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 • Venereal syphilis • Non venereal syphilis • Congenital syphilis
PATHOGENESIS • Venereal syphilis acquired mainly by sexual contact • Sourceofinfection :Infected person • Siteof entry : Minute abrasions in skin & mucous membrane • Infective dose : 60 Treponemes • Generation time : 33hours • Incubation period : 10 -90 days
Treponemes penetrates skin Lymphatic Blood stream Infection (10 – 90 days) chancre Natural course of untreated syphilis
Secondary syphilis Latent syphilis Natural cure tertiary syphilis
CLINICALMANIFESTATIONS • 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 bytransplacental passage ofTreponema pallidumfrom infected mother at any time . • Infection may also occur from contact with aninfectious 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
