SYPHILIS
SYPHILIS
Definition
It is a venereal disease caused by the bacteria - Treponema
Pallidum, a delicate spiral organism (spirochaete) of 6 to 15 pm
in length.
Mode of Transmission:
▪ Sexual Contact: The most common route of transmission is through
direct contact with a syphilis sore during a sexual intercourse.
• Mother-to-Child Transmission: Pregnant women with syphilis can pass the infection to their
unborn child, leading to serious health consequences for the baby.
• Once inside the body, it can spread through the bloodstream to various organs.
• The organism dies rapidly on drying, so early lesions are mostly seen in moist areas e.g.
external genitalia, anus and mouth.
SYPHILIS
CLINICAL PRESENTATION
The disease is divided into four stages —
1. Primary syphilis 3. Tertiary syphilis
2. Secondary syphilis 4. Latent syphilis.
PRIMARY SYPHILIS
▪ Classically, a genital chancre occurs in the penis or vulva after 3–4 weeks of sexual exposure.
▪ Chancre is shallow, indurated, painless ulcer called Hunterian chancre.
▪ Associated inguinal lymph nodes which are shotty (like tiny pellets), multiple, nontender are
diagnostic.
▪ Extragenital chancres can occur in the lips, tongue, nipple, etc. and can be painful. They
produce large enlargement of the corresponding lymph nodes.
SYPHILIS
SECONDARY SYPHILIS:
▪ This stage appears in 2 to 3 months after the primary
syphilis.
▪ It is characterised by macular or papular, generalised,
bilaterally symmetrical, coppery red rashes.
▪ Condylomata lata—fleshy wart-like growths, seen in
the mucocutaneous junctions e.g. anus, vulva and
perineum.
▪ Snail-track ulcers - formed by coalescence of small,
round and superficial erosions in the mouth.
▪ A generalized painless lymphadenopathy also
occurs at this stage. The most characteristic finding is
enlargement of epitrochlear and suboccipital groups
of lymph nodes.
▪ Moth-eaten alopecia, iritis, bone and joint pains are
other symptoms
SYPHILIS
LATENT SYPHILIS:
If secondary syphilis is not treated, it will develop into latent syphilis.
There are no signs but serum tests are positive.
SYPHILIS
LATE SYPHILIS (tertiary syphilis)
▪ This stage develops after 5–15 years of primary syphilis.
▪ It causes neurosyphilis and cardiovascular syphilis (aortitis).
▪ Localized lesion is the Gumma or the gummatous ulcer, which
is a painless punched out ulcer with wash-leather slough on the
floor.
▪ Neurosyphilis includes general paresis and tabes dorsalis
involving posterior column and dorsal roots. It presents with
sensory atonia, lancinating pain and Argyll Robertson pupil.
SYPHILIS
SYPHILIS
Congenital syphilis:
Treponema pallidum from an infected mother may cross the placental barrier to enter
foetal circulation.
The manifestations in this group appear within a few weeks in the new born.
Early stage - Snuffles (rhinitis), epiphysitis, periostitis, osteochondritis.
Late Stage -
• Hutchinson’s triad
– Interstitial keratitis
– 8th nerve deafness
– Hutchinson’s teeth
SYPHILIS
Investigations:
• Nonspecific: VDRL
• Specific treponemal antigen tests
• FTA-Abs—fluorescent treponema antibody absorption test
• Demonstration of Treponema pallidum in the clear exudate from the lesion by dark field
microscopy confirms the diagnosis.
SYPHILIS
Treatment:
▪ Penicillin is the antibiotic of choice in syphilis.
▪ To prevent congenital syphilis the same dose of procaine penicillin G should be given to the
mother for 15 days as early as possible in pregnancy.
