Syphilis is a bacterial infection spread through sexual contact or skin-to-skin contact with sores caused by the spirochete Treponema pallidum. It progresses through primary, secondary, latent, and tertiary stages if left untreated. Primary syphilis causes painless sores, usually on the genitals or mouth. Secondary syphilis symptoms include a rash, swollen lymph nodes, and general symptoms. Without treatment, syphilis can spread to the nervous system causing neurosyphilis. Diagnosis involves dark-field microscopy of sores or serological tests detecting antibodies. Penicillin is the treatment of choice and can cure syphilis if given early enough in the infection.
2. Introduction
Syphilis is a bacterial infection usually spread
by sexual contact.
The disease starts as a painless sore – typically
on the genitals, rectum or mouth.
Syphilis spreads from person to person via
skin or mucous membrane contact with these
sores.
After the initial infection, the bacteria can
remain inactive in the body for decades
becoming active again.
3.
4. Causative agent :
Treponema pallidum.
Spiral spirochete that is mobile of spirals
varies from 4 to 14 length 5 to 20 microns and
very thin 0.1 to 0.5 microns. Can be seen on
fresh primary or secondary lesions by dark
field microscopy or fluorescent antibody
techniques
5. Stages of syphilis
Primary Syphilis
Chancre :
Appears 10-90 days after infection
Typically single, painless, clean-based lesion with
rolled edges
6. Secondary Sphilis
Sign and symptoms
Usually occurs 3-6 weeks after primarily chancre
• Rash (75-90%)
• Generalized lymph node swelling (70-90%)
• Constitutional symptoms (50-80%)
• Mucous patches (5-30%)
• Condyloma lata (5-25%)
• Patchy alopecia or hair loss (10-15%)
• Symptoms of neurosyphilis (1-2%)
• Less common: meningitis, hepatitis, arthritis,
nephritis
7. The symptoms of secondary syphilis will go
away with or without treatment. However,
without treatment, the infection will progress
to the latent and possibly tertiary stage of
disease.
8. Latent syphilis
No clinical manifestations: only evidence is positive
serologic tests
60-80% remain asymptomatic for years without
treatment
Divided into two stages for treatment purposes:
oEarly latent syphilis: <1yr duration
oLate latent syphilis: >1yr duration
9. Tertiary Syphilis
70% of untreated patients remain asymptomatic
30% of untreated patients progress to tertiary stage
in 5-20 years
oGummas: destructive lesions of soft tissue, cartilage ,
internal organs and bone
oCardiovascular involvement : aortic aneurysm, aortic
insufficiency
oCentral nervous system involvement: general paresis,
tabes dorsalis, optic atrophy
Progressive inflammatory disease
10. Neurosyphilis
Central nervous system invasion occurs early
in infection in 30-40% of patients
Asymptomatic neurosyphilis can occur at any
stage of syphilis
Early symptomatic forms (months to a few
years)
o Acute meningitis
o Meningovascular (stuttering stroke)
Late symptomatic forms ( >2 years )
o General paresis
o Tabes dorsalis
11. Diagnostic Tests
Direct identification of
T.pallidum
Direct microscopic
identification of T.pallidum
by dark field microscopy
Direct antigen detection
tests
Nucleoside amplification
techniques (PCR)
Serological tests to
detect igG/igm
antibodies
N0nTreponemal
tests(for determining
the disease activity)
Treponemal tests(for
disease confirmation)
Detection of
Treponemal igM
antibodies( to detect
early infection )
12. Dark Field Microscopy
This method is traditionally used to
demonstrate T.pallidum in the exudate from
mucocutaneous lesions in early acquired and
early congenital syphilis
One of the most specific and easiest method
for diagnosis of infectious syphilis when
lesions are present.
13. Blood : Blood tests can confirm the presence
of antibodies that the body produces to fight
infection. The antibodies to the syphilis –
causing bacteria remain in your body for
years, sot the test can be used to determine a
current or past infection.
Cerebrospinal fluid : if it’s suspected that you
have nervous system complications of
syphilis, your doctor may also suggest
collecting a sample of cerebrospinal fluid
through a lumbar puncture.
14. Treatment
Late Latent and Unknown Duration
• Recommended regimen:
Benzathine Penicillin G 7.2 million units total,
given as 3 doses of 2.4 million units each at 1
week intervals
• Non-pregnant penicillin-allergic adults:
Doxycycline* 100mg orally two times a day for 4
weeks or
Tetracycline* 500mg orally four times a day for 4
weeks
15. Treatment Neurosyphilis
Recommended regimen:
o Aqueous Crystalline Penicillin G 18-24 million units
IV daily administered as 3-4 million IV every 4 hrs
for 10-14 days
Alternative regimen:
o Procaine Penicillin G 2.4 million units IM daily plus
Probenecid 500 mg PO daily, both for 10-14 days
16. Treatment Pregnancy
Penicillin is the only adequate bform of
treatment for syphilis in pregnancy.
Penicillin-allergic patients ->
Hospitalize,desensitise & treat with penicillin
Erythromycin is not accepted as alternative drug in
penicillin-allergic patients
17. Harm reduction
Abstain from sex until treatment is finished
and until partners have been evaluated and
treated
Use condoms consistently and correctly
Minimize # of sex partners
Avoid sex while under the influence of alcohol
or drugs to decrease risky behavior
Avoid having sex with partners with genital
ulcers/lesions or rashes
Get check-ups every 6 months if engaging in
sex with more than one sex partner