1. SYPHILIS

2. 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

3. 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

4. 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 : days

5. Natural course of untreated syphilis
Treponemes penetrates skin
Lymphatic
Blood stream
Infection
(10 – 90 days)
chancre

6. Secondary syphilis
Latent syphilis
Natural cure tertiary syphilis

7. CLINICAL MANIFESTATIONS
Untreated case of syphilis manifests in 4 stages
Primary syphilis
Secondary syphilis
Latent syphilis
Tertiary syphilis

8. 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

11. Contd… Also called Hard chancre
The lesion is covered with thick glairy exudate
Chancre heals within days
Persistent or multiple chancres are seen in HIV or immunodeficient patients
The regional LN’s are swollen discrete & nontender

12. 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

15. 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

16. 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

17. Tertiary syphilis The lesions occuring in this stage involve :
Gummatous syphilis
Cardiovascular syphilis
Neurosyphilis occurs in late tertiary (or) quaternary syphilis

19. 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

20. Contd.. Symptomatic neurosyphilis manifests as
Syphilitic meningitis-typical symptoms of meningitis ,head ache ,nausea , vomitings & photophobia
Meningiovascular syphilis
Parenchymatous neurosyphilis

21. 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

22. 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

23. 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

24. CLINICAL MANIFESTATIONS
Clinical manifestations after birth are divided in:
-early CS <= 2 years
-late CS >2 years

25. 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.

26. Contd..
The vesiculobullous eruption, known as pemphigus syphiliticus,. When the bullae rupture, they leave a macerated, dusky red surface that readily dries and crusts

27. 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

28. Contd….
Hepatospleenomegaly
Maculopapular rash

30. 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

31. 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