SYPHILIS

Definition
Chronic systemic infection caused by Treponema pallidum, is usually sexually
transmitted and is characterized by episodes of active disease interrupted by
periods of latency
Disease with local and systemic manifestations
Syphilis becomes a systemic disease shortly after infection & can be transmitted
from a pregnant woman to her fetus as early as the 9 th week of gestation

Epidemiology
In 2010, the rate of syphilis infection was 7.9 cases per 100,000 populations for men
& 1.1 cases per 100,000 for women.
Rate of primary & secondary syphilis has risen dramatically among men driven by
increased transmission of syphilis among men who have sex with men (MSM),
During pregnancy, untreated early syphilis results in perinatal death in as many as
40% of cases & may lead to fetal infection in more than 70% of cases
Worldwide, there are estimated to be 1.4 million cases of syphilis among pregnant
women, with 500,000 adverse pregnancy outcomes annually

Staging
1. Primary syphilis
Begins at the site of bacterial invasion, where T. pallidum multiplies in the
epithelium & produces a granulomatous tissue reaction called a chancre
Some microorganisms drain with lymph into adjacent lymph nodes. Within the
nodes and at the site of the chancre, the cell-mediated & humoral immune
responses are stimulated

2. Secondary syphilis
Systemic & bacteria spread to all major organ systems
It is followed by a period during which the immune system is able to suppress the
infection
Even without treatment, spontaneous resolution of the skin lesions occurs & the
individual enters the latent stage of infection

3. Latent syphilis
May be subdivided into early & late stages, however, no specific criteria delineate
one from the other
Medical history & serologic studies show that syphilis is present, but individual has
no clinical manifestations
Transmission is possible during the late & early latent stages

4. Tertiary syphilis
Most severe stage, involving significant morbidity and mortality
The destructive skin, bone & soft tissue lesions (called gummas) of tertiary syphilis
probably are caused by a severe hypersensitivity reaction to the microorganism.
CVS: may cause aneurysms, heart valve insufficiencies & heart failure
CNS: presence in CSF may cause the manifestations of neurosyphilis, which can
occur within any stage of syphilis infection

Microbiology Treponema Pallidum

i. Morphology & identification
Organism:
Slender spirals measuring 0.2 m (width) & 5 15 m (length)
Corkscrew like motility, rotating around their endoflagella

Microaerophilic, survives best at 3 5 % oxygen

Seen with immunofluorescent stain or dark field microscope
Culture:
Pathogenic T. pallidum has never been cultured on media, eggs or tissue
Non pathogenic can be cultured anaerobically in vitro

ii. Antigenic structure

Outer membrane surround the periplasmic space & peptidoglycan cytoplasmic
membrane complex
Membrane proteins are present that contain covalently bound lipid at amino
terminal anchor the proteins to cytoplasmic or outer membrane proteins
inaccessible to antibodies
Endoflagella in periplasmic space
Hyaluronidase invasiveness
Lipoproteins induce inflammation tissue destruction

iii. Pathogenesis
T. pallidum penetrate intact mucous membrane OR through break in epidermis
1 & 2 lesion rich in spirochetes & highly infectious but, 3 treponemas
are very rare
Progression:
30% early syphilitic infection progresses spontaneously to complete cure
without treatment
30% the untreated infection remains latent
Remainder progresses to the 3 characterized by the development of
granulomatous lesions (gummas), degenerative changes in CNS or CVS

Multiply locally at site of entry

Some spread to nearby lymph nodes & reach blood stream

2 10 weeks papule develops at site of infection

Papule breaks down forming ulcer with clean, hard base/chancre, painless (1 lesion)

2 10 weeks later red maculopapular rash anywhere on body & moist, pale papules in
anogenital region, axilla & mouth (2 lesion)

Symptoms of 2 lesion will go away with or without treatment & enter latent stage (no
symptoms)

After 3 5 years contagious lesion may recur & not infectious except for mother to fetal
transmission

May progress to 3 stage (RARE)

Gumma: form of progressive inflammation that appear as rubbery masses of tissue

in various organ after about 15 years
CVS: weakening of aorta
Neurosyphilis: dementia, seizure, loss coordination of voluntary movement, sight or
hearing loss