SYPHILIS SYPHILIS The term syphilis derived from poem

SYPHILIS

SYPHILIS The term syphilis derived from poem written by Fracastorius describing the legend of a shepherd named Syphilus l One of the sexually transmitted disease l bad blood l

Contd… l l Syphilis is a bacterial infection Causative agent: Treponema pallidum Infection occurs only in humans Syphilis can be classified as Ø Acquired syphilis a) Venereal syphilis b) Non venereal syphilis Ø 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 : 33 hours 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 l Untreated case of syphilis manifests in 4 stages Ø Primary syphilis Secondary syphilis Ø Ø Ø Latent syphilis Tertiary syphilis

Primary syphilis Primary lesion is CHANCRE l Site –GENITILIA l Other sites -mouth, nipples l Also called Hunterian chancre l Chancre is painless , avascular & circumscribed l It is indurated & superficially ulcerated lesion l

Contd… Also called Hard chancre l The lesion is covered with thick glairy exudate l Chancre heals within 10 -40 days l Persistent or multiple chancres are seen in HIV or immunodeficient patients l The regional LN’s are swollen discrete & nontender l

Secondary syphilis Most infective stage of syphilis l Occurs 1 -3 months after primary lesion heals l Characteristic lesions ü Roseolar (or) Papular skin rashes ü Mucous patches in oropharynx ü Condylomata at mucocutaneous junctions l

Contd… Spirochetes are abundant in the lesions l Great imitator as the above lesions can be seen in many other infetions l Systemic involvement like ophthalmic, osseous & meningeal involvement l Secondary lesions heal spontaneously (or) take 4 -5 years to heal l

Latent syphilis Period of quiescence l asymptomatic l No clinical manifestations l Diagnosis is only by serological tests l This stage is followed by natural cure (or) manifests as tertiary syphilis after several years l

Tertiary syphilis The lesions occuring in this stage involve : Ø Gummatous syphilis Ø Cardiovascular syphilis Ø Neurosyphilis occurs in late tertiary (or) quaternary syphilis l

Contd… l • • • 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 ü Syphilitic meningitis-typical symptoms of meningitis , head ache , nausea , vomitings & photophobia ü Meningiovascular syphilis ü Parenchymatous neurosyphilis l

Nonvenereal syphilis • By direct contact with lesion • Usually seen in Doctors , nurses l Natural evolution of disease is same as venereal syphilis l Primary chancre is extragenital l By blood transfusion

CONGENITAL SYPHILIS l Infant usually infected in utero by transplacental passage of. Treponema pallidum from infected mother at any time . l 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 l Infection to foetus occurs in 4 month of gestation l Complications involve ü Abortions ü Still births ü Live birth with stigmata of syphilis l

CLINICAL MANIFESTATIONS l Clinical manifestations after birth are divided in: -early CS <= 2 years -late CS >2 years

Clinical manifestations of early CS l The earliest sign of CS is nasal discharge (snuffles) that occurs 1 -2 weeks before the onset of the rash.

Contd. . l 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…. l l Hepatospleenomegaly Maculopapular rash

ENDEMIC SYPHILIS Syphilis that is transmitted non venereally endemic in several foci l Causative agent: T. pallidum endemicum l OTHER NAMES: Ø Sibbens-scotland Ø Bejel-middle east Ø Siti-gambia l

CONTD… primary chancre usually not seen CLINICAL MANIFESTATIONS: l Mucous patches & skin eruptions as in secondary syphilis l Tertiary lesions-like gummatous lesion l Cardiovascular & neurological involvement is rare l