Syphilis is caused by the bacterium Treponema pallidum and is transmitted sexually, from mother to fetus, or rarely through other means. It progresses through primary, secondary, latent, and tertiary stages if left untreated. Primary syphilis presents as a painless chancre at the infection site while secondary syphilis causes a rash, fever, and mucous patches. Latent syphilis involves positive blood tests without symptoms. Tertiary syphilis can damage internal organs. Treatment involves penicillin or alternatives like doxycycline for non-pregnant patients and higher dose penicillin for pregnant patients and congenital cases.

1. SYPHILIS
MUNIVENKATESH PARAMASIVAM
GROUP : 02

2. SYPHILIS
INTRODUCTION
• Caused by Treponema pallidum.
• Transmission: sexual; maternal-fetal, and
rarely by other means.
• Primary and secondary syphilis in the US
dropped by ~ 90 %t from 1990 to 2000, the
number of cases have gone up since then.
• A dramatic increase in cases in men from 2000
to 2002 reflected syphilis in MSM.
• Syphilis increases the risk of both transmitting
and getting infected with HIV.
• Do HIV testing in all patients with syphilis.

3. STAGES OF SYPHILIS
1. Primary
2. Secondary
3. Latent
• Early latent
• Late latent
1. Late or tertiary
• May involve any organ, but main parts are:
– Neurosyphilis
– Cardiovascular syphilis
– Late benign (gumma)

4. PRIMARY SYPHILIS
(The Chancre)
 Incubation period 9-90 days, usually ~21 days.
 Develops at site of contact/inoculation.
 Classically: single, painless, clean-based, indurated ulcer, with
firm, raised borders. Atypical presentations may occur.
 Mostly anogenital, but may occur at any site (tongue,
pharynx, lips, fingers, nipples, etc...)
 Non-tender regional adenopathy
 Very infectious.
 May be darkfield positive but serologically negative.
 Untreated, heals in several weeks, leaving a faint scar.

5. Chancre

6. Oral chancres in primary syphilis

7. SECONDARY SYPHILIS
• Seen 6 wks to 6 mos after primary chancre
• Usually diffuse non-pruritic, indurated rash, including palms &
soles.
• May also cause:
– Fever, malaise, headache, sore throat, myalgia,
arthralgia, generalized lymphadenopathy
– Hepatitis (10%)
– Renal: an immune complex type of nephropathy
with transient nephrotic syndrome
– Iritis or an anterior uveitis
– Bone: periostitis
– CSF pleocytosis in 10 - 30% (but, symptomatic
meningitis is seen in <1%)

8. SECONDARY SYPHILIS
(Cont.)
 The skin rash:
Diffuse,
often with a superficial scale (papulosquamous).
May leave residual pigmentation or depigmentation.
 Condylomata Lata:
Formed by coalescence of large, pale, flat-topped papules.
Occur in warm, moist areas such as the perineum.
Highly infectious.
 Mucosal lesions:
~ 30% of secondary syphilis patients develop mucous patch (slightly
raised, oval area covered by a grayish white membrane, with a pink
base that does not bleed).
Highly infectious

10. Condylomata lata

11. LATENT SYPHILIS
Positive syphilis serology without clinical signs of
syphilis (& has normal CSF).
– It begins with the end of secondary syphilis and
may last for a lifetime.
– Pt may or may not have a h/o primary or
secondary syphilis.
– Diseases known to cause occasional false-positive
nontreponemal test reactions for syphilis, such as
systemic lupus erythematosus (SLE), and
congenital syphilis must be excluded before the
diagnosis of latent syphilis can be made.
• Is divided into early and late latency.

12. LATENT SYPHILIS (cont.)
1. Early latent:
 The first year after the resolution of primary or
secondary lesions, or
 A reactive serologic test for syphilis in an
asymptomatic individual who has had a negative
serologic test within the preceding year.
 Infectious.
1. Late latent:
 Usually not infectious, except for the pregnant
woman, who may transmit infection to her fetus.

13. LATE SYPHILIS
‘Tertiary Syphilis’
• Is the destructive stage of the disease.
• Lesions develop in skin, bone, & visceral organs (any organ).
• The main types are:
– Late benign (gummatous)
– Cardiovascular &
– Neurosyphilis
• Can be crippling and life threatening
• Blindness, deafness, deformity, lack of coordination, paralysis, dementia
may occur
• It is usually very slowly progressive, barring certain neurologic syndromes
which may develop suddenly due to endarteritis and thrombosis in the CNS
• Late syphilis is noninfectious.

14. LATE BENIGN SYPHILIS
(THE GUMMA)
• The gumma was the most common complication of late syphilis.
• Gummas may be single or multiple. Start as a superficial nodule or as a deeper lesion
that breaks down to form punched-out ulcers. They are ordinarily indolent, slowly
progressive, and indurated granulomata, with central healing with an atrophic scar
surrounded by hyperpigmented borders.
• May be destructive, but responds rapidly to treatment, thus, is relatively benign.

15. TESTS FOR SYPHILIS
• Dark field Microscopy
• VDRL, RPR
• FTA-ABS, MHA-TP
• Direct Fluorescent Antibody (DFA)

16. Primary, Secondary, Early Latent
Syphilis
Recommended regimen
-Benzathine Penicillin G, 2.4 million units IM
Penicillin Allergy*
-Doxycycline 100 mg twice daily x 14 days
or
-Ceftriaxone 1 gm IM/IV daily x 8-10 days (limited studies)
or
-Azithromycin 2 gm single oral dose (preliminary data)
*

17. Congenital Syphilis
 Congenital syphilis is transmitted in utero after the first 16 weeks of
pregnancy, therefore it is usually not a cause of abortion during the first
trimester.
 The infected child born later in a family usually has less severe syphilis.
 Again, it has been divided according to the arbitrary dividing line of two
years into early and late types.
 Early Congenital
 The features are similar to secondary syphilis. Usually it occurs 2-8 weeks
after birth, presenting with failure to thrive, muco-cutaneous lesions
(condylomata lata), generalized lymphadenopathy, nasal snuffles and
skin rash.
 Late Congenital
 The onset usually occurs at or near puberty. Well-known stigmata include
nerve deafness, interstitial keratitis, Hutchison's teeth (Hutchison's triad),
rhagades around mouth, clutton's joint, osteitis & chondritis (saddle nose,
frontal bossing, sabre tibia) and perforated palate.

18. CONGENITAL SYPHILIS
• The permanent dentition may show characteristic abnormalities
known as Hutchinson's teeth; the upper central incisors are widely
spaced, centrally notched, and tapered in the manner of a
screwdriver. The molars may show multiple, poorly developed
cusps (i.e., mulberry molars).

19. Congenital Syphilis
Proven/highly probable disease
Aqueous crystalline penicillin G 100,000
-150,000 units/kg/day, administered as
50,000 units/kg/dose IV q 12 hours during the
first 7 days and thereafter q 8 hours for 10
days
or
Procaine penicillin G 50,000 units/kg/dose IM in
a single daily dose for 10 days