This document discusses syphilis, a sexually transmitted disease caused by the spirochete Treponema pallidum. It provides details on the classification, signs and symptoms, diagnosis, and treatment of syphilis. Key points include that syphilis presents in primary, secondary, latent, and tertiary stages, and can cause ocular manifestations such as uveitis. Diagnosis involves serological tests like VDRL and FTA-ABS. Treatment depends on the stage of syphilis and may include penicillin or doxycycline. Congenital syphilis is also discussed.

1. Bipin Bista
Resident
Ophthalmology
National medical College
& Teaching Hospital

2. Well known over a century.
Syphilis remains an important cause of
blindness & is diagnosed with increasing
frequency.

3. Helically coiled cells.
3 groups :
Treponema : Syphilis
Borrelia : Relapsing fever & Lyme disease
Leptospira : Leptospirosis

4.  Syphilis : called as
great pox, acquired its
name from great
Veronese poet &
physician Giralamo
Fracastoro – great
imitator.
 1905- Schauldin &
Hoffman : isolated
spirochete from skin
lesion.

5. Spirochete
0.01-0.02 micrometer long.
Transmitted by sexual contact.
Most infectious with primary syphilis
Less infectious with secondary & tertiary.
Incubation period : 10 to 90 days.

6.  Primary
 Secondary
 Latent
 Tertiary

7. Chancre – 4 weeks after infection & heals
in 1-2 months in untreated individuals.
Erythematous papule which later erodes
Genitals
Eyelids & conjunctiva.

8. 4-10 weeks
Disseminates
90% skin involvement
Flexor & volar surfaces
Resolves without scarring
Condylomata lata
Fever, malaise, headache, nausea,
anorexia, joint pain.
Syphilitic infiltration : Anterior Uveitis

9. In the first year of infection, may have
recurrences – early latent.
After an year – latent. Relapses are rare.
30 % experience tertiary syphilis.

10. Benign tertiary
Cardiovascular syphilis
Neurosyphilis

11. Gumma : chronic granulomatous lesion

12. Aortitis
Aortic aneurysms
Aortic valvular insufficiency
Narrowing of coronary ostia
5-10 years after infection
Not evident till 20 years.

13.  5-10 %
 Positive VDRL in CSF.
 Uveitis & hearing loss –
early
 U/l or B/l cranial nerve
palsies
 Headache,neck stiffness,
dizziness, lassitude &
blurred vision.
 Argyll Robertson pupil
commonly seen in
meningovascular syphilis.
 Parenchymatous
neurosyphilis : prog. Loss
of vision.
 Altered mental status
 Irritability
 Poor judgement
 Confusion delusion.
 CSF is hypercellular &
has a positive VDRL .
 Tabes dorsalis
 Charcot’s arthropathy

14.  Transplacental.
 Preventable.
 Signs & symptoms
usually comes after
several days of birth.
 Rash, snuffles,
jaundice,
Hepatosplenomegaly,
Anorexia,&
Pseudoparalysis.
 Osteochondritis (90%)
 Chorioretinitis
 Diagnosis : FTA-ABS.
 Late C S : after 2 years.
 CVS
 Meningovascular
syphilis with
neurological
manifestation
 8th nerve palsy.
 Acute syphilitic
meningitis, Gen. paresis
& Tabes dorsalis.
 Hutchinson teeth

15. Chancres of eyelid & conjunctiva.
Primary syphilitic in lacrimal gland (rare)
Eyelids – secondary syphilis – rash,
blepharitis, madarosis.
Conjunctivitis mimicking trachoma, but
dacrocystitis & dacroadenitis is rare.
Keratitis, iris nodules, iridocyclitis,
episcleritis & scleritis.
Chorioretinitis & vitritis.
Pigmentary retinopathy

17. Gummas – tertiary syphilis- destructive
ulceration.
Diffuse bilateral periostitis.
Tertiary – uniocular interstital keratitis
Punctate stromal keratitis with iritis.
Uveitis
Episcleritis & scleritis.
Chorioretinitis, vasculitis, occlusive
disease, RD, macular edema,
neuroretinitis, vasculitis, pseudoretinitis

19. Based on clinical history, physical
examination, and laboratory tests.
Serological tests.
Darkfield microscopy- expertise
VDRL test and RPR test. (Most Useful)
VDRL : 1-2 weeks

20. T. pallidum agglutination tests (TPHA)
Microhemagglutination T. pallidum (MHA-
TP)
Fluorescent treponemal antibody
absorption (FTA-ABS)

21. FTA-ABS is more sensitive than VDRL .
False positive results are seen in SLE,
Biliary cirrhosis, RA.
Immediate diagnosis requires Dark Field
Microscopy
VDRL test is excellent screening test for
later primary syphilis & secondary syphilis.
Infants with congenital syphilis have
positive VDRL & FTA-ABS & CSF
examination.

22. Primary & Secondary
Syphilis
Latent & tertiary ,
Including
Neurosyphilis
Congenital Syphilis
Procaine penicillin , 2.4
million units IM daily &
Probenecid 1 gm po QD
for 14 days or
Benzathine penicillin G,
2.4 million units IM in a
single dose
In case of allergy,
Doxycycline 200 mg BD
or Tetracycline 500 mg
QID for 15 days.
Aqueous crystalline
penicillin G, 3-4 million
units IV q 4h x 10-14
days or benzathine
penicillin G, 2.4 million
units IM weekly for 3
days.
Procaine penicillin ,
50,000 units/kg/day IM x
10 days, or aqueous
crystalline penicillin G,
50,000 units/kg/day IV in
two divided doses x 10
days.

23. Jarisch-Herxheimer reaction.

24. Reference:
- Nussenblatt and
whitecup 4th edition
- Myron yanoff 4th
edition