Syphilis

1. Dr. Vamshikrishna Dussa

2. • Syphilis is a venereal (sexually-transmitted)
disease caused by spirochaetes, Treponema
pallidum.
• The word ‘syphilis’ is derived from the name
of the mythological handsome boy, Syphilus,
who was cursed by Greek god Apollo with the
disease.

3. Mode of Transmission:
Syphilitic infection can be transmitted by the following routes:
1. Sexual intercourse is the most common route of infection and
results in lesions on glans penis, vulva, vagina and cervix.
2. Intimate person-to-person contact with lesions on lips, tongue or
fingers.
3. Transfusion of infected blood.
4. Materno-foetal transmission in congenital syphilis if the mother is
infected.

4. Types:
SYPHILIS
ACQUIRED
PRIMARY
STAGE
SECONDARY
STAGE
TERTIARY
STAGE
CONGENITAL

5. ACQUIRED SYPHILIS:
• Acquired syphilis is caused due to Sexual intercourse, Intimate
person-to-person contact, Transfusion of infected blood.
• Acquired syphilis is divided into 3 stages depending upon the period
after which the lesions appear and the type of lesions.
• These are:
• PRIMARY,
• SECONDARY &
• TERTIARY SYPHILIS

6. PRIMARY SYPHILIS
• After 2-4 weeks of infection, symptoms and signs of
primary syphilis develops.
• HALLMARK SIGN OF THIS STAGE: Development of
CHANCRE.
– SEEN AT GENITAL OR EXTRA-GENITAL SITES

7. EXTRA-GENITAL SITES
GENITAL – MALE & FEMALE

8. CHANCRE:
• The chancre is the predominant lesion of primary syphilis.
• It appears about 3-4 weeks after infection and heals in about 1–2
months in untreated individuals.
• In Men lesions occur on the
 Penis, Anus, and Rectum
 In Women lesions occur on the
 Cervix, Vulva, and Perineum.
• Small lesions may also occur on the lips, tongue, buccal mucosa,
and skin, and chancres of the eyelids and conjunctiva.

9. CHARACTERISTIC FEATURES OF CHANCRE:
• Lesion begins as an erythematous papule at the inoculation site and
later erodes to form a PAINLESS ULCER.
• The fully-developed chancre is an INDURATED LESION WITH
CENTRAL ULCERATION accompanied by regional lymphadenitis.
• Classically lymph nodes are RUBBERY, PAINLESS, & BILATERAL
• The chancre heals WITHOUT SCARRING, even in the absence of
treatment.
• Multiple chancres are seen in HIV patients infected with syphilis.
• Serous fluid from these lesions contains spirochetes.

10. • Antibody tests/serological tests are positive after 1-3
weeks of appearance of chancres.

11. SECONDARY SYPHILIS
• Inadequately treated patients of primary syphilis
develop mucocutaneous lesions and painless
lymphadenopathy in 2-3 months after the exposure
• Mucocutaneous lesions may be in the form of:
 Mucous patches on mouth, pharynx and vagina; and
 Generalised skin eruptions and
 Condylomalata in anogenital region.

12. MUCOUS PATCHES

13. GENERALISED SKIN ERUPTIONS

14. CONDYLOMA LATA

15. • Secondary syphilis is highly infective stage
• Spirochaetes can be easily demonstrated in the
mucocutaneous lesions.
• Antibody tests are always positive at this stage

16. TERTIARY SYPHILIS
• After a latent period of appearance of secondary
lesions and about 2-3 years following first exposure,
tertiary lesions of syphilis appear.
• Lesions of tertiary syphilis are much less infective than
the other two stages.
• Spirochaetes can be demonstrated with great difficulty
in the lesions .

17. Lesions are of 2 main types in Tertiary syphilis:
1. Syphilitic Gumma
2. Diffuse lesions of tertiary syphilis
1. SYPHILITIC GUMMA:
• It is a solitary, localised, rubbery lesion with central
necrosis, seen in organs like liver, testis, bone and brain.
• It is a form of granuloma
• More commonly seen liver: HEPAR LOBATUM/GUMMA
HEPATIS.

18. GUMMA

19. FEATURES OF GUMMAS
• Gummas have a firm, necrotic center (coagulative necrosis)
surrounded by inflamed tissue.
• Other histological features of gummas include:
an intervening zone containing Epithelioid cells with
indistinct borders & Multinucleated giant cells,
a peripheral zone of fibroblasts and capillaries.
Infiltration of lymphocytes and plasma cells can be seen in
the peripheral zone as well.

20. 2. DIFFUSE LESIONS OF TERTIARY SYPHILIS:
• The lesions appear following widespread dissemination of spirochaetes in the
body.
• The diffuse lesions are predominantly seen in cardiovascular and nervous systems.
a. Cardiovascular syphilis:
- aortic aneurysm,
- Incompetence of aortic valve
b. Neurosyphilis:
- Meningovascular syphilis
- ”Tabes dorsalis affecting the spinal cord; and
- ”General paresis affecting the brain.

21. Aortic aneurysm

22. CONGENITAL SYPHILIS
• Congenital syphilis may develop in a foetus of more than 16 weeks
gestation who is exposed to maternal spirochaetaemia.
• The major morphologic features as under:
i) Saddle-shaped nose deformity due to destruction of bridge of
the nose.
ii) The characteristic ‘Hutchinson’s teeth’ which are small, widely
spaced, peg-shaped permanent teeth.
iii) Mucocutaneous lesions of acquired secondary syphilis
iv) Bony lesions like epiphysitis and periostitis.

23. v) Interstitial keratitis with corneal opacity.
vi) Diffuse fibrosis in the liver.
vii) Interstitial fibrosis of lungs.
Hutchinson’s teeth Saddle-shaped nose