1. Dr. Meg-angela Christi Amores
Syphilis
Dr. Meg-angela Christi Amores

2. Etiology chronic systemic infection caused by Treponema pallidum
usually sexually transmitted
characterized by episodes of active disease interrupted by periods of latency
Incubation period: 2-6 weeks average

3. Transmission
Nearly all cases of syphilis are acquired by sexual contact with infectious lesions
nonsexual personal contact
infection in utero
blood transfusion
organ transplantation

4. Stages Primary stage Secondary Stage Tertiary Stage
Lesion with regional lymphadenopathy
Secondary Stage
generalized mucocutaneous lesions and generalized lymphadenopathy
Tertiary Stage
characterized by progressive destructive mucocutaneous, musculoskeletal, or parenchymal lesions; aortitis; or symptomatic central nervous system (CNS) disease

5. Natural Course
T. pallidum rapidly penetrates intact mucous membranes or microscopic abrasions in skin
within a few hours enters the lymphatics and blood
primary lesion appears at the site of inoculation, usually persists for 4–6 weeks, and then heals spontaneously

6. generalized parenchymal, constitutional, and mucocutaneous manifestations of secondary syphilis usually appear ~6–8 weeks after the chancre heals
some patients may enter the latent stage without ever recognizing secondary lesions

7. Secondary Syphilis
Invasion of the CNS by T. pallidum occurs during the first weeks
CSF abnormalities are detected in as many as 40% of patients during the secondary stage
Generalized nontender lymphadenopathy is noted in 85% of patients with secondary syphilis
lesions subside within 2–6 weeks, then latency

8. Tertiary Syphilis 30% in pre-antibiotic era
most common types of tertiary disease were the gumma , cardiovascular syphilis , symptomatic neurosyphilis (tabes dorsalis)

9. Clinical Manifestations
Primary Syphilis
Chancre – painless papule that becomes eroded
Becomes indurated
Characteristic cartilaginous consistency at base/edge
Heterosexual men: Penis
Homosexual men: anus or rectum
Women: cervix and labia

11. Clinical manifestations
Lymphadenopathy
The nodes are firm, nonsuppurative, and painless. Inguinal lymphadenopathy is bilateral and may occur with anal as well as with external genital chancres. The chancre generally heals within 4–6 weeks (range, 2–12 weeks), but lymphadenopathy may persist for months

12. Other diseases that must be differentiated:
Herpes Simplex
inguinal adenopathy, but the nodes are tender and the lesions consist of multiple painful vesicles, which later ulcerate and are often accompanied by systemic symptoms
Chancroid
painful, superficial, exudative, nonindurated ulcers, more often multiple than in syphilis
Tender adenopathy

14. Secondary Syphilis
localized or diffuse mucocutaneous lesions and generalized nontender lymphadenopathy
healing primary chancre is still present in 15% of cases
macular, papular, papulosquamous, and occasionally pustular syphilides
pale red or pink, nonpruritic, discrete macules distributed on the trunk and proximal extremities; these macules progress to papular lesions, frequently involve the palms and soles

16. Secondary Syphilis Condylomata lata Mucous patches
broad, moist, pink or gray-white, highly infectious lesions in warm, moist, intertriginous areas : perianal region, vulva, scrotum
Mucous patches
superficial mucosal erosions that occur in 10–15% of patients and commonly involve the oral or genital mucosa

17. Secondary Syphilis
Constitutional symptoms that may accompany or precede secondary syphilis:
sore throat (15–30%)
fever (5–8%)
weight loss (2–20%)
malaise (25%)
anorexia (2–10%)
headache (10%)
meningismus (5%)

18. Latent Syphilis Positive serologic tests for syphilis
normal CSF examination
absence of clinical manifestations of syphilis

19. CNS Involvement Asymptomatic Neurosyphilis
lack neurologic symptoms and signs but who have CSF abnormalities
reactive Venereal Disease Research Laboratory (VDRL) slide test
T. pallidum can be isolated from CSF of 30% of patients even in the absence of other CSF abnormalities

20. CNS Involvement Symptomatic Neurosyphilis
onset of symptoms usually comes <1 year after infection for meningeal syphilis
5–10 years for meningovascular syphilis
20 years for general paresis,
25–30 years for tabes dorsalis
ataxic wide-based gait and footslap; paresthesia; bladder disturbances; impotence; areflexia; and loss of position, deep pain, and temperature sensations

21. Management Diagnosis T. pallidum cannot be detected by culture
Serologic tests:
Treponemal (FTA-ABS)
Non-treponemal (RPR, VDRL)
False positive tests: autoimmune, drug use, leprosy

22. Management Treatment Penicillin G : 2.4 mU IM single dose
Neurosyphilis:
Aqueous penicillin G (18–24 mU/d IV, given as 3–4 mU q4h or continuous infusion) for 10–14 days

23. Jarisch-Herxheimer Reaction
After initiation of treatment
mild reaction consisting of fever, chills, myalgias, headache, tachycardia, increased respiratory rate, increased circulating neutrophil count, and vasodilation with mild hypotension
a response to lipoproteins released by dying T. pallidum organisms