Syphilis

The Great Imitator of

Diseases
The Pox

1
Syphilis a chronic infectious disease
caused by a spirochete Treponema
pallidum.
Four types of treponemal disease which
affect man are: endemic syphilis
Treponema endemicus
yaws- T. pertenue
nonsexual contact
pinta T. carateum
usually
during childvenereal syphilis
hood

Syphilis
Stage

Clinical

Primary Stage

Painless chancre (ulcer)

Secondary
Stage

1. Rash on palms & soles

2. Condylomata latum
3. CNS, eyes, bones, kidneys
and/or joints can be involved

Latent Syphilis

25% may relapse and develop

secondary stage and symptoms
again

Tertiary Stage

1. Gummas of skin and bone

2. Cardiovascular (aortic
aneurysm)
3. Neurosyphilis

2
Clinical Manifestations of Syphilis may be conveniently
divided into 3 stages: 1o,2o,& 3o.
Primary Syphilis: The primary lesion develops at the
site/s of inoculation within 2-6 weeks of exposure &
usually lasts for about 6 w eeks. Frequently located on
the penis, the labia, cervix and the anorectal region,
is a hard ulcer (chancre) at the site of infection.
Secondary Syphilis: Untreated Pxs enter the bacteremic
stage, often about 6 weeks after the primary chancre
has healed (altho sometimes the manifestations of 2
syp occur while the 1chancre is still healing).The 2 nd
stage is systemic unlike the 1syp there is: 1.
generalized, symmetrical & non-pruritic
papulosquamous rash, characteristically affecting the
palms and soles syphillide (or syphilid).

2. Generalized lymphadenopathy
3. Mucosal secretions (mucosal patches, snail
track ulcer)
4.Condylomata lata at the perianal area & mouth.
-weeping papules ( coalesced papules
characteristically in moist areas such as noso
labial folds).
5. Patchy alopecia
6. Systemic fever, malaise, anorexia, weight loss
& anemia.
The rash & codylomata lata resolve over 6 wks
and this disease enters the latent phase.

Latent Syphilis

4
Tertiary Syphilis: Gummatous Syphilis
(destructive lesions of skin & bones)
1. Cardiovascular Syphilis- usually occurs
after a latent period of 10 20 or more
years.
Aortitis pathological process starts
in the root of the aorta & leads to loss
of elastic tissue & fibrosis.
2. Neurosyphilis asymptomatic. The CSF
should be examined
3. General Paralysis of the Insane: usually

5
to 20 years or more after infection . Clinical
features
: dementia with recent memory loss, loss of
insight, euphoria w/ delusion of grandeur, tremor,
spastic paralysis, convulsions, incontinence &
finally bed- ridden.
4. Tabes dorsalis: lightning pain in legs, Argyll
Robertson pupil,shooting pains, ataxia, urinary &
fecal incontinence, Charcot joint, Rombergs sign.
Rombergs sign: evidence of a sensory disorder
affecting those nerves that transmit information
to the brain about the position of the limbs &

6
joints & the tension in the muscles. The
patient is asked to stand upright .
Rombergs sign is positive if he
maintains his posture when his eyes are
open but sways & falls when his eyes
are closed.
Charcots joint : a damaged, swollen, &
deformed joint, often the knee resulting
from repeated minor injuries of which
the patient is unaware bec the nerves
that normally register pain are not
functioning. The condition may occur in

7
Argyll Robertson Pupil : a disorder of the eyes,
common to several diseases of the CNS, caused
by a midbrain lesion, in which the pupillary
(light) reflex is absent. Although the pupils
contract normally for near vision, they fail to
contract in bright light. Aka prostitutes pupil
because the prostitute accommodates but does
not react & is frequently infected w/ syphilis.
Paralysis of the legs sometimes with blindness is
known as tabes dorsalis or locomotor ataxia.
Parenchymatous involvement of the brain gives
rise to GPI (general paralysis of the insane) or
syphilitic insanity.

CONGENITAL SYPHILIS : occurs in the

fetus of an infected pregnant woman.
Treponema pallidum crosses the
placental blood barrier & the
treponemes rapidly disseminate
throughout the infected fetus. Fetuses
that acquire the infection have a high
mortality rate ( stillbirth,spontaneous
abortion, & neonatal death), & almost
all of those that survive will develop
early or late congenital syphilis.

8
CONGENITAL SYPHILIS : Early C S: occurs 2
8 weeks after birth: presenting with failure
to thrive, mucocutaneous lesions
(condylomata lata), generalized
lymphadenopathy, nasal snuffles & skin rash.
Late : occurs at or near puberty.
Well-known stigmata, nerve deafness,
interstitial
keratitis, Hutchinsons teeth, rhagades
around the mouth, osteitis (inflammation of
the bone) & chondritis ( saddle nose, frontal
bossing, sabre tibia) & perforated palate.

9
Serological Tests for Syphilis:
1. Non-treponemal tests tests which
use a component of normal tissue
( e.g. beef heart cardiolipin) as an
antigen to measure non-specific
antibodies (reagin ) formed in the
blood of patients with syphilis.
2. Treponemal tests which employ live
or killed T. pallidum as an antigen to
detect antibodies specific for
pathogenic treponemes.

10
Treatment: Specific Measures: penicillin, as
benzathine penicillin G or aqueous procaine
penicillin G is the drug of choice for all forms of
syphilis & other spirochetal infections.
Jarisch-Herxheimer reaction: may occur in
patient given large doses of penicillin, probably
caused by rapid killing of treponemes.
Fever develops w/in 10 hours after the 1 st
injection & there is often an exacerbation of
syphilitic lesion. The patient should be warned
that there may be a reaction & that he must
continue treatment despite it.