Std syphilis

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Std syphilis

  1. 1. SYPHILIS
  2. 2. SYPHILIS IS : a sexual transmitted disease caused by spirochetal bacterium Treponema pallidum , a motile anaerobic <ul><li>Transmission </li></ul><ul><li>of syphilis is almost always through sexual contact or congenitally through the placenta to a fetus or at birth from an infected mother. </li></ul>
  3. 3. Different manifestations occur depending on the stage of the disease
  4. 5. <ul><li>Primary Syphilis: </li></ul><ul><li>it’s the first stage after infection </li></ul><ul><li>painless & localized ulcer with rolled edge (chancres). </li></ul><ul><li>single or multiple. </li></ul><ul><li>appear 2-3 weeks after contact. </li></ul><ul><li>most common site are cervix , vagina , vulva , anus and mouth. </li></ul><ul><li>regional L.N become enlarged. </li></ul>.
  5. 6. PRIMARY SYPHILIS (The Chancre) <ul><li>Incubation period 9-90 days, usually ~21 days. </li></ul><ul><li>Develops at site of contact/inoculation. </li></ul><ul><li>Classically: single, painless, clean-based, indurated ulcer, with firm, raised borders. Atypical presentations may occur . </li></ul><ul><li>Mostly anogenital, but may occur at any site (tongue, pharynx, lips, fingers, nipples, etc...) </li></ul><ul><li>Non-tender regional adenopathy </li></ul><ul><li>Very infectious. </li></ul><ul><li>May be darkfield positive but serologically negative. </li></ul><ul><li>Untreated, heals in several weeks, leaving a faint scar. </li></ul>
  6. 7. SECONDARY SYPHILIS (Cont.) <ul><li>The skin rash: </li></ul><ul><ul><li>Diffuse, </li></ul></ul><ul><ul><li>often with a superficial scale (papulosquamous). </li></ul></ul><ul><ul><li>May leave residual pigmentation or depigmentation . </li></ul></ul><ul><li>Condylomata Lata: </li></ul><ul><ul><li>Formed by coalescence of large, pale, flat-topped papules. </li></ul></ul><ul><ul><li>Occur in warm, moist areas such as the perineum. </li></ul></ul><ul><ul><li>Highly infectious. </li></ul></ul><ul><li>Mucosal lesions: </li></ul><ul><ul><li>~ 30% of secondary syphilis patients develop mucous patch (slightly raised, oval area covered by a grayish white membrane, with a pink base that does not bleed). </li></ul></ul><ul><ul><li>Highly infectious </li></ul></ul>
  7. 8. <ul><li>Secondary Syphilis: </li></ul><ul><li>Systemic </li></ul><ul><li>1-6 months after contact </li></ul><ul><li>fever, malaise, general adenopathy and non-itchy maculopapular skin rash “money spot” . </li></ul><ul><li>involve the palms of the hands and the soles of the feet. </li></ul><ul><li>Mucous patches and linear (snail track) ulcers are seen on the mucosal surfaces. </li></ul>
  8. 9. SECONDARY SYPHILIS <ul><li>Seen 6 wks to 6 mos after primary chancre </li></ul><ul><li>Usually w diffuse non-pruritic, indurated rash, including palms & soles. </li></ul><ul><li>May also cause: </li></ul><ul><ul><li>Fever, malaise, headache, sore throat, myalgia, arthralgia, generalized lymphadenopathy </li></ul></ul><ul><ul><li>Hepatitis (10%) </li></ul></ul><ul><ul><li>Renal: an immune complex type of nephropathy with transient nephrotic syndrome </li></ul></ul><ul><ul><li>Iritis or an anterior uveitis </li></ul></ul><ul><ul><li>Bone: periostitis </li></ul></ul><ul><ul><li>CSF pleocytosis in 10 - 30% (but, symptomatic meningitis is seen in <1%) </li></ul></ul>
  9. 10. SECONDARY SYPHILIS Differential diagnosis <ul><li>The rash may be confused with </li></ul><ul><ul><li>Pityriasis rosea (usually has a herald patch and lesions seen along lines of skin cleavage) </li></ul></ul><ul><ul><li>Drug eruptions </li></ul></ul><ul><ul><li>Acute febrile exanthems </li></ul></ul><ul><ul><li>Psoriasis </li></ul></ul><ul><ul><li>Lichen planus </li></ul></ul><ul><ul><li>Scabies </li></ul></ul><ul><li>The mucous patch may be confused with oral thrush. </li></ul><ul><li>Malaise, sore throat, generalized adenopathy, hepatitis, & rash may be confused with infectious mononucleosis. </li></ul><ul><li>Fortunately, the serologic tests for syphilis are positive in 99% of secondary syphilis pts. </li></ul>
  10. 11. LATENT SYPHILIS <ul><li>Positive syphilis serology without clinical signs of syphilis (& has normal CSF). </li></ul><ul><ul><li>It begins with the end of secondary syphilis and may last for a lifetime. </li></ul></ul><ul><ul><li>Pt may or may not have a h/o primary or secondary syphilis. </li></ul></ul><ul><ul><li>Diseases known to cause occasional false-positive nontreponemal test reactions for syphilis, such as systemic lupus erythematosus (SLE), and congenital syphilis must be excluded before the diagnosis of latent syphilis can be made . </li></ul></ul><ul><li>Is divided into early and late latency. </li></ul>
  11. 12. LATENT SYPHILIS (cont.) <ul><li>Early latent : </li></ul><ul><ul><li>The first year after the resolution of primary or secondary lesions, or </li></ul></ul><ul><ul><li>A reactive serologic test for syphilis in an asymptomatic individual who has had a negative serologic test within the preceding year. </li></ul></ul><ul><ul><li>Infectious. </li></ul></ul><ul><li>Late latent: </li></ul><ul><ul><li>Usually not infectious, except for the pregnant woman, who may transmit infection to her fetus. </li></ul></ul>
  12. 13. LATENT SYPHILIS ‘Tertiary Syphilis’ <ul><li>Is the destructive stage of the disease. </li></ul><ul><li>Lesions develop in skin, bone, & visceral organs (any organ). </li></ul><ul><li>The main types are: </li></ul><ul><ul><li>Late benign (gummatous) </li></ul></ul><ul><ul><li>Cardiovascular & </li></ul></ul><ul><ul><li>Neurosyphilis </li></ul></ul><ul><li>Can be crippling and life threatening </li></ul><ul><li>Blindness, deafness, deformity, lack of coordination, paralysis, dementia may occur </li></ul><ul><li>It is usually very slowly progressive, barring certain neurologic syndromes which may develop suddenly due to endarteritis and thrombosis in the CNS </li></ul><ul><li>Late syphilis is noninfectious. </li></ul>
  13. 14. LATENT SYPHILIS <ul><li>Positive syphilis serology without clinical signs of syphilis (& has normal CSF). </li></ul><ul><ul><li>It begins with the end of secondary syphilis and may last for a lifetime. </li></ul></ul><ul><ul><li>Pt may or may not have a h/o primary or secondary syphilis. </li></ul></ul><ul><ul><li>Diseases known to cause occasional false-positive nontreponemal test reactions for syphilis, such as systemic lupus erythematosus (SLE), and congenital syphilis must be excluded before the diagnosis of latent syphilis can be made . </li></ul></ul><ul><li>Is divided into early and late latency. </li></ul>
  14. 15. <ul><li>Latent syphilis </li></ul><ul><li>Absent of symptoms or physical finding. </li></ul><ul><li>13 proceed to tertiary. </li></ul><ul><li>Tertiary syphilis </li></ul><ul><li>Ocurre 1-10 years after infection </li></ul><ul><li>gummas: ulcerative nodule in the skin, bone and nervous system as a result of hypersensitivity reactions. </li></ul><ul><li>Systemic manifestation: CVS, CNS and bone </li></ul>
  15. 16. Congenital Syphilis <ul><li>Mode of transmission: </li></ul><ul><li>- trans placental passage from infected mother </li></ul><ul><li>- at birth </li></ul><ul><li>Congenital infection is associated with several adverse outcomes including: </li></ul><ul><li>-low birth wt -congenital anomalies </li></ul><ul><li>-premature birth -miscarriages or death of baby </li></ul>
  16. 17. Congenital Syphilis <ul><li>Early: </li></ul><ul><li>-skin lesions , maculopapular tissue </li></ul><ul><li>-Lymphadenopathy </li></ul><ul><li>-Hepatosplenomegaly </li></ul><ul><li>-failure to thrive </li></ul><ul><li>-jaundice , anemia </li></ul><ul><li>- osteochondritis </li></ul><ul><li>Late: </li></ul><ul><li>-gummatous ulcers </li></ul><ul><li>-bony prominence of forehead </li></ul><ul><li>-Saddle nose </li></ul><ul><li>-Short maxilla </li></ul><ul><li>-keratitis, 8 nerve deafness and dental deformities </li></ul>
  17. 18. Prevention <ul><li>Treatment </li></ul><ul><li>The first-choice treatment for all manifestations of syphilis is penicillin. </li></ul><ul><li>Parenteral penicillin G is the only therapy with documented effect during pregnancy. </li></ul><ul><li>Non-pregnant individuals who have severe allergic reactions to penicillin </li></ul><ul><li>may be effectively treated with oral tetracycline or doxycycline </li></ul>
  18. 19. THANX THANX

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