REFERAT
“SYPHILIS”
Presented By : Athiqoh
Supervisor : dr. Frista Martha Rahayu, Sp.DV
Medical Degree Program
Department of Dermatology and Venereology
Waled Regional General Hospital
Swadaya Gunung Jati University
2025
S
Syphilis is a sexually transmitted infection caused by
0
Treponema pallidum
1 bacteria, is highly chronic and
systemic in nature. In its course it can affectalmost all
organs of the body, can resemblemany diseases, have a
latent period, can be transmitted from mother to fetus
and can be cured
ETIOLOGY
TRANSMISSI
1. ON
Acquired syphilis : Treponema pallidum enters via
body fluids
• Cuts/breaks in Sexual contact
skin • oral Contaminated Direct contact
• Mucous • Anal needles with a skin lesion
membranes • Vaginal
(external
genitalia/mouth)
2. Congenital syphilis : mother has syphilis infects the baby in the
uterus or the vagina at birth
ON
Early Syphilis 1. Primary stage syphilis (SI)
(easily transmitted, 2. Secondary stage syphilis (SII)
responds well to treatment, 3. Early latent syphilis
suffered ≤1 year) 4. Recurrent stage (relapse)
Acquired syphilis
1. Advanced latent syphilis
Advanced Syphilis
2. Tertiary syphilis (S III) : guma,
(not contagious, neurosyphilis, and cardiovascular
suffered >1 year)
SYPHILIS
syphilis.
Early Congenital Syphilis
Syphilis infection appears within the first 2 years of life
Congenital syphilis
Advanced Congenital Syphilis
Persistent syphilis infection up to >2 years after birth
CLINICAL MANIFESTATIONS
•
Acquired syphilis : Primary stage (SI)
Duration : 2-4 weeks
• Lesion : a lenticular papule becomes eroded, becoming an ulcer usually round, solitary, the base
is a net of clean, red-colored granulations, above which appears serum, induration, painless;
regional lymph node enlargement.
• Location :
- In males : penis (especially glans penis or around the coronary sulcus), scrotum
- In women : vulva, cervix, fourchette, or perineum.
- Extragenital : tongue, tonsils, and anus.
CLINICAL MANIFESTATIONS
Acquired syphilis : Secondary stage (SII)
• Duration : 3 - 12 weeks
• Lesion : diffuse mucocutaneous, lymphadenopathy. rash, erythematous macules (roseola
syphilitica) or maculopapules, patchy nonscarring alopecia, Annular papules and plaques,
Confluence of mucous patches
• Location :
- In males : penis
- other : tongue, palmar, plantar, mouth, nose. body
CLINICAL MANIFESTATIONS
Asymptomatic, no clinical symptoms,
but the syphilis serology test (TSS)
Acquired syphilis : Early latent 1. Gumma : a granulomatousnodular lesion with variable central
was reactive
necrosis, most commonly affect the skin or mucous membranes.
Advanced syphilis : Tertiary (SIII) Location : sites of previous trauma, more common on the scalp,
forehead, buttocks, and presternal, supraclavicular, or pretibial
areas
2. Neurosyphilis : Ocular abnormalities, other cranial
nerveinvolvement, acute meningitis, other syndromes (headache,
altered mental status, or both), and cerebrovascular accidents,
neurologic deficits
3. Cardiovascular syphilis : Angina pectoris aneurysm of the aorta
voice becomes hoarse. Death is caused by rupture into the
trachea, pleura, pericardium, or mediastinum.
CLINICAL MANIFESTATIONS
Congenital syphilis : Early
• Duration : < 2 years old
• Lesion : Rash, Desquamation and crusting, mucouspatches, fissures around the lips, nares, or
anus, andpetechiae from thrombocytopenia.The skin is often dry and wrinkled, condyloma lata
• fever,rash, hepatosplenomegaly, and persistent rhinitis(“snuffles”). Hydrops fetalis (edema),
lymphadenopathy, neurosyphilis, leukocytosis, thrombocytopenia, periostitis, and osteochondritis
also may bepresent, with the pain associated with osteochondrotic lesions
CLINICAL MANIFESTATIONS
Congenital syphilis : Late
• Duration : > 2 years old
• Hutchison's triad: Hutchinson's tooth, interstitial keratitis, deafness of nerve VIII
(vestibulocochlear)
• Other manifestations: saddle nose, frontal boosing, cluttons joint, lymphadenopathy,
hepatosplenomegaly, bone destruction, neurosyphilis
DIAGNOSIS
A. Direct detection of Treponema Pallidum
1. Darkfield microscopy : Serum was taken from the skin lesions and the shape and movement.
The treponemes is white on a dark background. They move around their axis, moving slowly
across the field of view, so they do not move quickly.The test is done on three consecutive
days. If negative does not always mean the diagnosis is not syphilis, perhaps there are too
few germs.
2. Direct fluorescence antibody test : The lesional exudate is smeared on a glass slide and
stained with fluorescein-labeled anti–T. pallidum immunoglobulin. the smear can be held for
later evaluation and oral or anal lesions can be examined because only T. pallidum is stained.
The sensitivity of the test is 73% to 100%
3. Molecular tests : In research settings, PCR-based methods have beenused to detect T.
pallidum DNA from lesions
B. SEROLOGY
DIAGNOSIS
1. Non treponemal test : If the titer of a quarter or more of suspected syphilis sufferers, begins to be positive
after two to four weeks from the onset of S I. The titer will increase until it peaks at advanced SII (1/64 or
1/128) then gradually decreases and becomes negative.
- Complement fixation test : wasserman
- Floculation test : VDRL (Venereal Disease, Research Laboratories), Kahn, RPR (Rapid Plasma Reagin), ART
(Automated Reagin Test), dan RST (Reagin Screen Test).
2. Treponemal test :
- Immobilization tests: TPI (Treponemal pallidum Immobilization test (Treponemal pallidum /mobilization Test)
- Complement fixation test: RPCF (Reiter ProteinComplement Fixation Test).
- Immunofluorescent test: FTA-Abs (Antibody Absorption Test Treponemal Antibody Absorption Test).
- Hemoglutization test: TPHA (Treponemalpal/idum Haemogglutination Assay)
DIFFERENTIAL DIAGNOSIS
- Herpes simplex
- Pyogenic ulcer
- Balanitis
- Lymphogranuloma venereum
- Squamous cell carcinoma
- Behcet's disease
- Mole ulcer
TREATMENT
COMPLICATIO
NSreaction: an acute febrile reaction with
- The Jarisch-Herxheimer
headache, myalgia, rash, lymphadenopathy, throat pain and
hypotension.
- Reactions begin within 1-2 hours after treatment, peak at 8
hours, and usually resolve within 24-48 hours. Reactions may
be more common in HIV-positive women. Encountered in 50-
80% of early syphilis.
PREVENTI
ON
1. Syphilis screening : all pregnant women, mother giving birth, all sex workers
(female, male, transgender), all MSM who have multiple sex partners, all STI
patients, women with a history of miscarriages or stillbirths
2. Rapid test usage : The current standard is the RPR test, followed by the TPHA or TP
rapid test in those with positive RPR results, and the RPR titer test in those with
positive TPHA/TPrapid test results.
3. Syphilis in pregnant women : screening for syphilis in pregnant women, especially
those who have never been screened before, treating all pregnant women who test
positive for syphilis at that time, treat all partners of each pregnant woman who test
positive for syphilis, education, active counseling, and condom promotion to prevent
re-infectionrepeat, treat all babies born to syphilis positive mothers, thoroughly
E
1.Menaldi SL, Bramono K, Indriatmi W. Ilmu Penyakit Kulit dan Kelamin.
Jakarta: Badan Penerbit FKUI; 2016.
2.Kang S., Amagai M., Bruckner A. L., etc. Mc Graw Hill : Fitzpatrick’s
Dermatology Vol 1. 9th Ed.
3.PPK PERDOSKI. 2021
4.KEMENKES RI. Pedoman Tatalaksana Sifilis Untuk Pengendalian Sifilis Di
Layanan Kesehatan Dasar. Jakarta. 2013
