Syphilis
Title
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Syphilis
Definition
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Congenital or acquired
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Chronic systemic disease
Caused by:
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Treponema pallidum
Pathogenesis
Causative organism
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Treponema pallidum:
Spirochaete
Transmission
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Sexual contact
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Transplacental
Pathological Process
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Spirochaete binds to endothelial
cells of blood vessels
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This causes obliterative
endarteritis and plasma cell infiltration
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This occurs in all stages of the
disease
Gumma
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Characteristic lesion of
tertiary syphilis
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May form in any organ or tissue
Consists of:
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A central area of necrosis
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Surrounded by epithelioid cells,
giant cells and a rim of fibrous tissue
Clinical Features
Acquired Syphilis
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Primary
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Secondary
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Latent
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Tertiary
Primary
Syphilis
History
Incubation period
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10-90 days
Examination
RAG
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Chancre:
Painless indurated lesion with raised border
Site of inoculation
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Regional lymphadenopathy
Secondary
Syphilis
History
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4-10 weeks after primary lesion
E&M
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Fever
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Malaise
RS
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Sore throat
LMS
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Arthralgia
Examination
HS
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Generalised lymphadenopathy
IS
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Generalised, reddish-brown,
maculopapular rash, scaling
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Patchy alopecia
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Condylomata lata
GIT
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Snail track ulcers
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Hepatosplenomegaly
CNS
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Cranial nerve palsies
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Aseptic meningitis
LMS
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Periostitis
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Osteitis
KUB
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Glomerulonephritis
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Nephritic syndrome
Latent Syphilis
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Symptoms and signs of secondary
syphilis abate without treatment in about 3-12 weeks
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Followed by a latent period of
several years before the features of tertiary syphilis arise
Tertiary
Syphilis
LMS
Gumma:
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Causes bone destruction
Results in:
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Pain and swelling
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Pathological fractures
IS
Gumma:
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Red or brown-red nodule
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Eventually ulcerates
CNS
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Tabes dorsalis
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General paralysis of the insane
CVS
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Aortic aneurysm
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Aortic regurgitation
HS
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Paroxysmal cold haemoglobinuria:
Very rare
Congenital
Syphilis
Early Congenital
Syphilis
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Nasal infection:
Snuffles
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Skin and mucous membrane
involvement similar to secondary syphilis
Late Congenital
Syphilis
GIT
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Hutchinson’s teeth
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Protruding mandible
RS
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Saddle nose
LMS
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Sabre tibia
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Clutton’s joints
IS
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Facial gumma
CNS
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Fontal bossing
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Keratitis
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Uveitis
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Nerve deafness
Investigations
Fluids
Chancre
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Dark ground microscopy
demonstrates organism
Blood
Immunology
Positive immunology
Non-treponemal tests:
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VDRL (venereal disease research
laboratory)
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RPR (rapid plasma reagin)
Treponemal tests:
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FTA-Abs (fluorescent treponemal
antibodies)
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TPHA (treponema pallidum
haemagglutination)
CSF
Haematology
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Pleocytosis
Biochemistry
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Protein:
Raised
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Glucose:
Normal or low
Immunology
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VDRL:
Positive > 90%
Management
Cure
Drugs
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Penicillin
Allergy to penicillin:
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Doxycycline, tetracycline,
ceftriaxone
Pregnancy and penicillin allergy:
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Erythromycin followed by
doxycycline after delivery
Jarisch-Herxheimer Reaction
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Release of TNF alpha, IL-6, IL-8
with commencement of treatment
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This causes fever, malaise,
headache
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May exacerbate cardiovascular
and neurological disease
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Prednisolone may ameliorate the
reaction
