise, headache, sore throat, myalgia, arthralgia, generalized lymphadenopathy

◦ Hepatitis (10%)◦ Renal: an immune complex type of

nephropathy with transient nephrotic syndrome

◦ Iritis or an anterior uveitis◦ Bone: periostitis◦ CSF pleocytosis in 10 - 30% (but,

symptomatic meningitis is seen in <1%)

SECONDARY SYPHILISSECONDARY SYPHILIS Differential diagnosisDifferential diagnosis The rash may be confused with

◦ Pityriasis rosea (usually has a herald patch and lesions seen along lines of skin cleavage)

◦ Drug eruptions◦ Acute febrile exanthems◦ Psoriasis◦ Lichen planus ◦ Scabies

The mucous patch may be confused with oral thrush.

Malaise, sore throat, generalized adenopathy, hepatitis, & rash may be confused with infectious mononucleosis.

Fortunately, the serologic tests for syphilis are positive in 99% of secondary syphilis pts.

LATENT SYPHILISLATENT SYPHILIS

Positive syphilis serology Positive syphilis serology without without clinical signs of syphilis (& has clinical signs of syphilis (& has normal CSF).normal CSF). ◦ It begins with the end of secondary syphilis

and may last for a lifetime.◦ Pt may or may not have a h/o primary or

secondary syphilis. ◦ Diseases known to cause occasional false-

positive nontreponemal test reactions for syphilis, such as systemic lupus erythematosus (SLE), and congenital syphilis must be excluded before the diagnosis of latent syphilis can be made.

Is divided into early and late latency.Is divided into early and late latency.

LATENT SYPHILIS (cont.)LATENT SYPHILIS (cont.)

1. Early latent:◦ The first year after the resolution of

primary or secondary lesions, or◦ A reactive serologic test for syphilis in an

asymptomatic individual who has had a negative serologic test within the preceding year.

◦ Infectious.

2. Late latent:◦ Usually not infectious, except for the

pregnant woman, who may transmit infection to her fetus.

LATENT SYPHILISLATENT SYPHILIS‘Tertiary Syphilis’‘Tertiary Syphilis’

Is the destructive stage of the disease. Lesions develop in skin, bone, & visceral organs (any

organ). The main types are:

◦ Late benign (gummatous) ◦ Cardiovascular & ◦ Neurosyphilis

Can be crippling and life threatening Blindness, deafness, deformity, lack of coordination,

paralysis, dementia may occur It is usually very slowly progressive, barring certain

neurologic syndromes which may develop suddenly due to endarteritis and thrombosis in the CNS

Late syphilis is noninfectious.

LATENT SYPHILISLATENT SYPHILIS

Positive syphilis serology without clinical signs of syphilis (& has normal CSF). ◦ It begins with the end of secondary syphilis and

may last for a lifetime.◦ Pt may or may not have a h/o primary or

secondary syphilis. ◦ Diseases known to cause occasional false-

positive nontreponemal test reactions for syphilis, such as systemic lupus erythematosus (SLE), and congenital syphilis must be excluded before the diagnosis of latent syphilis can be made.

Is divided into early and late latency.

Latent syphilisAbsent of symptoms or physical finding.

1\3 proceed to tertiary.

Tertiary syphilis1.Ocurre 1-10 years after infection2.gummas: ulcerative nodule in the skin,

bone and nervous system as a result of hypersensitivity reactions.

3.Systemic manifestation: CVS, CNS and bone

Congenital SyphilisCongenital SyphilisMode of transmission: -trans placental passage from infected

mother - at birthCongenital infection is associated with

several adverse outcomes including: -low birth wt -congenital

anomalies -premature birth -miscarriages or

death of baby

Congenital SyphilisCongenital SyphilisEarly:-skin lesions ,

maculopapular tissue

-Lymphadenopathy-

Hepatosplenomegaly

-failure to thrive-jaundice , anemia- osteochondritis

Late:-gummatous ulcers-bony prominence of

forehead-Saddle nose -Short maxilla -keratitis, 8 nerve

deafness and dental deformities

PreventionPrevention

TreatmentTreatmentThe first-choice treatment for all

manifestations of syphilis is penicillin.Parenteral penicillin G is the only

therapy with documented effect during pregnancy.

Non-pregnant individuals who have severe allergic reactions to penicillin

may be effectively treated with oral tetracycline or doxycycline

THANXTHANXTHANXTHANX