This document provides information about syphilis, caused by the spiral bacteria Treponema pallidum. It can affect all organs and cause a variety of manifestations. Syphilis is classified as either acquired or congenital. Acquired syphilis progresses through primary, secondary, early latent, and late stages. Primary syphilis causes painless ulcers. Secondary syphilis presents with rashes and mucous membrane lesions. Tertiary syphilis can cause gummas or damage to internal organs. Neurosyphilis can also occur. Congenital syphilis is transmitted from mother to child and can cause early symptoms or late complications if untreated. Diagnosis involves blood and CSF tests. Treatment depends on the

1. SYPHILIS

2. • Infectious disease due to Treponema pallidum
of great chronicity, systemic from the onset
and capable of affecting all organs with florid
manifestations as well as years of latency.

3. TREPONEMA PALLIDUM
• Coiled, slender, regular spiral org.
• 6-15 m in length, 0.25 m width
• 8-24 coils
• Axial bundle & spirally wound filaments
• Movt. of locomotion & change of shape
• Seen by dark ground, phase contrast or
electron microscope or silver impregnation

5. CLASSIFICATION
ACQUIRED SYPHILIS
• EARLY INFECTIOUS- Primary, Secondary,
Recurrent & Early Latent
• LATE NON-INFECTIOUS-
Late latent & Tertiary
• Cardiovascular & Neurosyphilis

6. CLASSIFICATION
• CONGENITAL SYPHILIS
• Early- 1st 2 yrs of life
• Late-2nd year onwards
• Stigmata- Scars & deformities

7. CLINICAL FEATURES
• PRIMARY SYPHILIS
• IP - 10-90d
• Round ,regular,clearly defined ulcer with dull red
clean looking granulation tissue
• Characteristically painless ulcer with indurated
base
• Manipulation produces serous exudate which
contains treponemes

9. • Discrete,painless firm & rubbery LNE
• Often B/L
• 1o stage absent in syphilis d’ emblee
• Males- coronal sulcus, glans, prepuce, ext urinary
meatus, shaft of penis
• Female- labia, fourchette, clitoris or near urethral
orifice
• Diagnosis- DGI

10. SECONDARY SYPHILIS
• Occur 6-8wks after start of primary
• Constitutional symptoms +/-
• Cut lesions- any generalised eruption except
vesicle or bulla; widespread symmetrical
• Types- Macular Papulosquamous
Papular Pustular

12. Mucous membrane lesions-mucous patch,
snail track ulcer, syphilitic laryngitis genital
mucous erosions
Lymphadenitis,
Uveitis & chorioretinitis
Hepatitis
Arthritis, bursitis
Neuro &cardio involvement

13. Condylomata lata

14. Condylomata lata

15. Syphilitic alopecia

16. Syphilitic Ulcer

17. DIAGNOSIS
• DGI
• VDRL- +7-14d after chancre
• FTA-ABS- earliest to be positive
• TPI +ve if >50% immobilised

18. EARLY LATENT SYPHILIS
• No clinical evidence
• But blood tests are +ve
• Infectious
• CSF negative
• Confirm by doing VDRL + TPHA

19. RELAPSE
• CLINICAL-sec. Appearance of lesions like 2o
syphilitis
Chancre redux
• SEROLOGICAL-Blood becomes +ve or rising
titre

20. LATE LATENT SYPHILIS
• After 2nd yr syphilis enters late stage
• No clinical signs/symptoms
• Non-Infectious
• Diag based +ve blood tests
• Examine CSF to R/O neurosyphilis

21. TERTIARY SYPHILIS
 3-10 yrs after primary
 Characteristic lesions are called GUMMA
CUTANEOUS-
Nodular
Squamous or psoriasiform
Subcutaneous gummata

22. Gumma

23. Mucous membrane gumma
• LOCALISED
nasal septum-deformity soft
palate-perforation
pharynx&larynx-deformity&stenosis
• DIFFUSE-tongue
-fissures, leukoplakia, smooth glazed areas

24. Palatal Perforation

25. Destruction of nasal septum

26. Tertiary Syphilis
BONES- 5-20yrs later
• Syphilitic osteomyelitis
• Osteosclerotic-sabre tibia
• Osteolytic-esp skull,nasal septum&hard palate
 worm eaten skull
Cartilage,muscle,joints

27. VISCERA
• Liver-hepar lobatum
• Testes-billiard ball testes
• Stomach,intestine,lung,spleen

28. CARDIOVASCULAR SYPHILIS
SYPHILIS OF GREAT VESSELS
o Uncomplicated aortitis- bruit de tabourka(S2),
Linear calcification of ascending aorta
o Coronary ostial stenosis-angina pectoris
o Aortic regurgitaion d/t dialatation of aortic
ring +/- involvement of cusps

29. • ANEURYSM
o Ascending aorta-m/c; aneurysm of signs
o Arch of aorta- aneurysm of symptoms
o Descending thoracic aorta- aneurysm of no
symptoms and no signs
o Abdominal aorta
o Other sites raraely

30. • Syphilis of heart
Diffuse myocarditis
Gumma of myocardium
• Syphilis of medium sized arteries

31. NEUROSYPHILIS
• Asymptomatic
No neurological signs or symptoms
Changes in CSF
Blood reagin +ve
• Symptomatic

32. Symptomatic Neurosyphilis
• MENINGEALheadache,nausea, vomiting,
stiff neck,cranial nerve palsies, hydrocephalus
• VASCULAR
MCA ,ACA,PCA,basilar, cerebellar
• MENINGOVASCULAR
• GUMMA
• PARENCHYMATOUS- GPI

33. GENERAL PARALYSIS OF INSANE
• Period of onset-insidious,congestive attack or brain
storm
• Period of full development-psychosis. Grandiose /
deteriorated&demented
• Period of decline-dementia
• Dysarthria
• Impairment of handwriting
• Trombone tremor- on protrusion of tongue
• Mild spastic paraplegia

34. SYPHILIS OF SPINAL CORD
• Motor > Sensory tracts
• Meningeal-Dorsolumbar, cervical, syphilitic
amyotrophy
• Vascular-spinal shock-paraplegia in
flexion,loss of pain &temp on opp side
• GUMMA
• PARENCHYMATOUS-TABES DORSALIS

35. TABES DORSALIS
• LIGHTENING PAINS
• ATAXIA
• PARAESTHESIAE
• BOWEL & BLADDER DISTURBANCES
• IMPOTENCE
• CRISES-gastric,rectal,renal,vesical,laryngeal
• VISUAL FAILURE

36. DIAGNOSIS
• CSF study
• VDRL more specific
• TPHA/ FTA-ABS more sensitive but less
specific

37. CONGENITAL SY
• EARLY,LATE& STIGMATA

38. EARLY CONG. SY
• Appear before 2y age, Infectious
• Cutaneous-Bullae/vesicles on palms &soles,supf
desquamation, petechiae, papulosquamous
lesions
• Mucosal-rhinitis/Snuffles, mucous patches
• Bone osteochondritis, osteitis, periostitis
• HSM, Jaundice, LNP
• Anemia, thrombocytopenia, leukocytosis

40. LATE CONG. SY
• After 2y age, Non infectious
• Cardiovascular syphilis
• Interstitial Keratitis
• 8th nerve deafness
• Reccurent arthropathy, Clutton’s joints
• Asymptomatic neurosyphilis

41. STIGMATA
• STIGMATA OF EARLY LESIONS- saddle nose,
bulldog facies, hutchinsons teeth,moons or
mulberry molars, rhagades, pepper and salt
fundus
• STIGMATA OF LATE LESIONS-ghost vessels in
cornea, perforations in nose & palate, frontal
bossing, sabre shin, nerve deafness, optic atrophy

42. TREATMENT
PRIMARY&SECONDARY
INJ. BENZATHINE PENICILLIN 2.4 MILLION
UNITS IM IN SINGLE DOSE
LATENT SYPHILIS, GUMMA
&CARDIOVASCULAR
BENZATHINE PENICILLIN G 2.4 MILLION
UNITS IM 3 DOSES 1 WEEK APART

43. NEURO SYPHILIS
• AQUEOUS CRYSTALLINE PENICILLIN 18-24
MILLION UNITS /DAY
• GIVEN AS
• 3-4 MILLION UNITS IV EVERY 4HOURS OR
• CONTINUOUS INFUSION FOR 10-14 DAYS

44. THANK YOU