SYPHILIS

SYPHILIS
 Syphilis is a sexually transmitted infectious (STI) disease caused by the

bacterium Treponema pallidum. The three means of syphilis transmission
are:
1. Person to person via vaginal, anal, or oral sex through direct contact with
syphilis chancre.
2. Person to person during foreplay, even when there is no penetrative sex
(much less common).
3. Pregnant mother with syphilis to fetus.
Etiology
The pathogenesis of Primary syphilis
 The spirochete reaches the subepithelial tissues through inapparent breaks
in the skin or possibly by passage between the epithelial cells of a mucous
membrane.
 It multiplies locally with a generation time of about 30 hours; although the
primary lesion is local, the organism also disseminates rapidly to local
lymph nodes and then to other organs by way of the bloodstream.
 The primary lesion develops 2 to 10 weeks after infection as an indurated
swelling at the site of infection.
 The surface necroses to yield a hard-based ulcerated lesion, termed the
chancre, which is teeming with spirochetes and is highly infectious.
 The basic pathologic lesion is an endarteritis.
 The small arterioles show swelling and proliferation of their endothelial
cells.
 This reduces or obstructs local blood supply and probably accounts for the
necrotic ulceration.
 Dense, granulomatous cuffs of lymphocytes, monocytes, and plasma cells
surround the vessels. Untreated, the lesion heals within 3 to 8 weeks. The
primary lesion is not always apparent.
The pathogenesis of Secondary syphilis:
 Occurs 2 to 10 weeks after the primary hematoenous dissemination stage
and results in a secondary stage with varying degrees of severity.
 Lesions are heavily infected with T. pallidum. In moist areas around the
vulva or anus, hypertrophic papular lesions (condyloma lata) can occur.
 Generalized lymphadenopathy, fever, malaise, spienomegaly, sore throat,
headache, and arthralgia can be present.
 Immune complexes of antibody, spirochetal components and complement
are present in arteriolar walls and account for some of he clinical
manifestations.
 This stage may last several weeks and may relapse. It may be mild, however,
and go unnoticed by the patient. The factors that control the secondary
stage are unclear.
The pathogenesis of Tertiary syphilis:

 After the secondary state, nontreponemal antibody test results of one
fourth of patients revert to negative, possibly the result of spontaneous
cure.
 In another 45%, serologic tests remain positive, but no further clinical
manifestations appear.
 The remaining untreated cases develop tertiary manifestations.
 The manifestations may appear as early as 5 years after infection, but
characteristically occur after 15 to 20 years.
 Meningovascular syphilis involves vascular changes of the meninges
associated with increased cells and protein in the cerebrospinal fluid and
focal neurologic changes.
 In general paresis, there is extensive cortical degeneration of the brain, with
mental changes ranging from decreased memory to hallucinations or frank
psychosis.
 Tabbes dorsalis involves demyelination of the posterior columns and dorsal
roots and damage to dorsal root ganglia.
 The latter produces ataxia, wide-based gait, foot slap, and loss of the
sensations of position, pain, and temperature.
 Not all patients with central nervous system involvement have symptomatic
disease.
 The most characteristic lesion of late cardiovascular syphilis is the
development of an aneurysm of the ascending and transverse segments of
the aortic arch as a result of gummatous changes in the middle coat of the
aorta and loss of elasticity.
 This aneurysm can lead to aortic valve incompetence, pressure necrosis of
structures adjacent to the aorta, or rupture of the aorta.
 The isolated gumma is a granulomatous reaction to T. pallidum infection. .
 It occurs most often in skin, bones, or joints, but may involve any organ.
 Clinical manifestations of gumma are similar to those of other mass-
producing lesions in the tissues, such as tumors.
 Too few spirochetes are in the lesions to be demonstrated by microscopic
techniques, except in general paresis, when large numbers are found in the
cerebral cortex.
 Late disease is not infectious to others.
Risk factors for syphilis:

 Unprotected sexual activity involving contact with oral, genital mucosa or
anal especially in gbMSM
 Sexual contact with a known case of syphilis
 Sex with someone from a country/region with a high prevalence of syphilis
 Previous syphilis, HIV infection or other STBBI
 Born to a person diagnosed with infectious syphilis in pregnancy
 Member of a vulnerable populations
Symptoms
Syphilis has three stages:
 Primary syphilis
 Secondary syphilis
 Tertiary syphilis (the late phase of the illness)
The incubation period for primary syphilis is 14 to 21 days. Symptoms of primary
syphilis are:
 Small, painless open sore or ulcer (called a chancre) on the genitals, mouth,
skin, or rectum that heals by itself in 3 to 6 weeks
 Enlarged lymph nodes in the area of the sore
The bacteria continue to grow in the body, but there are few symptoms until the
second stage.
The symptoms of secondary syphilis start 4 to 8 weeks after the primary syphilis.
The symptoms may include:
 Skin rash, usually on the palms of the hands and soles of the feet
 Sores called mucous patches in or around the mouth, vagina, or penis
 Moist, warty patches (called condylomata lata) in the genitals or skin folds
 Fever
 General ill feeling
 Loss of appetite
 Muscle and joint pain
 Swollen lymph nodes
 Vision changes
 Hair loss
Primary and secondary syphilis usually resolve without treatment. At that point,
syphilis becomes latent and may have no symptoms for many years. But, during
this time, it may be damaging organs leading to tertiary syphilis.
Tertiary syphilis develops in untreated people. The symptoms depend on which
organs have been affected. They vary widely and can be difficult to diagnose.
Symptoms include:
 Damage to the heart, causing aneurysms or valve disease
 Central nervous system disorders (neurosyphilis)
 Tumors of skin, bones, or liver
Intervention
TREATMENT
 A single injection of long-acting Benzathine penicillin G can cure the early
stages of syphilis. This includes primary, secondary, or early latent syphilis.
CDC recommends three doses of long-acting Benzathine penicillin G at
weekly intervals for late latent syphilis or latent syphilis of unknown
duration. Treatment will cure the infection and prevent further damage, but
it will not repair damage already done.
https://www.slideshare.net/drsomeshwaranamsana/syphilis-treponema-pallidum?
from_action=save
https://www.meddean.luc.edu/lumen/meded/mech/cases/case21/syphilis.htm#:~:text=The
%20pathogenesis%20of%20Primary%20syphilis&text=The%20primary%20lesion%20develops
%202,spirochetes%20and%20is%20highly%20infectious.
https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-
transmitted-infections/canadian-guidelines/syphilis/risk-factors-clinical-manifestation.html
https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-
treated-a-to-z/syphilis
https://www.cdc.gov/std/syphilis/treatment.htm#:~:text=What%20is%20the%20treatment
%20for,secondary%2C%20or%20early%20latent%20syphilis.

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SYPHILIS

 Syphilis is a sexually transmitted infectious (STI) disease caused by the

The pathogenesis of Tertiary syphilis:

Risk factors for syphilis:

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