Early syphilis
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Early syphilis

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DERMATOLOGY

DERMATOLOGY

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Early syphilis Presentation Transcript

  • 1. Early syphilisIncludes :-Primary , secondary and latent stage KEERTHI NS
  • 2. Syphilis:- A venereal disease caused by spirochaetes, treponema pallidium . Your Logo
  • 3. HISTORICAL ASPECTS Evidence and Information for Policy
  • 4. SYPHILIS WAS CARRIED TO EUROPE BY COLUMBIAN RETURNING CREWMEN HYPOTHESIS FROM AMERICA BY CHRISTOPHER COLUMBUS’S VOYAGES 2 PRIMARYHYPOTHESIS: PROPOSES SYPHILIS EXISTED PRE- IN EUROPE COLUMBIAN HYPOTHESIS PREVIOUSLY’BUT WENT UNRECOGNIZED
  • 5. Girolamo Fracastoro• Italian physician and poet• 1530• Latin poem ‘syphilis sive morbus gallicus’ describing the ravages of the disease in Italy.• Coined the name from the legend of a shepherd called Syphilus who had purportedly gotten the illness as a punishment for defying the god APPOLO
  • 6. JHON HUNTER• The notorious self experimentation of hunter by inoculating himself with gonococcal pus to see if gonorrhoea and syphilis were manifestation of same infection.• Later he developed classical syphilitic heart disease due to which he died in 1739.
  • 7. PHILLIPPE RICORDHe classified syphIlisinto primary ,secondaryand tertiary stages.He distinguishedgonorhoea from syphilisafter carrying out over2500 inoculations inhumans.
  • 8. EtiologyTreponema pallidum• A spirochete; corkscrew shaped• Motile with characteristic movements like angulation,bending,rotatory motion and back and forth squiggle
  • 9. Mainly sexual Rarely via Acquired bloodTransmission Accidental Trans Congenital placentally
  • 10. Infections < 24 Early syphilis months; highly infectioussyphilis Infection > Late syphilis 24months; not infectious
  • 11. Sexual contact 9-90 days Primary syphilis 3-12 weeks EARLY SYPHILIS; Highly infectiousSecondary syphilis Latent syphilis 24 MONTHS Tertiary syphilis LATE SYPHILIS
  • 12. Different manifestations occurdepending on the stage of the disease Your Logo
  • 13. primaryCongenital * Early secondary * late Signs & symptoms tertiary latent
  • 14.  Morphology of lesion Location of lesion Lymphadenopathy
  • 15. Primary syphilis Morphology• In 50% of patients ,the typical lesion is called Hunterian chancre• Features:- Single,painless Regular,indurated(button like) Reddish plaque;frequently ulcerates Ulcer:-oozes clear serum on pressure
  • 16. • In the rest 50%,the ulcers are atypicalo Painfulo Multipleo Indurated
  • 17. Location of ulcers Male genital areas:- Coronal sulans Glans Prepuce Shaft of penis Perianal areas in homosexual males
  • 18. Females:- Labia minora Labia majora Mons pubis Sometimes in vagina or cervix Your Logo
  • 19. Extra genital lesions:-• Lips• Nipples• Fingers
  • 20. Lymphadenopathy in PSInguinal:-• Multiple• Small• Firm
  • 21. Secondary syphilis• Systemic disease with cutaneous as well as extracutaneous manifestations.• It manifest itself 3- 12 weeks after the appearance of primary chancre.
  • 22. Cutaneous lesion in SS• Skin lesions may be a few or numerous• Lesions are symmetrical early , become asymetrical later• Rashes; of any morphology Macular Papular Papulo squamous Nodular
  • 23. Types of rashes in SSRoseolar syphilidePapular syphilidePsoriasiform lesionMalignant syphilide
  • 24. Roseolar syphilideSymmetrical erythematous macular rashes
  • 25. Papular syphilideMost common rash of SSDull red papules, initiallydiscreteLater coalesce to formannular lesions
  • 26. Psoriasiform lesion• When scaling is predominant
  • 27. Malignant syphilide• Pustular• Necrotic in Immuno compromised patients.• Rupioid lesions
  • 28. Palm • Hyper pigmented, coppe and ry red, scaly sole lesionslesions
  • 29. • In intertriginousCondyloma area, the papules lata: may erode superficially
  • 30. Mucosal lesionsMucosal • Dull erythematous plaques withpatches: grayish sloughSnail- • Mucous patches track with serpiginousulcers: erosions
  • 31. Lymphadenopathy in SS • Generalised, symmetrical, and rubbery Axillary Cervical Inguinal
  • 32. Systemic involvement in SS• SS is a systemic disease with invovement of many organ system:• Musculo-skeletal system: • Periostitis , arthritis• Ocular: • Iridocyclitis, uveitis, choroidretinitis• Renal: • Nephrotic symdrome• CNS: • CSF Abnormalities
  • 33. Latent syphilis• Patient has only serological evidence of syphilis without any clinical evidence.
  • 34. • Depending on the number of of years passed :  Early latent (<2 yrs)  Late latent syphilis(>2yrs)
  • 35. TERTIARY SYPHILIS• It manifest 3-10 years after the primary stage
  • 36. TERTIARY SYPHILIS• Mucocutaneous tertiary – Gumma*(well defined punched out ulcer)• Neurosyphilis – Asymptomaticparenchymatous /meningeal
  • 37. • CVS syphilis – Aortitis – coronary stenosis – aneurysm
  • 38. CONGENITAL SYPHILIS
  • 39. CONGENITAL SYPHILIS• T.Pallidum can be transmitted by an infected mother to foetus in utero
  • 40. EARLY CONGENITAL SYPHILISAppear with in first 2 .yearof life Signs First appear 3rd-8thweek of lifeA form of rhinitis is thefirst specific finding.In severe infection there isclassic picture of marasmicsyphilis-wrinkled pot belliedold man.
  • 41. Cutaneouseruptions,hepatosplenomegaly,bone andjoint involvement arecommon.C/F similar toacquired SS butvisceral and boneinvolvement are morecommon.
  • 42. Cutaneouslesions:bullous ,fissuring of lips,nasolabial folds
  • 43. Late congenital syphilis• Hutchison’s triad – Hutchinson’s teeth – Interstitial keratitis – 8th nerve deafness.• Other manifestations – Saddle nose – Frontal bossing – Cluttons joint(painless swelling of joint
  • 44. DIAGNOSIS Demonstration of T.pallidum Dark ground microscopy Direct immunofluroscent staining Recent method-ELISA and PCR have failed to improve diagnostic detection rates.
  • 45. Serological testing• VDRL[Non treponemal/Reaginic test] is good screening test and + in case of most SS & also in tertiary syphilis.• Confirmatory test (treponemal)- TPHA,TPI, FTA - ABS
  • 46. Csf examination and chest radiography:- in tertiary syphilis.Skin biopsy may be used for histopathologic changes and organisms in tissue can be demonstrated by silver staining.
  • 47. Differential diagnosisChancre Chancroid – 3-5 days – IP:9-90 days – Very painful,Ulcer – Painless, single inflamed,multiple – Margin: regular – Irregular – inflammatory zone: absent – present – Button-like; induration – Soft, covered by a membrane – Lymphadenopathy :shotty; may be b/l, nontender – Lymphadenopathy:bubo; u/l, tender – nonsuppurative – suppurative – VDRL: +/_ve – _ve – DG M/S:+VE – _VE
  • 48. TREATMENTCOUNSELING• Advice on safe sex:Use of condoms.• Sex avoidance till healing of lesions• Follow up testing for HIV;hep B virus & VDRL at 3 months & further if necessary
  • 49. TREATMENTEarly syphilis -Benzathine penicillin(2.4 mega dose)Late syphilis – Three week i/m injection of benzathine penicillin