This document discusses the diagnosis and treatment of syphilis. It describes the various stages of syphilis from primary to secondary to latent to tertiary. Primary syphilis presents as a painless chancre while secondary syphilis presents with a rash. Diagnosis involves clinical examination as well as serological tests like VDRL and TPHA. Treatment for early syphilis is benzathine penicillin while late or latent syphilis requires 3 doses of benzathine penicillin weekly. Patient follow up is needed at 6 and 12 months to monitor serological response to treatment.

1. Case
A 30 year male
presented with
rash as shown.
How will you
proceed??

2. Syphilis
By:
Dr. Pawan KB Agrawal, MD
Consultant General Practitioner
Bayalpata Hospital, Accham.
15th
November, 2016, Tuesday.

3. Introduction
• venereal infection
• caused by the bacterium Treponema
pallidum
• Transmission: sexual contact, transplacental,
transfusion, and occasionally skin breaks
contact with infectious lesions.
November 15, 2016 3Dr. Pawan KB Agrawal

4. Introduction
• Incubation time : averages 3 weeks but can
range from 10-90 days
• 4 stages:
– primary, secondary, latent, and tertiary
• can be either acquired or congenital.
November 15, 2016 4Dr. Pawan KB Agrawal

5. Presentation
• Primary syphilis:
– Develops within 3-6 weeks
– a painless chancre with punched-out base
and rolled edges
– Regional lymph nodes
– highly infectious
November 15, 2016 5Dr. Pawan KB Agrawal

6. •
November 15, 2016 6Dr. Pawan KB Agrawal

7. Presentation
• Secondary syphilis:
– develops about 4-10 weeks after the
appearance of the primary lesion
– macular, discrete, reddish brown lesions 5
mm or smaller in diameter; however, can be
pustular, annular, or scaling
– Widespread and may involve palms, soles
and oral mucosa.
November 15, 2016 7Dr. Pawan KB Agrawal

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9. •
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10. Presentation
• Secondary syphilis (contd) :
– condylomata lata - painless, highly infectious
gray-white lesions often involving perineum.
– patchy alopecia & may cause loss of eyebrow
• Latent syphilis :
– features of secondary syphilis have resolved,
though patients remain seroreactive.
– 1/3 to tertiary syphilis and rest asyptomatic
November 15, 2016 10Dr. Pawan KB Agrawal

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13. Presentation
• Tertiary syphilis:
– gummatous syphilis, Cardiovascular (80-
85%) and neurosyphilis (5-10%)
– Gummatous syphilis – granulomatous lesions
with necrotic centre; primarily affects liver,
bone and testes.
– Cardiovascular syphilis occurs at least 10
years after primary infection; aneurysm of
ascending aorta.
November 15, 2016 13Dr. Pawan KB Agrawal

14. Presentation
• Tertiary syphilis:
– Neurosyphilis: can be meningovascular ,
tabes dorsalis or general paresis.
– Tabes dorsalis: posterior column and dorsal
roots of spinal cord are damaged.
– General paresis: damage to cortical regions
November 15, 2016 14Dr. Pawan KB Agrawal

15. •
November 15, 2016 15Dr. Pawan KB Agrawal

16. Diagnosis
• Clinical
• Serological
– Non treponemal – VDRL
– Treponemal – TPHA
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17. Diagnosis
• Both non treponemal & treponemal tests are
reactive : active syphilis
• Asymptomatic persons with reactive
nontreponemal and treponemal serologies :
latent syphilis
• Titers of VDRL decline following therapy and
serologic testing usually revert to nonreactive
over time
November 15, 2016 17Dr. Pawan KB Agrawal

18. Diagnosis
• However, some patients may remain
seroactive; but will have low titer (eg, 1:2)
• Newly acquired syphilis then is diagnosed by
four fold or greater rise in titre.
November 15, 2016 18Dr. Pawan KB Agrawal

19. Treatment
• Early syphilis:
– Benzathine penicillin 2.4 mega units as a
single dose
– If allergic; Doxycycline 100 mg bid for 15 days
but in pregnancy erythromycin 500 mg qid for
15 days.
November 15, 2016 19Dr. Pawan KB Agrawal

20. Treatment
• Late syphilis or latent syphilis of unknown
duration:
– 3 doses of benzathine penicillin (2.4 million units
IM) at weekly intervals.
– If allergic; doxycycline for 4 weeks.
November 15, 2016 20Dr. Pawan KB Agrawal

21. Follow up
• Jarisch-Herxheimer reaction : fever with
headache & mayalgia within 24 hrs of
treatment; supportive treatment.
• @ 6 & 12 months.
• A decrease in titre by four fold – effective
treatment.
November 15, 2016 21Dr. Pawan KB Agrawal

22. • THANK YOU>>
THANK YOU.