syphilis

1. Syphilis
a chronic contagious usually venereal and often congenital disease
caused by Treponema pallidum and if left untreated producing chancres,
rashes, and systemic lesions in a clinical course with three stages
continued over many years.
Epidemiology
Each year, there are an estimated 6 million new cases of syphilis
globally in persons aged 15 to 49 years
(National library of medicine, Feb 19, 2018)
Cause
Treponema pallidum
Incubation period: 9-90 days
Mode of transmission
• Syphilis is transmitted from person to person by direct contact with a
syphilitic sore, known as a chancre.
• Chancres can occur on or around the external genitals, in the vagina,
around the anus, or in the rectum, or in or around the mouth.
• Transmission of syphilis can occur during vaginal, anal, or oral sex.
• In addition, pregnant women with syphilis can transmit the infection
to their unborn child.

2. Clinical features
Asymptomatic for years
1. Primary stage
➢ Painless sores appear at the site of infection (mouth, nipples,
fourchette, anus, rectum, vagina, or penis). These are called
chancres.
➢ Chancre is usually firm, round, small and painless
➢ The sores heal on their own after 3 to 6 weeks, but you can still
spread syphilis.
➢ It’s easily treated and cured with medicine.
➢ Inguinal glands are enlarged, discrete and painless
2. Secondary syphilis
➢ Appears Within 6 weeks to 6 months after the onset of primary
chancre
➢ Evidenced in the vulva in the form of condyloma lata
➢ They are coarse, flat-topped, moist, necrotic lesions and teeming
with treponemes
➢ Skin rashes (rough,red or reddish brown spots both on palms and
bottom of feet)
➢ Fever
➢ Swollen lymph nodes
➢ Sore throat
➢ Patchy hair loss
➢ Headaches
➢ Weight loss
➢ Muscle aches
➢ Fatigue
➢ Without treatment the infection will progress to the latent and late
stage
3. Late and latent stage
➢ Also known as tertiary syphilis
➢ Can last for 2 to 20 years

3. ➢ Damages the internal organs, including brain, nerves,eyes,
heart,blood vessels,liver, bones and joints so it is also a systemic
stage of the disease
➢ Cranial nerve palsies (III, VI, VII and VIII)
➢ hemiplegia,
➢ tabes dorsalis,
➢ aortic aneurysms,
➢ Gummas of skin and bones
➢ Endarteries and periarteries of small and medium sized vessels
➢ Infection of brain (stroke, mental confusion, meningitis,
neurosyphilis,ocular syphilis)
Symptoms of neurosyphilis include
• severe headache;
• difficulty coordinating muscle movements;
• paralysis (not able to move certain parts of your body);
• numbness; and
• dementia (mental disorder).
➢ Symptoms of ocular syphilis include changes in your vision and
even blindness.
➢ Also, may cause death
4. Congenital syphilis
➢ Miscarriage (losing the baby during pregnancy),
➢ Stillbirth (a baby born dead),
➢ Prematurity (a baby born early),
➢ Low birth weight, or
➢ Death shortly after birth.
For babies born with CS, CS can cause:
• Deformed bones,
• Severe anemia (low blood count),
• Enlarged liver and spleen,

4. • Jaundice (yellowing of the skin or eyes),
• Brain and nerve problems, like blindness or deafness,
• Meningitis, and
• Skin rashes.
Syphilis and HIV
➢ There is an estimated 2- to 5-fold increased risk of acquiring HIV
if exposed to that infection when syphilis is present
➢ Chancres caused by syphilis make it easier to transmit and acquire
HIV
Diagnosis
I. History taking
• Present history: sign and symptoms like rashes, chancre, genital
ulcers
• Sexual history: number of sexual partners, duration of sexual
relationship
• 5 p’s (partners, practices, prevention from pregnancy, protection
from STDs and past history of STDs)
• Exposure to infected person
II. Examination
• Bimanual examination
Inspection of vagina, cervix, anus
Cervical inspection through speculum to check edema,
ectopy, friability
Per vaginal examination to check the discharge, soreness,
edema
Palpation of abdomen (rebound tenderness)
Palpation of lymph nodes
III. Serological test
i. dark field tests: to detect T. pallidum directly from lesion exudate or
tissue are the definitive methods for diagnosing early syphilis
ii. VDRL:

5. • It measures substances (proteins), called antibodies, which your
body may produce if you have come in contact with the bacteria
that cause syphilis
• Is positive after 6 weeks of initial infection
iii. The specific test include
a. a treponemal test (i.e., fluorescent treponemal antibody absorbed
[FTA-ABS] tests
• is a blood test that checks for the presence of antibodies to
Treponema pallidum bacteria. These bacteria cause syphilis
b. various enzyme immunoassays [EIAs],
• An enzyme-linked immunosorbent assay, also called ELISA
or EIA, is a test that detects and measures antibodies in
your blood.
c. Treponema pallidum hemoagglutination (TPHA)
• helps in the detection of Palladium antibodies via the
hemagglutination method
d. Treponema pallidum immobilization (TPI)
• a serological test for syphilis in which a solution containing the
living causative spirochete (Treponema pallidum) is combined
with serum in the presence of complement with immobilization
of the active spirochetes indicating a positive result
iv. Currently immunoblotting and PCR tests are evaluated as more
sensitive and confirmatory test
Treatment
Recommended Regimens for Adults*
Primary and Secondary Syphilis
Recommended Regimen for Adults
• Benzathine penicillin G 2.4 million units IM in a single dose
Early Latent Syphilis

6. • Benzathine penicillin G 2.4 million units IM in a single dose
Late Latent Syphilis or Latent Syphilis of Unknown Duration
• Benzathine penicillin G 7.2 million units total, administered as 3
doses of 2.4 million units IM each at 1-week intervals
Recommended Regimens for Infants and Children
Primary and secondary syphilis
Recommended Regimen for Infants and Children
• Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of
2.4 million units in a single dose
Early Latent Syphilis
• Benzathine penicillin G 50,000 units/kg IM, up to the adult dose
of 2.4 million units in a single dose
Late Latent Syphilis
• Benzathine penicillin G 50,000 units/kg IM, up to the adult dose
of 2.4 million units, administered as 3 doses at 1-week intervals
(total 150,000 units/kg up to the adult total dose of 7.2 million
units)
Complications
• greater risk of HIV infection because of the existence of open
sores.
• An infected mother may pass the infection to her unborn baby
during pregnancy, causing birth defects such as mental retardation

7. or seizures, and is also at higher risk of miscarriage, stillbirth and
premature birth.
• Damage to skin and bones
• Neurosyphilis
• occulosyphilis