5. Primary stage
• Classical present with a genital ulcer (chancre)
• Single, painless, clean-based, indurated ulcer,
with firm ,raised borders.
• Atypical presentations may occur
• Mostly anolgenital, but may occur at any
site(tongue, pharynx, lips, fingers, nipples,
e.t.c
7. Secondary syphilis
• Develop six weeks to six month after primary
chancre.
• Usually present with diffuse non- pruritic ,
indurated rashes , including palms and soles.
• May also cause fever ,sore throat, myalgia,
arthralgia, and generalized lymphadenopathy.
9. Latent stage (asymptomatic phase)
• Early latent :the first years after the resolution
of primary or secondary or its infectious.
• Late latent: usually not infectious, but pregnant
mother could transmit to her foetus.
10. Tertiary syphilis
• Lesions develop in skin, bone and visceral organs.
• The main type late benign (gummatous),
cardiovascular and neurosyphilis.
• Blindness ,deafness, deformity, paralysis ,
dementia may occurs.
• It is usually very slowly progressive , barring
certain neurologic syndrome which may develop
suddenly due to endarteritis and thrombosis in the
CNS.
• Late syphilis is non infectious .
12. Management of syphilis
Investigations
• Non- treponemal tests( for screening tests and for
follow-up response to treatment)
– VDRL (Venereal Disease Research Laboratory)
– RPR ( Rapid Plasma Reagin)
• Treponemal tests (confirmatory tests )
– Treponema pallidum particle agglutination assay
(TPPA).
– Fluorescent treponemal antibody absorption (FTA-
ABS) test.
– Treponema pallidum haemoglutination antibody test
(TPHA.
13. Management cont…
Non reactive VDRL test does not exclude
primary syphilis
VDRL is positive for 99% of patient with
secondary syphilis.
VDRL reactivity tend to diminish in letter stages
of disease.
For patient with cardiovascular and
neurosyphilis the TPHA may be the only test
to be positive
14. Treatment:
Primary, secondary and early latent syphilis:
• Dose:
• Benzathine penicillin 2.4 MU IM stat (1.2 MU in each
buttock). Or Azithromycin po 1gm start.
• Repeat dose is needed for HIV infected patients and
pregnant women after 7 days.
• For pts allergic to penicillin use doxycycline 100mg po 12
hourly for 15 days.
Late syphilis:
• Syphilis of more than one year’s duration, cardiovascular,
gumma and late-latent syphilis.
• Dose:
• Benzathine penicillin 2.4 MU IM weekly for 3 weeks (1.2
MU in each buttock). Or Azithromycin 2gm stat.
15. Treatment cont…
Neurosyphilis:
• Dose:
• Benzylpenicillin 3-4 MU IV 4 hourly or 24 MU
continuous IV infusion for 10-14 days. Or
• Ceftriaxone 2 g IV once daily for 10-14 days.
Congenital syphilis:
• Dose: Benzylpenicillin 50,000 units/kg 8-12 hourly IM
daily for 10-14 days.
• For pts allergic to penicillin after first month of life
;Erythromycin 7.5-12.5mg/kg daily for 30 days.
16. Management cont …
• Re-examine clinically and serologically at 6
and 12 months
• Treatment failure is considered if sign and
symptoms persist or sustained 4times increase
in non treponema test.
– In this case do HIV test , CSF analysis, the
administer benzathine weekly for three weeks .
17. Complications during pregnancy
• Untreated syphilis may result in spontaneous
abortion.
• Prematurity
• Low birth weight
• Stillbirth
• Congenital syphilis
18. Prevention:
• Safer sexual practice.
• Tracing and treating the sexual contacts of
patients with infectious syphilis.
• All patients with syphilis should be tested for
other STDs including HIV infection.
