Early syphilis

7,752 views
6,716 views

Published on

DERMATOLOGY

Published in: Health & Medicine
0 Comments
6 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,752
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
210
Comments
0
Likes
6
Embeds 0
No embeds

No notes for slide

Early syphilis

  1. 1. Early syphilisIncludes :-Primary , secondary and latent stage KEERTHI NS
  2. 2. Syphilis:- A venereal disease caused by spirochaetes, treponema pallidium . Your Logo
  3. 3. HISTORICAL ASPECTS Evidence and Information for Policy
  4. 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. 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. 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. 7. PHILLIPPE RICORDHe classified syphIlisinto primary ,secondaryand tertiary stages.He distinguishedgonorhoea from syphilisafter carrying out over2500 inoculations inhumans.
  8. 8. EtiologyTreponema pallidum• A spirochete; corkscrew shaped• Motile with characteristic movements like angulation,bending,rotatory motion and back and forth squiggle
  9. 9. Mainly sexual Rarely via Acquired bloodTransmission Accidental Trans Congenital placentally
  10. 10. Infections < 24 Early syphilis months; highly infectioussyphilis Infection > Late syphilis 24months; not infectious
  11. 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. 12. Different manifestations occurdepending on the stage of the disease Your Logo
  13. 13. primaryCongenital * Early secondary * late Signs & symptoms tertiary latent
  14. 14.  Morphology of lesion Location of lesion Lymphadenopathy
  15. 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. 16. • In the rest 50%,the ulcers are atypicalo Painfulo Multipleo Indurated
  17. 17. Location of ulcers Male genital areas:- Coronal sulans Glans Prepuce Shaft of penis Perianal areas in homosexual males
  18. 18. Females:- Labia minora Labia majora Mons pubis Sometimes in vagina or cervix Your Logo
  19. 19. Extra genital lesions:-• Lips• Nipples• Fingers
  20. 20. Lymphadenopathy in PSInguinal:-• Multiple• Small• Firm
  21. 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. 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. 23. Types of rashes in SSRoseolar syphilidePapular syphilidePsoriasiform lesionMalignant syphilide
  24. 24. Roseolar syphilideSymmetrical erythematous macular rashes
  25. 25. Papular syphilideMost common rash of SSDull red papules, initiallydiscreteLater coalesce to formannular lesions
  26. 26. Psoriasiform lesion• When scaling is predominant
  27. 27. Malignant syphilide• Pustular• Necrotic in Immuno compromised patients.• Rupioid lesions
  28. 28. Palm • Hyper pigmented, coppe and ry red, scaly sole lesionslesions
  29. 29. • In intertriginousCondyloma area, the papules lata: may erode superficially
  30. 30. Mucosal lesionsMucosal • Dull erythematous plaques withpatches: grayish sloughSnail- • Mucous patches track with serpiginousulcers: erosions
  31. 31. Lymphadenopathy in SS • Generalised, symmetrical, and rubbery Axillary Cervical Inguinal
  32. 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. 33. Latent syphilis• Patient has only serological evidence of syphilis without any clinical evidence.
  34. 34. • Depending on the number of of years passed :  Early latent (<2 yrs)  Late latent syphilis(>2yrs)
  35. 35. TERTIARY SYPHILIS• It manifest 3-10 years after the primary stage
  36. 36. TERTIARY SYPHILIS• Mucocutaneous tertiary – Gumma*(well defined punched out ulcer)• Neurosyphilis – Asymptomaticparenchymatous /meningeal
  37. 37. • CVS syphilis – Aortitis – coronary stenosis – aneurysm
  38. 38. CONGENITAL SYPHILIS
  39. 39. CONGENITAL SYPHILIS• T.Pallidum can be transmitted by an infected mother to foetus in utero
  40. 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. 41. Cutaneouseruptions,hepatosplenomegaly,bone andjoint involvement arecommon.C/F similar toacquired SS butvisceral and boneinvolvement are morecommon.
  42. 42. Cutaneouslesions:bullous ,fissuring of lips,nasolabial folds
  43. 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. 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. 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. 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. 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. 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. 49. TREATMENTEarly syphilis -Benzathine penicillin(2.4 mega dose)Late syphilis – Three week i/m injection of benzathine penicillin

×