The correct answer is e) Treponema pallidum. This clinical scenario describes the primary and secondary stages of syphilis. The initial painless penile ulcer (chancre) and inguinal lymphadenopathy are characteristic of primary syphilis. The subsequent widespread rash and mouth ulcers occurring 2 months later are features of secondary syphilis. Treponema pallidum is the causative organism of syphilis.

1. Half An Hour With MRCP
Topic: Syphilis
Dr. Sharif Raihan
MRCP (PACES Candidate)
FCPS (Final part)

2. Syphilis
Spirochaete -Treponema pallidum
Primary, secondary and tertiary stages
Incubation period= 9-90 days.

3. Primary Stage:
Primary lesion or chancre in the genital area.
Dull red macule develops, becomes papular and
then erodes to indurated ulcer (chancre).
Inguinal lymph nodes may become moderately
enlarged, mobile, discrete and rubbery.
Chancre and the lymph nodes are both painless and
non-tender

4. Secondary features:
occurs 1-6 months after primary infection:
Systemic symptoms: fevers, painless generalized
lymphadenopathy
Generalized symmetrical rash on trunk, palms and
soles
Buccal 'snail track' ulcers
Condylomata lata.

5. Snail track ulcer

6. Condylomata lata

7. Tertiary features:
(cardio-syphilis & Neuro-syphilis)
Occurs up to 10-25 years following the original
inoculation.
Gummas
Cardiovascular syphilis: AA Aortic aneurysms,
Aortic regurgitation and Aortitis.
Neurosyphilis:
GPI (General paralysis of the insane): Gradual
onset confusion, Hallucinations, Tremors, Fits,
Cognitive impairment, Hyperreflexia, and Argyll-
Robertson pupils.
TD (Tabes dorsalis) – Ankle reflex absent &
extensor plantar

8. Gumma

9. Features of congenital syphilis:
1) Blunted upper incisor teeth
2) Saddle nose
3) deafness
4) Keratitis
5) Sabre shins

10. Hutchinson teeth & sabre shin

11. Investigation:
Serological tests can be divided into:
Cardiolipin tests (not treponeme specific): VDRL
(Becomes negative after treatment) and RPR.
Treponemal specific antibody tests:
TPHA (Remains positive all the life even after
treatment)
TPHA is positive for both syphilis and Yaws

12. False positive cardiolipin tests (VDRL):
1) Pregnancy
2) SLE, anti-phospholipid syndrome
3) Tb
4) Leprosy
5) Malaria
6) Hiv

13. Management:
Benzyl-penicillin long-acting 2.4 million units single
IM injection.
Alternatives: doxycycline

14. Chancre
1) Treponema pallidum
2) Painless
3) Hard indurated edge
4) Non exudative
5) Heal spontaneously
within 3-6 wks. even
if no ttt.
Chancroid
1) Haemophilus ducreyi
2) Painful
3) Soft, ragged edge
4) Grey or yellow
purulent exudate
5) Need Treatment

15. Chancre Chancroid

16. 1. A 34-year-old man presents with a widespread
maculopapular rash and mouth ulcers. Two
months ago he presented to the local GUM clinic
after developing a painless penile ulcer. At the
time he was noted to have inguinal
lymphadenopathy. Which one of the following
organisms is most likely to be responsible?
• a) Lymphogranuloma venereum
• b) Herpes simplex virus type 2
• c) Mycoplasma genitalium
• d) Haemophilus ducreyi
• e) Treponema pallidum