This document summarizes syphilis, caused by the spirochete Treponema pallidum. It is transmitted sexually or vertically. Primary syphilis presents as a chancre, which disseminates and causes secondary syphilis skin lesions. Without treatment, it can progress to latent, tertiary cardiovascular, or neurosyphilis stages involving the brain, heart and blood vessels. Diagnosis involves clinical history, exams, and serological tests detecting nontreponemal and treponemal antibodies. Penicillin is the treatment, while abstinence and safe sex practices prevent transmission.

1. "He who knows syphilis,
knows medicine"
Sir William Osler
SYPHILIS
NIBIN M
MBBS Student
Calicut Medical College

2. INTRODUCTION
 Syphilis is a chronic sexually
transmitted disease with varied
clinical and pathological
manifestations
Causative org: Treponema
pallidum
 Transmission: Sexual and
vertical

3. SPIROCHETES
Long, slender, helically tightly coiled bacteria
Gram-negative
Corkscrew motility
Can be free living or parasitic
Best-known are those which cause disease: Syphilis
and Lyme’s disease

4. TRYPONEMA PALLIDUM
Microaerophilic spirochete
Not seen in gram stain
By silver stains and
immunofluorescence or dark-
field microscopy

5. PATHOGENESIS
 Penetration
• Via skin and mucuos membrane
through abrasions during sexual contact
•Also transplacentally
Dissemination
• Lymphatic and haematological

6. PATHOLOGY
 Proliferative endarteritis
 Ischaemia produced by vascular lesions
 Immune response
 Chancres and rashes – T-cells, plasma cells and
macrophages
 TprK – structural diversity by gene recombination

8. PRIMARY SYPHILIS
 3 weeks after infection
 CHANCRE : Single firm non-tender, raised, red
lesion •Progresses from macule to papule to ulcer
• Plasma cells , scattered macrophages,
lymphocytes
• Proliferative endarteritis
• Endothelial cell activation to proliferation to
fibrosis
Regional lymphadenopathy: classically rubbery,
painless, bilateral
 Serologic tests for syphilis may not be positive during
early primary syphilis

10. SECONDARY SYPHILIS
 2-10 Weeks after
primary chancre
Painless
mucocutaneous lesions
Skin lesions on palms
and soles
Same plasma cell
infiltrate as primary
chancre

11. SECONDARY SYPHILIS
 Condylomata lata – broad based elevated
plaques
- in moist areas of skin

12. Other manifestations of
secondary syphilis
- lymphadenopathy,Rashes,
-Malaise, fever,weight loss
- Alopecia
- Neurosyphilis
 Serological tests – highest
especially in red lesions in vagina
or mouth

13. Latent Syphilis
 Host suppresses the infection enough so that
no lesions are clinically apparent
 Only evidence is positive serologic test for
syphilis
 May occur between primary and secondary
stages, between secondary relapses, and
after secondary stage
 Categories:
 Early latent: <1 year duration
 Late latent: 1 year duration

14. TERTIARY SYPHILIS
CARDIOVASCULAR SYPHILIS
NEUROSYPHILIS
BENIGN TERTIARY SYPHILIS

15. CARDIOVASCULAR SYPHILIS
 Syphilitic aortitis
 Immune response
 Aortitis dilation
valve incompetence
aneurysm

16. CARDIOVASCULAR SYPHILIS –
MORPHOLOGIC CHANGES
 Aortitis – endarteritis of vaso vasorum of proximal
aorta
 Occlusion of vaso vasorum- scaring of media of
proximal aortic wall
- loss of elasticity
Narrowing of coronary artery ostia – subintimal
scarring

17. NEUROSYPHILIS
SYMPTOMATIC
• 10% untreated individuals
•Meningovascular, paretic, tabes dorsalis
•Taboparesis
•AIDS patients - meningovascular

18. Meningovascular neurosyphilis
• Chronic meningitis
• obliterative endarteritis
Paretic neurosyphilis
• progressive mental deficits leading to
dementia
• parenchymal damage in cerebral cortex
Tabes dorsalis
• Damage to sensory nerves – loss of
position&pain sense
• loss of axons and myelin in dorsal roots

19. ASYMPTOMATIC NEUROSYPHILIS
• One third of neurosyphilic cases
CSF shows:
•Lymphocytic pleocytosis
•Elevated protein and usually normal
glucose concentrations
•VDRL test is usually reactive.
• It can mimic tuberculous or fungal
meningitis or aseptic meningitis of
various causes.
• Often involves the base of the brain
and may result in unilateral or bilateral
cranial nerve palsies.
• Without treatment, syphilitic meningitis
usually resolves, like the other
manifestations

20. BENIGN TERTIARY SYPHILIS
 Gummas in bone, skin , and mucous membrane
 Gummas – nodular lesions
- delayed hypersensitivity
 Bone – pain, tenderness, swelling, pathologic
fractures
 Skin & mucuos membrane – Nodular lesions
- ulcerative lesions

22. Syphilitic gummas
 White, gray, and rubbery
 single or multiple, vary in size
 In liver – scarring causes hepar lobatum
 Histologically, centre- coagulated necrotic material
margins - macrophages, fibroblasts,
- large no. of MNL
• Treponemes are scanty

23. Syphilis Diagnosis And
Treatment

24. Aspects of Syphilis Diagnosis
1. Clinical history
2. Physical examination
3. Laboratory diagnosis

25. Clinical History
Assess:
 History of syphilis
 Known contact to an early case of syphilis
 Typical signs or symptoms of syphilis in the past
12 months
 Most recent serologic test for syphilis

26. Physical Examination
 Oral cavity
 Lymph nodes
 Skin
 Palms and soles
 Genitalia and perianal area
 Neurologic examination

27. Laboratory Diagnosis
 Identification of Treponema pallidum in lesions
 Darkfield microscopy
 Direct fluorescent antibody - T. pallidum (DFA-TP)
 Serologic tests
 Nontreponemal tests
 Treponemal tests

28. Nontreponemal Serologic Tests
 Principles
 Measure antibody directed against a cardiolipin-lecithin-
cholesterol antigen
 Not specific for T. pallidum
 Titers usually correlate with disease activity and results are
reported quantitatively
 May be reactive for life
 Nontreponemal tests include VDRL, RPR
Diagnosis

29. Treponemal Serologic Tests
 Principles
 Measure antibody directed against T. pallidum antigens
 Qualitative
 Usually reactive for life
 Treponemal tests include , FTA-ABS, EIA

30. Usefullness
 Primary syphilis – both moderatively sensitive
 secondary – very sensitive
 Tertiary and latent – Treponemal sensitive
- non treponemal less
 To monitor therapy – non –treponemal
 Good for screening ,confirmatory test req
 False positive results – Pregnancy, autoimmune
diseases, infections

31. TREATMENT
 PENICILLIN
 Intramuscularly or
intravenously
 Treatment at any stage

32. PREVENTION
 Abstinance is the most effective way to
prevent the contraction of the disease
 practice safe sex
 be tested regularly for syphilis if married or
sexually active
 avoid direct contact with blood, sores or bodily
fluid
learn about safe sex and injection practices
 get tested for syphilis if pregnant
