Download Syphilis Epidemiology

Syphilis – Clinical Aspects
of Primary Syphilis
Thad Zajdowicz, MD, MPH
Medical Director, STD/HIV Program
Chicago Dept of Public Health
Why a lecture on syphilis?
Although syphilis is an eminently
treatable disease, its continuing
occurrence illustrates that our control
efforts still need to be improved. The
disease remains elusive clinically even
today, and unless thought of and sought
for can silently cause disease as it has for
centuries. Further, control of syphilis is
vital because of its interactions with HIV.
This lecture will focus on primary syphilis.
Objectives
• To review the pathogenesis of
primary syphilis
• To demonstrate the clinical
features of primary syphilis
• To illustrate clinical variants of
primary syphilis
Clinical Stages
• Syphilis is conventionally divided
into several stages:
– Primary
– Secondary
– Latent
– Late, or tertiary
• This lecture will focus on primary
syphilis
Treponema pallidum
Pathogenesis
• Infectious dose unknown in humans
– In rabbits, experimental infection
induced with as few as 4 spirochetes
– Estimated average inoculum 5001000 in humans
• Inoculation may occur at any body site
– Eternal genitalia most frequent
– Mouth, anus, cervix quite common
– Other sites also well described
Pathogenesis
• T. pallidum divides every 30-33 hrs
• Incubation period
– Primary syphilis – median 21 days,
range 3-90 days
• The most prominent
histopathological findings are
arteritis and periarteritis in
affected tissues
Primary syphilis - chancre
Chancre characteristics
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Indolent, “punched out” appearance
Indurated
Painless
Raised border
Red, smooth base
Scant serous secretions
Chancre characteristics
• Chancre usually solitary, but multiple
lesions can occur
• May occur at any site in the genital
tract:
– coronal sulcus, glans, frenum, prepuce,
shaft of penis, anorectal area, fourchette,
vulva, cervix
• May occur in the oropharyngeal area:
– lip, tongue, tonsil
• And may occur wherever treponemes
are inoculated
Penile Chancre
Penile Chancre
Penile Chancre
Rolled Edges
Crusted Chancre
Chancres – 18th Century
Multiple Chancres
Primary Chancre - Labial
“Kissing” Chancres
“Kissing” Chancres
Perianal Chancre
Chancre of the Tongue
Oral Chancre - Lip
Chancre of Hard Palate
Chancre of the Lip
Facial Chancre
Facial Chancre
Digital Chancre
Conclusions
• The typical primary syphilitic
chancre is solitary, indurated, and
painless, but many clinical variants
occur
• Most chancres are genital, oral, or
perianal, but may occur anywhere
T. pallidum is inoculated
• The primary histopathology seen in
syphilis is arteritis and periarteritis
Sources of Information
The following sites are useful if more
information on syphilis is sought:
www.cdc.gov Centers for Disease Control
www.who.int World Health Organization
www.ashastd.org American Social Hygiene Assoc
www.vnh.org Virtual Naval Hospital