[Group 9] 1st Year 2nd Semester Kursk State Medical university

1. SYPHILIS
-By. KESHAVSWAMI & KHUSHI DEV
OF GROUP 9

2. What isSyphilis?
•Syphilisisasystemic,sexuallytransmitted disease
(STD)causedbytheTreponema pallidumbacterium.The
threemeansof syphilistransmissionare:
•Persontopersonviavaginal,anal,ororalsexthrough
directcontactwithasyphilischancre.
•Persontopersonduringforeplay,evenwhen thereisno
penetrativesex(muchlesscommon).
•Pregnantmotherwithsyphilistofetus.

3. INTRODUCTION
• Causedby
Treponema
pallidum.
• Transmission: sexual;
maternal-fetal,
bloodtransfusion
and rarely by othermeans
of both transmitting and
getting infected with HIV.
SYPHILIS

4. Treponemapallidum
• Described in 1905 by
Schaudinn and
Hoffman, in chancres
and in inquinallymph
nodes of the patients

5. Treponemapallidum.
• Spiral spirochete that is mobile of
spirals varies from 4 to 14 Length 5 to
20 microns and very thin 0.1 to o.5
microns. Canbe seenon fresh primary
or secondary lesionsby
darkfield microscopy
or fluorescent
antibody techniques

6. ModeofTransmission
• Organism is very fragile, destroyed
rapidly by heat, cold anddrying.
• Sexualtransmission most common,
occurs when abraded skin or mucous
membranes come in contact withopen
lesion.
• Canbe transmitted to fetus.
• Raretransmission from needle stickand
blood transfusion.

7. MothertoChildTransmission
• Infection in utero
may have serious
consequencesfor
the fetus. Rarely,
syphilis hasbeen
acquired by
transfusion of
infected fresh
human blood.

8. STAGESOFSYPHILIS
1. Primary
2. Secondary
3. Latent
•
•
Earlylatent
Late latent
1. Late or tertiary
• May involve any organ, but main partsare:
– Neurosyphilis
– Cardiovascularsyphilis
– Latebenign (gumma)

9. PRIMARY SYPHILIS
(The Chancre)
• Incubation period 9-90 days, usually~21
days.
• Develops at site of contact/inoculation.
• Multiplies at the site of entry, asmall
painless primary lesion called chancreis
formed.

10. CHANCRE
10
• Appears on external genitilia corona of thepenis
labia, vaginal wall.
also occurs in cervix, perianal area, mouth,anal
canal.
It possessesahard ridge covered by thick,glairy
exudate rich in spirochaetes.
Serological tests are positive in 80%individuals at
this stage.
•
•
•

11. Secondary Syphilis
• Secondarysyphilis at 2-
10 weeks after primary
lesion – diffuse
symptoms:
– Fever
– Headache
– Skin pustules
• Usually disappears
even without treatment

12. Secondarysyphilis
• Skinrashes, nucleus patches in oropharynx.
• Multiplication of spirochaetes andtheir
dissemination through blood.
• e) Headache,anorexia, malaise,weight
loss, nauseaand vomiting, sore throat
and slight fever.
• f) Temporary alopecia mayoccur
• g) Nails become brittle andpitted

13. Latent Syphilis
• After several weeks, secondary lesions
disappear and disease becomes latent.
• Not infectious at this stage,
• Except for transmission from mother
to foetus (congenital syphilis)

14. TertiarySyphilis
• Developsafter manyyearsin persons with
untreated secondarysyphilis.
• Appearanceof degenerative lesions called
GUMMASin skin,boneand nervoussystem.
• Reductionin numberof spirochaetes observed.

15. • Affects2/3 of untreatedcases
– Gummata:rubbery tumors
– Bonedeformities
– Blindness
– Lossofcoordination
– Paralysis
– Insanity

16. Pathology
• Penetration:
–T.pallidum enters the bodyvia skinandmucous
membranesthrough abrasionsduringsexual contact
–Alsotransmitted transplacentally
•
• Dissemination:
– Travels via the lymphatic system to regional lymph
nodes and then throughout the body via the blood
stream
– Invasion of the CNScan occur during any stage
of syphilis

17. CongenitalSyphilis
17
• Congenital syphilis
usually occursfollowing
vertical transmissionof
T.pallidum from the
infected mother to the
fetus in utero, but
neonates may also be
infected during passage
through the infected
birth canal atdelivery.

18. DIAGNOSIS OF SYPHILIS
• 1. Clinical examination by serological tests.
• 2. Dark-field microscopy: special technique
use to demonstrate the spirochete as shiny
motile spiral structures with a dark
background.
• The specimen includes oozing from the
lesion or sometimes L.N. aspirate. It is
usually positive in the primary and
secondary stages and it is most useful in
the primary stage when the serological tests
are still negative.

19. DiagnosisofSyphilis
• Evaluation based on three factors:
– Clinical findings.
– Demonstration of spirochetes in clinicalspecimen.
– Present of antibodies in blood orcerebrospinal
fluid.
• More than one test should beperformed.
• No serological test candistinguishbetween
other Treponemalinfections.

20. LaboratoryTesting
• Direct examination of clinical specimen
by dark-field microscopy or fluorescent
antibody testing of sample.
• Non-specificor non-treponemal
serological test to detect reagin,utilized
asscreening test only.
• SpecificTreponemalantibody testsare
used asaconfirmatory test for apositive
reagin test.

21. ProvisionalDiagnosisofSyphilis
21
• Apresumptive
diagnosis is possible
with sequential
serologic tests (e.g.
VDRL,RPR),using the
sametesting method
eachtimeConfirmatory
tests should be
performed

22. SERLOGICAL TESTS OF SYPHILIS(depending
uponantigen)

23. VDRL
• Eachpreparation of antigen suspension should first be examinedby
testing with known positive ornegative serum controls.
• Theantigen particles appear asshort rod forms at magnification ofabout
100x.Aggregation of these particles into large or small clumps is
interpreted asdegrees of positivity
• Reactive on left, non-reactive onright

24. RPR
• Test Procedure:
– Serumor plasma added to circle on card andspread.
– Onedrop of antigen from aneedle capableof delivering60drops/mL
is added.
– Rotate at 100 rpms/minute for 8minutes.
– Resultsare read macroscopically.
Daily quality control:
– 20 gaugeneedle checked for delivery of 60drops/mL
– Rotator checkedfor 100rpms/minute
– Roomtemperature must be 23-29C.
– Three levels ofcontrol must be run and give appropriate results.
RPR appears to be more sensitive than theVDRL.
•
•

25. Treponemapallidum haemagglutination
(TPHA)
• Adapted to micro
techniques (MHA-TP)
• Tanned sheepRBCs
are coated with T.
pallidum antigenfrom
Nichol’s strain.
• Agglutination of the
RBCs is apositive
result.

27. • avoidance of sexual contact withdiseased
individual.
• usephysical barriers and antiseptics
• prompt and adequate treatment ofall new
cases
• follow-up on sourcesof infection andcontact
soasto get them cured.

28. TREATMENTOF SYPHILIS:
•
•
Early syphilis:
benzathine penicillin G2.4 million units intramuscularly
once
procaine penicillin 600,000 units intramuscularlydaily
for 10days
if the patient is unable to take penicillin, then give
tetracycline or erythromycin 500 mg 4 times aday by
mouth – or doxycycline 100 mg x2- for 15days.
Ceftriaxone, 2 gm qd IM/IV for 10-14 d is anewalternative
treatment and is effective specially inneurosyphilis.
•
•
•

29. THANKS FOR YOUR
ATTENTION!!!!