SYPHIILIIS

 

SYPHIILIIS

SYPHILIS IS :

a sexual transmitted disease caused by spirochetal bacterium Treponema pallidum ,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

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

4.single or multiple.

5.appear 2-3 weeks after contact.

6.most common site are cervix, vagina,vulva , anus and mouth.

7.regional L.N become enlarged.

 

PRIMARY SYPHILIS(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 SYPHILIS

 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:

2. Systemic

3. 1-6 months after contact

4. fever, malaise, general adenopathy and nonitchy maculopapular skin rash “money spot” .

5. involve the palms of the hands and the solesof the feet.

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

SECONDARY SYPHILIS

 Seen 6 wks to 6 mos after primary chancre

 Usually 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%)

 

Differential 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 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 secondarysyphilis.

◦ 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 SYPHILIS

 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 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 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 syphilis

Absent of symptoms or physical finding.

1\3 proceed to tertiary.

 

Tertiary syphilis

6. Ocurre 1-10 years after infection

7. gummas: ulcerative nodule in the skin, bone and nervous system as a result of hypersensitivity reactions.

8. Systemic manifestation: CVS, CNS and bone

 

Congenital Syphilis

 Mode of transmission:

-trans placental passage from infected mother

- at birth

 

 Congenital infection is associated with several adverse outcomes including:

-low birth wt

-congenital anomalies

-premature birth

-miscarriages or death of baby

 

Congenital Syphilis

 Early:

-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 dentaldeformities

 

Treatment

The 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