A case of interest… Rachel Stewart

The case Man in his 30s Few weeks history Visual hallucinations Intermittent fever Headaches

Why this topic?

Outline- Syphilis Clinical features History Management

Primary syphilis Painless pink papule which develops into ulcer at site of contact Painless local lymphadenopathy 2-3 weeks after exposure

Secondary syphilis 3 months Low grade fever, malaise, headache, generalized lymphadenopathy Symetrical non pruritic rash Patchy alopecia Mucous patches Condolymata lata

Latent syphlilis Low titres Sexual transmission uncommon Vertical transmission can occur

Tertiary syphilis Gumma - granulomata

Tertiary syphilis Cardiac Neurological Endarteritis obliterans of the aorta. Thoracic aortic aneurysms

Congenital syphilis Failure to thrive Fever, Irritability Saddle nose Early rash -- blisters on palms & soles Later rash -- copper-coloured, flat or bumpy rash on face, palms & soles Rash of the mouth, genitalia & anus Watery discharge from nose

Congenital syphilis Hutchinson teeth Bone pain & joint swelling Blindness & Clouding of cornea Hearing impairment Gray, mucus-like patches on the anus & outer vagina Saber shins Scarring of the skin around the mouth, genitalia, and anus

Early History Several theories Americas – spread globally by explorers Endemic – but not distinguished from leprosy Originally skin contact and rapid progression Developed into slow developing STI

Origins of the name The French disease, the Neapolitan disease, the spanish disease Described in a poem in Italy in 1530 By Girolamo Fracastoro - spore theory Sheperd called syphilis Acquired the disease as a punishment from the gods.

Linked with gonorrhea John Hunter -1767 Inoculated self with exudate of patient with gonorrhea Hunter contracted syphilis Site of exudate contact believed to cause disease form Gonorrhea - mucous membranes Syphilis -skin

Historical treatments Guaiacum wood – ineffective but marketed Wild pansy Mercury- effective for skin disease

Historical treatments Arsenic based treatments- effective-1910 Salvarsan & Neosalvarsan Malaria then quinine Penicillin- from 1943

20th Century Peak in wartime Then campaigns to be tested and treated

Management Treponemal enzyme immunoassay - screening If positive refer GUM VLRL/RPR – to quantify disease activity Procaine benzylpenicillin 600mg IM OD 10-17 days on named patient basis Doxycycline –100-200mg BD 14-28 days Contact tracing Jarisch-Herxheimer reaction

Summary Uncommon, but increasing Can be easy to miss Fully treatable by GUM Historical importance