Syphilis case PPT

1. Late Latent Syphilis
by
Nagaraju B

2. SYPHILIS INTRODUCTION
A. ACQUIRED SYPHILIS
 Primary syphilis
 Secondary syphilis
 Latent syphilis
 Early latent
 Late latent
 Tertiary syphilis
B. CONGENITAL SYPHILIS
C. SYPHILIS RELATED DISEASE
 Yaws [TP Pertenue], Pinta [TP
Yaws
endemecum], Bejel [TP carateum]

3. PRIMARY SYPHILIS
 10 days- 6 weeks, usually ~21 days.
 Develops at site of contact/inoculation.
 Classically: single, painless, clean-based, indurated
ulcer, with firm, raised borders
 Mostly ano-genital, but may occur at any site (tongue,
pharynx, lips, fingers, nipples, etc...)
 Non-tender regional adenopathy
 Very infectious

4. SECONDARY SYPHILIS
 4 wks to 6 months after primary chancre
 rash on body including palms & soles.
 Fever, malaise, headache, sore throat, alopecia, wt loss
 Highly infectious

5. LATENT SYPHILIS
EARLY & LATE
 Positive syphilis serology without
clinical signs of syphilis
 begins with the end of secondary
syphilis and may last for a
lifetime
 Early(infectious) and late
phase(Non-infectious)
 Untreated syphilis
 30% cure
 30% latent
 30% tertiary phase

6. TERTIARY SYPHILIS
 Years/ decades later
 Granulomatous lesion called
Gumma
 Skin, bones, liver
 Destructive lesions in CNS-stroke,
paresis, tabes, neuropsychiatric
symptoms etc.)
 CVS-Aortitis, aneurysm, valvular
insufficiency
 Non infectious

7. INTERPRETATION OF SEROLOGICAL TESTS
FOR SYPHILIS
Treponemal Possible Explanation
Tests
(TP-PA/
FTA-ADS)
Non-
Treponemal
tests
(RPR/ VDRL)
Syphilis - recent or previous
Yaws or pinta + +
No syphilis
False positive + –
Consistent with previously treated or
untreated Syphilis
Yaws, Pinta, Bejel
– +
No syphilis
Syphilis in incubation period – –

8. Etiology
Transmission
Pathology
Clinical Manifestations
Diagnosis
Treatment
Penidure:
MoA: Interferes with cell wall mucopeptide synthesis
during active multiplication resulting in bactericidal activity
against susceptible organisms

9. Dosing Forms
Warnings
Contraindications
Storage
Brands
Overdose
Drug Interactions
Side effects
ADRs

10. Patient Name -XXXX
IP/OP No -15197/14
DOA - 8/11/14
DOD - 10/11/14
Department - Med/IV
Age - 29years
Sex - Male

11. SUBJECTIVE
Chief complaint/ History of Presenting illness:
• c/o on and off fever, generalized weakness, pain in both groins,
skin rash and weight loss for 6 months.
• c/o on and off mouth ulceration for 1-2 yrs.
• c/o recently started hair falling.
• c/o sore on his penis was almost completely healed without
treatment.
Previous history:
Participated with unknown tourist foreigner without condom 6 weeks
prior.
Last HIV antibody Test (2 month prior) was negative.
Diagnosed and treated VDRL+ 7 years ago.
Past MedicationHistory/Allergy:
Allergy to Tetracycline but not with Doxycycline.

12. Personal history:
Family history:
Diet- Mixed
no f/h/o DVL issues
Appetite- Decreased
Sleep- Normal
B&B- Painful
Habits- h/o multiple sexual partnership when go on line duties.
OBJECTIVE
Physical examination :
A 29 year male patient moderately built, conscious, cooperative,
well-developed, well-nourished Vital signs:
BP - 120/80mmHg PR - 86bpm
RR - 18cpm Temp - 101.1°F.

13. P[-], I[-], C[-], C[-], L[-], E[-]
Systems:-
P/A-RS
WNL
CVS
CNS
Provisional diagnosis :
 ? LGV/ GI/ STS
[ Referred to Venerologist for further evaluation and adv.]

14. Test Test Value Normal Value
08/11 09/11 10/11
Body Temp 101 99.0 99.1 37 °C (98.6 °F)
NACO 08/11 Non-Reactive
VDRL Kit type
(J& Mitra) Reactive
VDRL Kit type
(Span)
Urine complete Pus cells+
N.Gono NAAT
Chlamydia NAAT
Negative
FTA-ABS
TPHA
10/11 +ve
1:320
DFM of Penile
lesion
TP+

15. ASSESMENT
Based on the subjective & objective evidence the
patient was diagnosed to have Un-treated Syphilis
(late latent stage).

16. TREATMENT CHART
BRAND NAME GENEROIC
NAME
DOSE FREQ
UENC
Y
DATE DATE
END
Tab. Febrex 650 Paracetamol 650mg 1tid 8/11 10/11
Inj. Penidure 2.4
mU IM ATD
Benzathine
Pencillin G
2.4 mU - 10/11 -
Prescription on DAMA
Inj. Penidure 2.4 mU IM ATD Weekly for another 2 doses
Tab. Supradyn 1od

17. PLAN
Suggestion to Physician-
Confirmatory tests for retroviral disease would have
been advised.
 Differential diagnostic tests for LGV and GI might have
been advised when chancre and pain in both groin
reported.

18. Advice to patient-
 Safe sex practices.
 Nil sexual contact until lesion or rash resolves.
 Adhere to medication.
 Bring partner to be screened and treated.
 Repeat syphilis serology in 3 months to asses
response to treatment.
 Once again after 1 or 2 months, just screen out for
retroviral disease profile.
 Contact tracing of at risk partners.

19. ‘’SYPHILIS IS A
TREATABLE INFECTION
AND CURABLE WITH
ADEQUATE THERAPY IF
PROVIDED BEFORE
ADVANCED DISEASE
DEVELOPS”
THANK YOU…