Introduction Stis Syphilis
Introduction Stis Syphilis
Introduction Stis Syphilis
• H/o Fever
Inspect for:
• Rashes
• Lumps
• Ulcers
• Discharge
• Smell
Examination
Inspect for:
• Pubic hair for lice & nits
• Indurated, button-like
Positive by 4 weeks
Natural History
Gjestland (1955)- a follow-up study of 1147 cases (the Oslo
study)
• 24% -mucocutaneous relapses
• 11% died of syphilis
• 16% - benign late manifestations (usually cutaneous) nodules
or gummata
• 10% cardiovascular syphilitic lesions
• 6% - neurosyphilis.
• Conclusion: Long before penicillin was introduced, at least
60% of people with syphilis lived & died without developing
serious symptoms (Rook’s 2010)
Secondary Syphilis
• 6-8 weeks after appearance of primary chancre
•Systemic disease
Cutaneous
Characteristic lesion is the gumma
• A deep granulomatous process involving the
epidermis secondarily
• Causes punched out ulcerative lesions with white
necrotic slough on the floor
• On lower leg, scalp, face, sternal area
Tertiary Syphilis
Cardio-vascular:
Develops 10-30 years after infection - so in middle / old
age; more in men
• Aortitis (ascending aorta)
• Aortic aneurysm sudden death due to rupture
• Coronary ostial stenosis
Tertiary Syphilis
Neuro-syphilis:
• In any patient with syphilis, CSF lymphocytosis, an
elevated CSF protein level or a reactive VDRL test
would suggest neuro-syphilis & must be treated
• Asymptomatic neurosyphilis
• Meningeal neurosyphilis -usually has its onset during
secondary disease; characterized by symptoms of
headache, confusion, nausea & vomiting, neck
stiffness & photophobia. Cranial nerve palsies cause
unilateral or bilateral facial weakness &
sensorineural deafness
• Meningovascular syphilis - occurs most frequently
between 4 and 7 years after infection. The clinical
features of hemiparesis, seizures & aphasia reflect
multiple areas of infarction from diffuse arteritis.
• Gummatous neurosyphilis - results in features typical of a
intracranial space-occupying lesion.
• Parenchymatous syphilis : general paralysis (GPI) from
parenchymatous disease of the brain used to occur 10–
20 years after infection. The onset is insidious with
subtle deterioration in cognitive function & psychiatric
symptoms that mimic those of other mental disorders.
• Tabetic neurosyphilis was the most common form of
neurosyphilis in the pre-antibiotic era, with an onset 15–
25 years after primary infection. The most characteristic
symptom is of lightning pains- sudden paroxysms of
lancinating pain affecting the lower limbs.
• Other early symptoms include paraesthesia, progressive
ataxia, & bowel & bladder dysfunction.
Treatment of Syphilis & STIs
Duration of treatment
• Early syphilis : 15 days
• Late syphilis : 30 days
• Pregnancy: Only penicillin G
• If patient allergic: desensitize
• CDC: Guidelines (Dr G. O. Wendel, Jr., et al. N Engl J
Med. 1985)
The Jarisch-Herxheimer reaction