Early syphilisIncludes :-Primary , secondary and latent stage KEERTHI NS
Syphilis:- A venereal disease caused by spirochaetes, treponema pallidium . Your Logo
HISTORICAL ASPECTS Evidence and Information for Policy
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
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
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.
PHILLIPPE RICORDHe classified syphIlisinto primary ,secondaryand tertiary stages.He distinguishedgonorhoea from syphilisafter carrying out over2500 inoculations inhumans.
EtiologyTreponema pallidum• A spirochete; corkscrew shaped• Motile with characteristic movements like angulation,bending,rotatory motion and back and forth squiggle
Mainly sexual Rarely via Acquired bloodTransmission Accidental Trans Congenital placentally
Infections < 24 Early syphilis months; highly infectioussyphilis Infection > Late syphilis 24months; not infectious
Sexual contact 9-90 days Primary syphilis 3-12 weeks EARLY SYPHILIS; Highly infectiousSecondary syphilis Latent syphilis 24 MONTHS Tertiary syphilis LATE SYPHILIS
Different manifestations occurdepending on the stage of the disease Your Logo
primaryCongenital * Early secondary * late Signs & symptoms tertiary latent
Morphology of lesion Location of lesion Lymphadenopathy
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
• In the rest 50%,the ulcers are atypicalo Painfulo Multipleo Indurated
Location of ulcers Male genital areas:- Coronal sulans Glans Prepuce Shaft of penis Perianal areas in homosexual males
Females:- Labia minora Labia majora Mons pubis Sometimes in vagina or cervix Your Logo
Extra genital lesions:-• Lips• Nipples• Fingers
Lymphadenopathy in PSInguinal:-• Multiple• Small• Firm
Secondary syphilis• Systemic disease with cutaneous as well as extracutaneous manifestations.• It manifest itself 3- 12 weeks after the appearance of primary chancre.
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
Types of rashes in SSRoseolar syphilidePapular syphilidePsoriasiform lesionMalignant syphilide
Lymphadenopathy in SS • Generalised, symmetrical, and rubbery Axillary Cervical Inguinal
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
Latent syphilis• Patient has only serological evidence of syphilis without any clinical evidence.
• Depending on the number of of years passed : Early latent (<2 yrs) Late latent syphilis(>2yrs)
TERTIARY SYPHILIS• It manifest 3-10 years after the primary stage
TERTIARY SYPHILIS• Mucocutaneous tertiary – Gumma*(well defined punched out ulcer)• Neurosyphilis – Asymptomaticparenchymatous /meningeal
CONGENITAL SYPHILIS• T.Pallidum can be transmitted by an infected mother to foetus in utero
EARLY CONGENITAL SYPHILISAppear with in first 2 .yearof life Signs First appear 3rd-8thweek of lifeA form of rhinitis is thefirst specific finding.In severe infection there isclassic picture of marasmicsyphilis-wrinkled pot belliedold man.
Cutaneouseruptions,hepatosplenomegaly,bone andjoint involvement arecommon.C/F similar toacquired SS butvisceral and boneinvolvement are morecommon.
Cutaneouslesions:bullous ,fissuring of lips,nasolabial folds
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
DIAGNOSIS Demonstration of T.pallidum Dark ground microscopy Direct immunofluroscent staining Recent method-ELISA and PCR have failed to improve diagnostic detection rates.
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
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.
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
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
TREATMENTEarly syphilis -Benzathine penicillin(2.4 mega dose)Late syphilis – Three week i/m injection of benzathine penicillin