This document provides an overview of syphilis, including: 1. Syphilis is caused by the spirochete Treponema pallidum, usually transmitted sexually or congenitally. It progresses through primary, secondary, latent, and tertiary stages. 2. Primary syphilis presents with a chancre at the site of infection that spreads locally and to lymph nodes. Secondary syphilis causes a rash, mucocutaneous lesions, and lymphadenopathy. 3. Syphilis can cause serious complications if left untreated, including damage to internal organs, the cardiovascular system, and the central nervous system. Ayurvedic management includes herbs, minerals, and formulations to

1. (Syphilis)
Prof Sriram Chandra Mishra
Kayachikitsa Department
VYDS Ayurved Mahavidyalaya,

2. • First described by Bhava Mishra in16th century (B.P. M. 59)
PARIBHASA (Definition)
• फिरङ्गसंज्ञक
े देशे बाहुल्येनैव यद्भवेत् ।
तस्मात्फिरङ्ग इफयुक्तो व्याधिव्यााधिववशारदैैः ॥ (भा.प्र. मध्यखण्ड 59/1)
फिरङ्ग नामक देश में यह रोग अधिकता से पाया जाता है, इसलिये इस रोग को
फिरंग रोग कहा जाता है ।
PARYAYA (Synonym)- गन्िरोगैः

3. SAMPRAPTI (Pathogenesis)
गन्िरोगैः फिरङ्गोऽयं जायते देहहनां ध्रुवम ् ।
फिरङ्धगणोऽङ्गसंसगाात्फिरङ्धगण्यैः प्रसङ्गतैः ॥
व्याधिरागन्तुजो ह्येष दोषाणामत्र सङ्रमैः ।
भवेत्तं लक्षयेत्तेषां लक्षणैर्भाषजां वरैः ॥ (भा.प्र. मध्यखण्ड 59/2-3)
• फिरंग रोग फिरङ्ग देश क
े मनुष्यों क
े अङ्ग संसगग तथा फिरंङ्ग देश की
युवततयों क
े साथ प्रसङ्ग करने से उत्पन्न होता है ।
• यह रोग आगन्तुक व्याधि है । जजसक
े क
ु छ समय पश्चात् वातादद तीनों
दोषों का प्रकोप होता है ।

4. सम्प्प्रात्तत चर

5. सम्प्प्रात्तत घटक
• दोष - कि प्रिान त्रिदोष
• दृष्य - रक्त, िसीका, मांस, मेद, अजथथ
• स्रोतस ्- शुक्रवह स्रोतस ् (प्रजनन संथथान )
• स्रोतोदुजष्ि िक्षण - लसराग्रजन्थ
• अधिष्ठान - जननेजन्िय व समथत शरीर
• संचार मागग - रसायनी द्वारा सवगशरीर

6. BHEDA (Types)
'फिरंगत्स्त्रवविो ज्ञेयो बाह्य आभ्यन्तरस्तथा ।
बहहरन्तभावश्चावि तेषां लिंगातन च ब्रुवे । (भा.प्र. मध्यखण्ड 59/4)
1. बाह्य
2. आभ्यंतर
3. बाह्याभ्यंतर
वाथतव में देखा जाय तो यह तीन प्रकार न होकर तीन अवथथा हैं ऐसा मानना
संयुजक्तक होगा । क्योंफक बाह्य फिरंग यही कािांतर से उपेक्षा से अभ्यंतर फिरंग
में रूपांतररत होता है ।

7. LAKSHANA (Symptoms)
तत्र बाह्यफिरंग: स्याद्ववस्िोटसदृशोऽल्िरुक् ।।
स्ि
ु हटतो व्रणवद्वेद्यैः सुखसाध्योऽवि स स्मृतैः ।
सत्न्िष्वाभ्यन्तरैः स स्यादामवात इव व्यथाम ् ।
शोथश्च जनयेदेष कष्टसाध्यो बुिैैः स्मृतैः ।। (भा.प्र. मध्यखण्ड 59/5-6)
1. बाह्य फिरंग- इसमें ववथिोि क
े समान िोडे तनकिते हैं, जजसमें पीडा कम
होती है व ि
ू िने पर व्रण क
े समान होता है । यह सुखसाध्य होता है ।
2. आभ्यन्तर फिरंग- यह फिरंग सजन्िगत होता है । इसमें आमवात रोग क
े
समान पीडा व शोथ होता है । यह - कष्िसाध्य होता है ।
3. बहहरान्तगात फिरंग- यह फिरंग बाह्य व आभ्यन्तर दोनों थथानों पर होता है ।

9. UPADRAVA (Complications)
काशं बलक्षयो नासाभङ्गो वह्नेश्च मन्दता ।
अत्स्थशोषोऽत्स्थवरफवं फिरङ्गोिद्रवा अमी ॥ (भा.प्र. मध्य खण्ड 59/7)
• कृ शता (Lean and thin body)
• बिक्षय (Loss of Immunity / physical strength)
• नासाभङ्ग (Depressed nose)
• अजननमांद्य (Reduced GI biofire)
• अजथथशोष (Loss of bony tissues)
• अजथथ वक्रता (Bowing of large bones)

10. साध्यासाध्यता (Prognosis)
बहहभावो भवेफसाध्यो नवीनो ननरुिद्रवैः ।
आभ्यन्तरस्तु कष्टेन साध्यैः स्यादयमामयैः ॥
बहहरन्तभावो जीणाैः क्षीणस्योिद्रवैयुातैः ।
व्याततो व्याधिरसाध्योऽयर्मफयाहुमुानयैः िुरा ॥ (भा.प्र. मध्य खण्ड 59 / 8-9)
• बाह्य फिरंग यो नवीन तथा उपिव रदहत हे, व साध्य है ।
• आभ्यन्तर प्रकार का फिरंग कष्िसाध्य होता है ।
• बाह्य व आभ्यन्तर दोनों प्रकार (उभय लमधित), पुराना, दुबगिक्षीण रोगी में
तथा उपिवों से युक्त सवगशरीरगत फिरंग रोग असाध्य होता है ।

11. समान्य धचफकफसा सूत्र (Treatment principle)
• संशोिन कराना िाभप्रद रहता है ।
• रक्तमोक्षण, लसराव्यि एवं जिौकावचारण करना चादहए । (Ex - Ahyantara )
• रक्तशोिक औषि िव्यों का प्रयोग करना चादहए ।
(Ex - Sariba, Manjistha, Haridra, Nimba,
Gandhaka )
• व्रण का थथातनक उपचार यथा - प्रक्षािन, िेपन, शोिन, रोपण एवं िूपन
करना चादहए । (Ex - BAHYA VRANA – Kajjali malahara)

12. Ayurvedic Management
• Rasa / Bhasma – Samirapannaga Rasa, Gandhaka
Rasayan, Vanga Bhasma, Rasamanikya, Rasakarpoora,
Vyadhiharan Rasayan, Mallasindoor, Somala (Arsenic
Trioxide), Suvarnaraja Vangeswar,
• Vati – Raktasodhak Vati, Arogyavardhini Vati, Malladi Vati,
Sukshma Triphala, Chopachini Guggulu
• Churna – Chopachini Churna, Nimbadi Churna,
Panchanimba Churna, Nimbaharidra Churna
• Kvatha – Patoladi Kvatha, Majisthadi Kvatha,
Mahamanjisthadi Kvatha

13. लम.ग्रा.

14. Syphilis
Definition
Syphilis is an highly infectious disease caused by
Treponema pallidum (a spirochete), usually transmitted
sexually or in utero, marked initially by local formation of
chancres, then progressing to bacteremia and
widespread organ damage.
• Chancres =SHANG-kur
• Spirochete = Spahy-ruh-keet – Free
living gram-negative bacteria. Long,
helically coiled cells

15. • Etiologic agent - Treponema pallidum
• Incubation period – One week to 3 months
• Penetration:
 T. pallidum enters the body through abrasions in skin
and mucous membranes during sexual contact.
 Also transmitted transplacentally, or by Kissing,
Blood Transfusion, Percutaneous injury etc.
• Dissemination (spread)
 Travels via the lymphatic system to regional lymph
nodes and then throughout the body via the blood
stream
 Invasion of the CNS can occur during any stage of

16. • Disease progresses in stages
 Acquired (through sex or blood transfusion)
 Primary
 Secondary
 Latent - Early latent, Late latent
 Tertiary - Gummatous, Neurological,
Cardiovascular
 Congenital (transmitted from mother to child in
utero)
• Early syphilis
• Primary
• Secondary
• Early latent stages
• Late syphilis
• Late latent syphilis
• Gummatous
• Neurological
• Cardiovascular
syphilis
Most contagious to sex partners during the primary and
secondary stages

17. Clinical Manifestations

18. Primary Syphilis
 Chancre:
• Primary lesion (Chancre) develops at the site of inoculation
 Progresses from macule to papule to ulcer
 Typically painless, indurated and has a clean base
(differ from soft Chanchoid, extremely painful with surrounding
erythema, erodes margins)
• Highly infectious
• Heals spontaneously within 1 to 6 weeks
• 25% present with multiple lesions
 Regional lymphadenopathy
• Classically rubbery, painless, bilateral
Serologic tests for syphilis may not be positive during early

19. clean base
Primary Syphilis - Penile Chancre

20. Primary Syphilis – Labial Chancre

21. Perianal Chancre
Chancre in tongue
Chancre below lip
Primary Syphilis

22. Secondary Syphilis
 Secondary lesions occur 3 to 6 weeks after the primary chancre
appears
 May persist for weeks to months.
• Skin Rash (75%-100%)
• Lymphadenopathy (50%-86%)
• Mucocutaneous lesions (6%-30%)
• Condylomata lata (10%-20%)
(knob-like / wart like lesions on the genitals)
• Alopecia (5%)
• Malaise
Serologic tests are usually highest in titer during

23. Papulosquamous
(both papules and scales
Palmar/Plantar Rash
Secondary
Syphilis
Skin Rash

24. Secondary Syphilis
Generalized Body Rash

25. Secondary Syphilis
Lymphadenopathy

26. Secondary Syphilis
Nickel/Dime Lesions
(Maculopapular lesions seen at the mucocutaneous borders at the mouth
and and nasolabial folds)

27. Secondary Syphilis
Condylomata lata
(knob-like / wart like lesions on the genitals)

28. Secondary Syphilis
Alopecia

29. Latent Syphilis
• Hidden Stage - Latent syphilis has no clinical manifestations as
host suppresses the infection enough, only evidence is positive
serologic test for syphilis.
• Sign & Symptoms may never return or the disease may progress
to the tertiary stage.
• Two phases –
• Early latent syphilis - Infection of less than two years duration.
• Late latent syphilis - Infection of more than two years duration
without clinical evidence of treponemal infection.
Early stages are more infectious but respond better to
treatment

30. Tertiary (Late) Syphilis
• Approximately 15-30% of untreated patients progress to the
tertiary stage within 1 to 20 years.
• Disease may damage the brain, heart, blood vessels, liver, bones
and joints.
• Manifestations
 Gummatous lesions (characteristic tissue nodule)
 Cardiovascular syphilis
 Neuro syphilis
• Rare because of the widespread availability and use of antibiotics

31. Gummata of Forearm
Gummatous lesions
(Soft, tumor-like balls of inflammation which may vary considerably
in size. They typically affect the skin, bone and liver but can occur
anywhere)

32. Ulcerating Gumma

33. Silver stain, 950x
Neurosyphilis
• Early neurosyphilis manifestations include acute syphilitic
meningitis, meningovascular syphilis, ocular involvement.
• Late neurosyphilis manifestations include general paresis, tabes
dorsalis (degeneration of nerves of the dorsal column), ocular
involvement

34. Cardiovascular syphilis
Cardiovascular syphilis usually occurs 10–30 years after the initial
infection. The most common complication is syphilitic aortitis, which
may result in aneurysm formation.

35. Congenital Syphilis
• Congenital syphilis
 Early phase - First two years of life
 Late phase - Becomes apparent later in life
• Babies born to women who have syphilis can become infected
through the placenta or during birth. (T. pallidum transmitted from
a pregnant woman with syphilis to her fetus)
• May lead to stillbirth, neonatal death, and infant disorders such as
deafness, neurologic impairment and bone deformities.
• Transmission to the fetus in pregnancy can occur during any
stage of syphilis; risk is much higher during primary and
secondary syphilis
• Fetal infection can occur during any trimester of pregnancy

36. The common pattern of presentation
for congenital syphilis consists of three
phenomena
Hutchinson's triad
1. Interstitial keratitis (corneal scarring)
2. Hutchinson incisors/teeth
3. Eighth nerve deafness

37. • Interstitial means space between cells i.e. corneal stroma which lies between
the epithelium and the endothelium.
• Keratitis means corneal inflammation.
• Interstitial keratitis (IK) is corneal scarring due to chronic inflammation of
the corneal stroma.
• Early symptoms include a painful, photophobic, red watery eye.
• Complicated to corneal opacification, chronic edema, astigmatism, amyloid
degeneration, and calcific band keratopathy.
Congenital Syphilis
Interstitial keratitis

38. Teeth that are smaller and more widely spaced than normal and which have
notches on their biting surfaces.
Congenital Syphilis
Hutchinson’s Teeth

39. Congenital Syphilis
Eighth nerve deafness

40. Congenital Syphilis
Mucous Patches

41. Congenital Syphilis
Perforation of Palate

42. Laboratory Findings
Identification of Treponema pallidum in lesions
 Dark-field microscopy
 Direct fluorescent antibody - T. pallidum (DFA-TP)
Serologic tests (blood/ swab test)
 Nontreponemal tests (qualitative and quantitative) - include
the VDRL slide test, the rapid plasma reagin (RPR) card test,
the unheated serum reagin (USR) test and the toluidine red unheated
serum test (TRUST).
 Treponemal tests (qualitative) – Include the Treponema pallidum
particle agglutination (TP-PA), fluorescent treponemal antibody-
absorbed (FTA-ABS), Treponemal antigen-based enzyme
immunoassay (EIA) for IgG & IgM.
Examination of the CSF
Highly desirable in all patients with syphilis of more than two years’

43. Treponema pallidum
Electron photomicrograph, 36,000 x.

44. Treponema pallidum
on darkfield microscopy

45. 45
Management

46. Primary, Secondary or Early latent syphilis
• A single IM dose of Benzathine Penicillin G (2.4 million units)
(Benzathine benzyl penicillin 2.4 million IU) OR
• Procaine penicillin G daily IM for 10 consecutive days.
(Procaine benzyl penicillin 1.2 million IU)
OR
• Inj Ceftriaxone (as effective as penicillin-based treatment)
• + Tab Azithromycin - 1 g orally as a single dose
(Azithromycin has the advantage of being effective agains C.
trachomatis, H. Ducreyi and the Gonococcus)
OR
• Tab Erythromycin - 500 mg orally, 4 times daily for 14 days
(Penicillin-allergic pregnant patients)

47. Jarisch-Herxheimer reaction
• It is an acute febrile reaction frequently
accompanied by headache, myalgia, fever, and
other symptoms that can occur within the first 24
hours after the initiation of any therapy for
syphilis.
• It is a Self-limited reaction to anti-treponemal
therapy.
• It is caused by cytokines released by the immune
system in response to lipoproteins released from
rupturing syphilis bacteria.
• Antipyretics can be used to manage symptoms.

48. Late latent syphilis (Tertiary Syphilis)
(infection of more than two years’ duration without evidence of treponemal
infection)
• Benzathine benzyl penicillin, 2.4 million IU by
intramuscular injection, once weekly for 3 consecutive
weeks. (Total Benzathine penicillin G 7.2 million units)
• If a person is allergic, ceftriaxone at least for a longer
duration.
• All persons who have tertiary syphilis should be tested for
HIV infection and should receive a CSF examination before
therapy is initiated.

49. Neurosyphilis and Ocular Syphilis
• Large doses of intravenous penicillin for a minimum of
10 days (due to the poor penetration of penicillin G into
the central nervous system)
• Example
 Aqueous crystalline penicillin G 18–24 million units per day,
administered as 3–4 million units IV every 4 hours or continuous
infusion, for 10–14 days
Alternative Regimen
 Procaine penicillin G 2.4 million units IM once daily
PLUS
 Probenecid 500 mg orally four times a day, both for 10–14 days

50. CONGENITAL SYPHILIS
• All infants of seropositive mothers should be examined at birth and
at monthly intervals for three months until it is confirmed that
serological tests are, and remain, negative.
• All infants born to seropositive mothers should be treated with a
single intramuscular dose of benzathine benzylpenicillin, 50000
IU/kg whether or not the mothers were treated during pregnancy
(with or without penicillin).

51. Early congenital syphilis (up to 2 years of age) AND Infants with
abnormal CSF
• Aqueous benzyl penicillin 50000 IU/kg/dose IV BD during the first 7
days of life and then QID for a total of 10 days.(TOTAL - 100000–
150000 IU/kg/day ) OR
• Procaine benzyl penicillin, 50000 IU/kg IM, as a single daily dose for
10 days.
Late congenital syphilis (2 or more years)
• Aqueous benzylpenicillin 50000 IU/kg/dose IV / IM every 4–6 hours
for 10–14 days. (TOTAL – 200000–30000 IU/kg/day )
Alternative regimen for penicillin-allergic patients
After the first month of life
• Erythromycin, 7.5–12.5 mg/kg orally, 4 times daily for 30 days.

52. Therapy for Syphilis in Pregnancy
• Treat with Penicillin according to stage of infection.
• Patients who are skin-test-reactive to penicillin should
be desensitized in the hospital and treated with
penicillin.
 Inj Ceftriaxone may used in allergy cases to
penicillin
 Erythromycin, 500 mg orally, 4 times daily for 30
days
 Doxycycline, 200 mg orally, twice daily for 30 days.

53. FOLLOW UP
• Primary or secondary syphilis - Re-examine at 3, 6 and 12 months
• Latent syphilis - Re-examine at 6, 12, 18, and 24 months
• Neurosyphilis
 Serologic testing as above
 Repeat CSF examination at 6-month intervals until normal
• All patients with cardiovascular syphilis and neurosyphilis should
be monitored for many years.
• At all stages of the disease, repeat treatment should be
considered when:
 Clinical signs or symptoms of active syphilis persist or recur;
 There is confirmed increase in the titre of a non-treponemal

54. Treatment Failure
• Indications of probable treatment failure or
reinfection include:
 Persistent or recurring clinical signs or symptoms
 Sustained 4-fold increase in titer
 Titer fails to show a 4-fold decrease within 6 months
• Retreat and re-evaluate for HIV infection
• Some specialists recommend CSF examination

55. 55
Management of Sex Partners
• For sex partners of patients with syphilis in any stage:
 Draw syphilis serology
 Perform physical exam
• For sex partners of patients with primary, secondary, or early
latent syphilis
 Treat presumptively as for early syphilis at the time of
examination, unless:
 The nontreponemal test result is known and negative AND
 The last sexual contact with the patient is > 90 days prior
to examination.

56. THANK U