This document discusses the origins, stages, transmission, diagnosis, and treatment of syphilis. It notes that syphilis was first observed following European contact with the Americas in 1494. Syphilis can cause significant pregnancy and birth complications, and in 1990 it caused over 200,000 deaths worldwide. The document outlines the four stages of syphilis infection - primary, secondary, latent, and tertiary - and describes their associated symptoms. Diagnosis involves clinical exams and tests like dark-field microscopy and serology. Treatment is with benzathine penicillin injections. The document concludes with a case study of a child presenting with late congenital syphilis and Hutchinson's triad of symptoms.

1. By:
A.A.ADENIJI
FAM MED REGISTRAR .
ENT ROTATTION
Tygerberg Academic Hospital
23/07/2015

2. .Origin of syphilis
*Pre columbus and columbus hypothesis
*First out break..1494/1945
*Obstetric sequelea ..700,000 to
1.6million pregnancy affected yearly.
*20% perinatal dealth in subsharan
African annually.
*202,000 mortality in 1990
*1999 syphilis surge..12million, 90% in
developing countries.

3. *202,000 mortality in 1990
*1999 syphilis surge..12million, 90% in
developing countries.
*113,000 mortality in 2010
*prevalence are proportionally high among
iv drug users, HIV patients and msm.
*1990 : increased rate among
heterosexuals in china and Russia
*syphilis increase risk of HIV by 2 to 5
times.

4.  *Spirocheate infections:
 -T pallidium
 ..sub species:
 .pertenue….yaws
 .careteum…Pinta
 .Endemicum..Bejel
 Only pallidium causes neurological
diseases.

5.  Primary transmission: sexual
contact.
 Vertical transmission..in utero
 Compromised mucosa
 Blood products.
 Needle sharing

6.  4 stages
 *Primary
 *Secondary
 *Latent
 *Tertiary

8.  Direct contact with infected lesion.
 Chancre within 3 to 90 days
 Chancre:often single, painless
ulceration with clean border and
sharp base.
 Extragenital:2%-7%, cervical:44%,
penile in
heterosexual:99%,Anal/recta in
MSM:34%, LN :80%

11.  4 to 10 wks after primary infection
 Variation of presentation involving:skin,
mucous membrane, maculopapular rashes
in the palm, trunk, soles or extremeties
 Fever, sorethroath, malaise, weight
loss, hair loss, headcahes,
 Rarely:intestitial keratitis, uveaitis,
optic neuritis and hepatitis.
 Most patients do not have previous
primary infection. 25% may have
recurrence.

12.  Serologic proof of infection with no
symptoms.
 Early L: Less than a year after
primary infection
 Late L: Over a year after primary
infection.
 Late LS are often asymptomatic.

13.  3 TO 15 years after primary
infection
 -Gummatous syphilis(15%)
 -Late neurosyphilis(6.5%)
 -Cardiovascular syphilis(10%)
 This is a non infective syphilis

14. *Clinical suspicion and investigation.
*Direct and indirect investigations.
*DIRECT: Dark ground microscopy,Direct
fluoresent antibody test and Nucleic
acid amplification test
*INDIRECT: Non treponema(VDRL and
RPR).
*Treponema Test:TPHA and FTA_Abs
*Trepona usually becomes positive 2-5
wks after initial infection.

15. Primary prevention’
 Secondary prevention.
 RPR titre>1.4
 Benzathine penicillin 2.4 million units wkly for
3 wks.
 If mother has received less than 3 doses
child to be treated for congenital syphilis
 28 days course of erythromycin or
doxycyline in penicillin allergic patients.
Symptomatic baby: procaine pen 50000 u dly
for 10 days.

16.  ASE PRESENTATION A 7-year-old female presented with
her mother to the clinic with the complaints of poor dental
esthetics. The patient was diagnosed with late congenital
syphilis (2 years after
 birth). She was non-reactive for HIV. The patient was on
regimen of penicillin treatment from late congenital syphi-
lis and corticoid therapy. Hutchinson’s triad was detected
by the presence of interstitial keratitis (fi gure 1 ), with
cor- neal scarring and initial presentation of bilateral
blindness; deafness from auditory nerve disease and
dental defects ( fi gures 2 and 3 ). Restorations in
posterior teeth were observed and it is not possible to affi
rm the presence of mulberry molars ( fi gure 4) . The
patient’s mother reported precocious loss of deciduous
teeth because of dental caries.

17.  Congenital syphilis sometimes is undiagnosed and often
inadequately treated. 14 It is also associated with poor
socio-economic conditions with a low educational level, 2 as
demonstrated in the case report presented, with the sev- eral
complications of disease. Most of the clinical signs of
congenital syphilis were developed later, 4 2 years after
birth. All the characteristics of Hutchinson’s triad were
identifi ed. 4 – 7 Interstitial kerati- tis was diagnosed when
she was 6-year-old, 10 with a bad prognosis. Although
eighth nerve deafness often starts when the child is between
8 and 10 years of age, 11 the patient had hearing loss when
she was 6-years-old. In the case reported, dental defects were
observed only on anterior teeth. This fi nding is associated of
degenerative changes in the enamel epithelium induced by T
pallidum , leading to the complete destruction of the
ameloblasts dur- ing odontogenesis.

18.  As a result, formation of abortive enamel and also
cessation of enamel production occurred. 5 7 It was
not possible to affi rm the presence of mulberry molars
because of dental restorations. Premature loss of
primary teeth associated with congen- ital syphilis has
been reported. 8 However; it is not possible to affi rm if
this occurrence in the patient was associated with
congenital syphilis or premature loss of deciduous teeth
because of caries reported.
 Congenital syphilis is an eminently preventable disease.
In order to reduce the likelihood of its occurrence, a
repeat test towards the end of gestation or at the time
of delivery should be done for women in high-risk
groups. 1

19.  Congenital syphilis refl ects a failure of
prenatal care systems and syphilis control
programs as found in this case reported.
*Detection and appropriate timely penicillin
treatment is a highly effective intervention to
reduce this infection disease, avoiding signifi
cant morbidity in the future.
 Hutchinson’s triad usually becomes apparent
after 5-years of age.

20.  BLIND RATS ARE WISE.
 DEAF RATS ARE STURBBORN.
 RATHER BE BLIND THAN BEING
DEAF.
 TAKE CARE OF YOUR EAR.