Syphilis

1. SYPHILIS

2. SYPHILIS
Syphilis - infectious treponematoses caused by
Treponema pallidum transmitted usually by sexual
intercourse
Discovered by Schaudinn and Hoffmann(1905)
Affects most of the organs
 Marked by florid manifestations on the one hand
 And years of asymptomatic latency on the other hand
Affects both man & women in age group of 20-40
years

3. Different
manifestations occur
depending on the
stage of the disease
SYPHILIS

4. SYPHILIS

6. Pathogenesis
Mode of transmission
1. Sexual intercourse
2. Blood transfusion
3. Contaminated needles
4. Vertical transmission
5. To hospital personnel by indiscriminate
handling of infected lesions

7. 1.ATTACHMENT, INVASION AND DISSEMINATION
2. INNATE HOST RESPONSE – TLR2
3. ACQUIRED IMMUNITY - clinical manifestations caused
by inflammatory and immune responses rather than by
any direct cytotoxic effect of T. pallidum
4. BACTERIAL CLEARANCE- phagocytosis of treponemes
by macrophages
 Predominant cytokine –Th1
 Predominant mediator- IFN-γ
5. ANTIBODIES IN SYPHILIS
6. INVASION OF HOST IMMUNITY AND
ESTABLISHMENT OF LATENT INFECTION
7. PROTECTIVE AND LONG-LASTING IMMUNITY
Pathogenesis

8. Classification of Syphilis
Clinical course of acquired syphilis is divided in to
early &late syphilis.
1. Early-duration is 1 yrs.
 Includes primary and secondary stage and early latent syphilis
2. Late-after 1 yrs.
 Include late latent & tertiary syphilis
 Congenital Syphilis
COLLES’S LAW(1837)
 Syphilitic infants could transmit the disease to previously healthy wet
nurses but never to their own mother
KASSOWITZ’S LAW(1876)
 Untreated syphilitic mother tends to improve on her past performance

9. Primary Syphilis
 It’s the first stage after infection
 Painless & localized ulcer with rolled edge
(chancres).
 Single or multiple.
 Appear 2-3 weeks after contact.
 Most common site are cervix , vagina , vulva
, anus and mouth.
 Regional L.N become enlarged.

10. Primary Syphilis

11. 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

12. Systemic
1-6 months after contact
Fever, malaise, general adenopathy and
nonitchy maculopapular skin rash “money
spot” .
Involve the palms of the hands and the soles
of the feet.
Mucous patches and linear (snail track)
ulcers are seen on the mucosal surfaces.
SECONDARY SYPHILIS

13. Secondary Syphilis, Macular Rashes

14. Secondary syphilitic rash on palm and sole

15. Syphilitic
alopecia scalp
has moth-
eaten
appearance
eyebrow hair
is absent there
is rash on the
cheek
SECONDARY SYPHILIS

16. Mucus
patches
involving
the tongue
in
secondary
syphilis.
SECONDARY SYPHILIS

17. 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.

18. 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.
Late latent:
 Usually not infectious, except for the pregnant
woman, who may transmit infection to her fetus.
LATENT SYPHILIS

19. LATENT SYPHILIS

20. TERTIARY SYPHILIS
Morbidity and mortality of syphilis in adults in
past years were due to late manifestations of illness
There may be an interval of 1 - 20 yrs from acute
infection to clinical onset of late or tertiary stages
of disease
Tertiary syphilis conveniently divided into three
main groups
 Late benign syphilis
 Cardiovascular syphilis
 Neurosyphilis

21. Nodular
syphilid on
inferior side
of the penis
BENIGN TERTIARY SYPHILIS

22. BENIGN TERTIARY SYPHILIS
Nodular
syphilid of the
pubic area and
solitary gumma
on dorsum of
the penis

23. BENIGN TERTIARY SYPHILIS
Nodular
syphilid
of the
knee

24. CARDIOVASCULAR SYPHILIS

25. NEUROSYPHILIS

26. 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

27. Lab diagnosis of syphilis
Tests are divided in four categories :
Direct microscopic exam - used when
lesions are present
Non treponemal tests - used for screening
Treponemal tests - are confirmatory
Direct antigen detection tests - used in
research settings and as gold standards for
test evaluation

28. TREATMENT
Early infections
 The first-line treatment for uncomplicated syphilis remains
a single dose of intramuscular benzathine benzylpenicillin.
 Doxycycline and tetracycline are alternative choices for
those allergic to penicillin; due to the risk of birth defects,
these are not recommended for pregnant women.
 Resistance to macrolides, rifampicin, and clindamycin is
often present.
 Ceftriaxone, a third-generation cephalosporin antibiotic,
may be as effective as penicillin-based treatment.
 It is recommended that a treated person avoid sex until the
sores are healed.

29. Late infections
 For neurosyphilis, due to the poor penetration of
benzathine penicillin into the central nervous system, those
affected are given large doses of intravenous penicillin for a
minimum of 10 days.
 If a person is allergic to penicillin, ceftriaxone may be used
or penicillin desensitization attempted.
 Other late presentations may be treated with once-weekly
intramuscular benzathine penicillin for three weeks.
 Treatment at this stage solely limits further progression of
the disease and has a limited effect on damage which has
already occurred.
TREATMENT

30. Jarisch-Herxheimer reaction
One of the potential side effects of treatment is
the Jarisch-Herxheimer reaction.
It frequently starts within one hour and lasts for 24
hours, with symptoms of fever, muscle pains,
headache, and a fast heart rate.
It is caused by cytokines released by the immune
system in response to lipoproteins released from
rupturing syphilis bacteria.
TREATMENT

31. Pregnancy
Penicillin is an effective treatment
for syphilis in pregnancy but there
is no agreement on which dose or
route of delivery is most effective.
TREATMENT

32. Shankar Lal Jat (Ma1501o)