Download Nivedita

SYPHILIS
SYPHILIS
The term syphilis derived from
poem written by Fracastorius
describing the legend of a shepherd
named Syphilus
 One of the sexually transmitted
disease
 bad blood

Contd…




Syphilis is a bacterial infection
Causative agent: Treponema pallidum
Infection occurs only in humans
Syphilis can be classified as
 Acquired syphilis
a) Venereal syphilis
b) Non venereal syphilis
 Congenital syphilis
PATHOGENESIS
•
•
•
•
•
•
Venereal syphilis acquired mainly by
sexual contact
Source of infection :Infected person
Site of entry : Minute abrasions in
skin & mucous membrane
Infective dose : 60 Treponemes
Generation time : 33hours
Incubation period : 10 -90 days
Natural course of untreated syphilis
Treponemes penetrates skin
Lymphatic
Blood stream
Infection
(10 – 90 days)
chancre
Secondary syphilis
Latent syphilis
Natural cure
tertiary syphilis
CLINICAL
MANIFESTATIONS

Untreated case of syphilis manifests in 4
stages

Primary syphilis
Secondary syphilis



Latent
syphilis
Tertiary syphilis
Primary syphilis
Primary lesion is CHANCRE
 Site –GENITILIA
 Other sites -mouth, nipples
 Also called Hunterian chancre
 Chancre is painless , avascular &
circumscribed
 It is indurated & superficially
ulcerated lesion

Contd…
Also called Hard chancre
 The lesion is covered with thick glairy
exudate
 Chancre heals within 10-40days
 Persistent or multiple chancres are
seen in HIV or immunodeficient
patients
 The regional LN’s are swollen
discrete & nontender

Secondary syphilis
Most infective stage of syphilis
 Occurs 1-3 months after primary
lesion heals
 Characteristic lesions
 Roseolar (or) Papular skin rashes
 Mucous patches in oropharynx
 Condylomata at mucocutaneous
junctions

Contd…
Spirochetes are abundant in the
lesions
 Great imitator as the above lesions
can be seen in many other infetions
 Systemic involvement like ophthalmic,
osseous & meningeal involvement
 Secondary lesions heal spontaneously
(or) take 4-5years to heal

Latent syphilis
Period of quiescence
 asymptomatic
 No clinical manifestations
 Diagnosis is only by serological tests
 This stage is followed by natural cure
(or) manifests as tertiary syphilis
after several years

Tertiary syphilis
The lesions occuring in this stage
involve :
 Gummatous syphilis
 Cardiovascular syphilis
 Neurosyphilis occurs in late tertiary
(or) quaternary syphilis

Contd…

•
•
•
Neurosyphilis may be symptomatic (or)
asymptomatic
Asymptomatic neurosyphilis
No signs & symptoms
But CSF abnormalities like-pleiocytosis
Elevated protein
Decreased glucose
reactive CSF VDRL Test is
demonstrable
Contd..
Symptomatic neurosyphilis manifests
as
 Syphilitic meningitis-typical symptoms
of meningitis ,head ache ,nausea ,
vomitings & photophobia
 Meningiovascular syphilis
 Parenchymatous neurosyphilis

Nonvenereal syphilis
• By direct contact with lesion
• Usually
seen in Doctors ,nurses
 Natural evolution of disease is same as
venereal syphilis
 Primary chancre is extragenital
 By blood transfusion
CONGENITAL SYPHILIS

Infant usually infected in utero by
transplacental passage ofTreponema
pallidum from infected mother at any
time
.

Infection may also occur from contact
with an infectious Lesion during
passage through the birth canal
Contd….
Woman in early syphilis is more
infective to foetus than after 2 years
of infection
 Infection to foetus occurs in 4 month
of gestation
 Complications involve
 Abortions
 Still births
 Live birth with stigmata of syphilis

CLINICAL MANIFESTATIONS

Clinical manifestations after birth are
divided in:
-early CS <= 2 years
-late CS >2 years
Clinical manifestations of early CS

The earliest sign
of CS is nasal
discharge
(snuffles) that
occurs 1-2 weeks
before the onset
of the rash.
Contd..

The vesiculobullous
eruption, known as
pemphigus
syphiliticus,. When
the bullae rupture,
they leave a
macerated, dusky
red surface that
readily dries and
crusts
Clinical manifestations of late congenital
syphilis
•
•
•
•
•
•
•
Frontal bossae
Saddle nose
Defect of hard palate
Clutton’sjoint (bilateral painless swelling
of the knees)
Saber chins
Short maxillas
Protruding mandible
Contd….


Hepatospleenomegaly
Maculopapular rash
ENDEMIC SYPHILIS
Syphilis that is transmitted non
venereally endemic in several foci
 Causative agent:T.pallidum endemicum
 OTHER NAMES:
 Sibbens-scotland
 Bejel-middle east
 Siti-gambia

CONTD…
primary chancre usually not seen
CLINICAL MANIFESTATIONS:
 Mucous patches & skin eruptions as in
secondary syphilis
 Tertiary lesions-like gummatous lesion
 Cardiovascular & neurological
involvement is rare
