Syphilis

Syphilis
- Can’t be Gram stained

- Treponema pallidum subspecies pallidum
- Transmission
o Direct contact
o Perinatal
o Parenteral (rare)
o Blood transfusion
- Other subspecies
o T. pallidum subspecies pertenue
 Yaws
 Tropics
o T. pallidum subspecies endemicum
 Bejel
 Non-venereal endemic
 Deserts
o T. pallidum subspecies carateum
 Pinta
 Often seen in Central and South America
Stages of Syphilis
- Infection
o Growth of organisms at the site of infection, dissemination to various tissues including
central nervous system
- Primary syphilis
o Hallmark of primary syphilis
 Chancre at site of infection
 Seen at genital or extra-genital sites
 Highly contagious (most contagious stage)
 30% of cases become serologically active
o Regional lymphadenopathy
o RPR or FT-Abs are used after 1-3 weeks
- Secondary syphilis
o Disseminated rash, generalized lymphadenopathy
o Condyloma lata
 Flat wart-like growths in genital area or anogenital area
o Neurological sings
 Ophthalmic signs, meningitis, nerve palsies
o All serological tests are positive
- Latent syphilis
o Recurrence of secondary syphilis symptoms in up to 25% of individuals
- Tertiary syphilis (late latent)
o Gumma, cardiovascular syphilis
o The lesions are less infective
o Nervous system is affected
o Spirochetes are difficult to demonstrate in the gummas
Lesions are of 2 main types in tertiary syphilis

- Syphilitic gumma
o Solitary, localized, rubbery lesion with central necrosis
o Seen in organs like liver, testis, bone and brain
o A form of granuloma
o Most commonly seen in liver
 Heparlobatum/ gummahepatis
- Diffuse lesions of tertiary syphilis
o Predominantly seen in cardiovascular and nervous systems
 Cardiovascular syphilis
 Aortic aneurysm
o Incompetence of aortic valve
o Will cause death
 Neurosyphilis
 Meningovascular syphilis
o Tabes dorsalis affecting the spinal cord
 Tabes dorsalis
 Slow degeneration of the nerve cells and nerve
fibers that will now carry the sensory
information to brain
 Secondary tabes dorsalis
 Charcot’s joints
o Destructive neuropathic arthropathy
o Due to loss of pain sensation
o General paresis affecting the brain
 Glossitis
 Predisposed to carcinoma
 Targets patients who are smokers
We cannot do culture and sensitivity for this bacterium because it is a spirochete.

RPR is more sensitive than VDRL and equally sensitive with FTA-Abs
Multiple chancres are seen in HIV patients infected with syphilis
Serological tests are positive after 1-3 weeks from appearance of chancre
Laboratory diagnosis
- Non-treponemal tests
o Qualitative RPR or VDRL
o If reactive
 Proceed to quantitative RPR or VDRL
  treponemal serologic test
o  if reactive
  reactive treponemal serologic test previously treated
or untreated syphilis
o  if nonreactive
 Syphilis is unlikely
Serologic tests
Direct detection
Nontreponemal Treponemal
TPI
VDRL
FTA-ABS
Darkfield Microscopy RPR
TPHA
Fluorescent antibody test USR
MHA-TP EIA
TRUST
DNA Probe
Antigens of Syphilis
- Wasserman antigens
o Cardiolipin
 In serology
 Comes from cow heart or from extracts of liver from newborns that had
died of congenital syphilis
- Treponemal antigens
o Reiter strain
 nonvirulent
o Nichol strain
 Virulent
Antibodies against Syphilis
- Nontreponemal antibodies
o Reagin
 Antibody against cardiolipin
- Treponemal antibodies
o Antibodies against T. pallidum
PRIMARY SECONDARY LATENT TERTIARY

RPR is more sensitive All serologic tests detect Diagnosis can only be DSF VDRL
than VDRL and equally the infection made by serologic (neurosyphilis)
sensitive with FTA-ABS methods
INTERPRETATION OF SEROLOGICAL TESTS FOR SYPHILIS
Non treponemal tests Treponemal tests Possible explanation
Syphilis – recent or previous
+ +
Yaws or pinta
No syphilis
+ -
False positive
Consistent with previously
- + treated or untreated syphilis
Yaws. Pinta. Bejel
No syphilis
- -
Syphilis in incubation period
Treatment
- Antibiotics
o Early stage
 One shot of penicillin
o Late stage
 Three shots of penicillin
 One shot given each week for three weeks

Syphilis

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Syphilis

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Syphilis

- Can’t be Gram stained

Lesions are of 2 main types in tertiary syphilis

We cannot do culture and sensitivity for this bacterium because it is a spirochete.

PRIMARY SECONDARY LATENT TERTIARY

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