Std   syphilis
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Std syphilis

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Std syphilis Presentation Transcript

  • 1. SYPHILIS
  • 2. SYPHILIS IS : a sexual transmitted disease caused by spirochetal bacterium Treponema pallidum , a motile anaerobic
    • Transmission
    • of syphilis is almost always through sexual contact or congenitally through the placenta to a fetus or at birth from an infected mother.
  • 3. Different manifestations occur depending on the stage of the disease
  • 4.  
  • 5.
    • Primary Syphilis:
    • it’s the first stage after infection
    • painless & localized ulcer with rolled edge (chancres).
    • single or multiple.
    • appear 2-3 weeks after contact.
    • most common site are cervix , vagina , vulva , anus and mouth.
    • regional L.N become enlarged.
    .
  • 6. PRIMARY SYPHILIS (The Chancre)
    • Incubation period 9-90 days, usually ~21 days.
    • Develops at site of contact/inoculation.
    • Classically: single, painless, clean-based, indurated ulcer, with firm, raised borders. Atypical presentations may occur .
    • Mostly anogenital, but may occur at any site (tongue, pharynx, lips, fingers, nipples, etc...)
    • Non-tender regional adenopathy
    • Very infectious.
    • May be darkfield positive but serologically negative.
    • Untreated, heals in several weeks, leaving a faint scar.
  • 7. SECONDARY SYPHILIS (Cont.)
    • The skin rash:
      • Diffuse,
      • often with a superficial scale (papulosquamous).
      • May leave residual pigmentation or depigmentation .
    • Condylomata Lata:
      • Formed by coalescence of large, pale, flat-topped papules.
      • Occur in warm, moist areas such as the perineum.
      • Highly infectious.
    • Mucosal lesions:
      • ~ 30% of secondary syphilis patients develop mucous patch (slightly raised, oval area covered by a grayish white membrane, with a pink base that does not bleed).
      • Highly infectious
  • 8.
    • Secondary Syphilis:
    • Systemic
    • 1-6 months after contact
    • fever, malaise, general adenopathy and non-itchy maculopapular skin rash “money spot” .
    • involve the palms of the hands and the soles of the feet.
    • Mucous patches and linear (snail track) ulcers are seen on the mucosal surfaces.
  • 9. SECONDARY SYPHILIS
    • Seen 6 wks to 6 mos after primary chancre
    • Usually w diffuse non-pruritic, indurated rash, including palms & soles.
    • May also cause:
      • Fever, malaise, headache, sore throat, myalgia, arthralgia, generalized lymphadenopathy
      • Hepatitis (10%)
      • Renal: an immune complex type of nephropathy with transient nephrotic syndrome
      • Iritis or an anterior uveitis
      • Bone: periostitis
      • CSF pleocytosis in 10 - 30% (but, symptomatic meningitis is seen in <1%)
  • 10. SECONDARY SYPHILIS Differential diagnosis
    • The rash may be confused with
      • Pityriasis rosea (usually has a herald patch and lesions seen along lines of skin cleavage)
      • Drug eruptions
      • Acute febrile exanthems
      • Psoriasis
      • Lichen planus
      • Scabies
    • The mucous patch may be confused with oral thrush.
    • Malaise, sore throat, generalized adenopathy, hepatitis, & rash may be confused with infectious mononucleosis.
    • Fortunately, the serologic tests for syphilis are positive in 99% of secondary syphilis pts.
  • 11. LATENT SYPHILIS
    • Positive syphilis serology without clinical signs of syphilis (& has normal CSF).
      • It begins with the end of secondary syphilis and may last for a lifetime.
      • Pt may or may not have a h/o primary or secondary syphilis.
      • Diseases known to cause occasional false-positive nontreponemal test reactions for syphilis, such as systemic lupus erythematosus (SLE), and congenital syphilis must be excluded before the diagnosis of latent syphilis can be made .
    • Is divided into early and late latency.
  • 12. LATENT SYPHILIS (cont.)
    • Early latent :
      • The first year after the resolution of primary or secondary lesions, or
      • A reactive serologic test for syphilis in an asymptomatic individual who has had a negative serologic test within the preceding year.
      • Infectious.
    • Late latent:
      • Usually not infectious, except for the pregnant woman, who may transmit infection to her fetus.
  • 13. LATENT SYPHILIS ‘Tertiary Syphilis’
    • Is the destructive stage of the disease.
    • Lesions develop in skin, bone, & visceral organs (any organ).
    • The main types are:
      • Late benign (gummatous)
      • Cardiovascular &
      • Neurosyphilis
    • Can be crippling and life threatening
    • Blindness, deafness, deformity, lack of coordination, paralysis, dementia may occur
    • It is usually very slowly progressive, barring certain neurologic syndromes which may develop suddenly due to endarteritis and thrombosis in the CNS
    • Late syphilis is noninfectious.
  • 14. LATENT SYPHILIS
    • Positive syphilis serology without clinical signs of syphilis (& has normal CSF).
      • It begins with the end of secondary syphilis and may last for a lifetime.
      • Pt may or may not have a h/o primary or secondary syphilis.
      • Diseases known to cause occasional false-positive nontreponemal test reactions for syphilis, such as systemic lupus erythematosus (SLE), and congenital syphilis must be excluded before the diagnosis of latent syphilis can be made .
    • Is divided into early and late latency.
  • 15.
    • Latent syphilis
    • Absent of symptoms or physical finding.
    • 13 proceed to tertiary.
    • Tertiary syphilis
    • Ocurre 1-10 years after infection
    • gummas: ulcerative nodule in the skin, bone and nervous system as a result of hypersensitivity reactions.
    • Systemic manifestation: CVS, CNS and bone
  • 16. Congenital Syphilis
    • Mode of transmission:
    • - trans placental passage from infected mother
    • - at birth
    • Congenital infection is associated with several adverse outcomes including:
    • -low birth wt -congenital anomalies
    • -premature birth -miscarriages or death of baby
  • 17. Congenital Syphilis
    • Early:
    • -skin lesions , maculopapular tissue
    • -Lymphadenopathy
    • -Hepatosplenomegaly
    • -failure to thrive
    • -jaundice , anemia
    • - osteochondritis
    • Late:
    • -gummatous ulcers
    • -bony prominence of forehead
    • -Saddle nose
    • -Short maxilla
    • -keratitis, 8 nerve deafness and dental deformities
  • 18. Prevention
    • Treatment
    • The first-choice treatment for all manifestations of syphilis is penicillin.
    • Parenteral penicillin G is the only therapy with documented effect during pregnancy.
    • Non-pregnant individuals who have severe allergic reactions to penicillin
    • may be effectively treated with oral tetracycline or doxycycline
  • 19. THANX THANX