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
