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 Source of infection :Infected person Site of entry : Minute abrasions in skin & mucous membrane Infective dose : 60 Treponemes Generation time : 33hours 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 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 by transplacental passage ofTreponema pallidum from infected mother at any time . Infection may also occur from contact with an infectious Lesion during passage through the birth canal

Live birth with stigmata of syphilis 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