1. A case of interest…
Rachel Stewart

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

3. Why this topic?

4. Outline- Syphilis
Clinical features
History
Management

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

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

8. Latent syphlilis Low titres Sexual transmission uncommon
Vertical transmission can occur

9. Tertiary syphilis
Gumma - granulomata

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

11. 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

12. 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

13. 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

14. 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.

15. 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

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

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

18. 20th Century
Peak in wartime
Then campaigns to be tested and treated

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

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