This document provides an overview of syphilis, including its history, transmission, stages, diagnosis, and treatment. It describes how syphilis was an epidemic in 15th century Europe that coincided with Columbus' return from America. The bacterium Treponema pallidum was identified in 1905 as the cause. Syphilis has primary, secondary, and latent stages involving the skin and other organs. Diagnosis involves dark-field microscopy, PCR and serological tests. Penicillin remains the preferred treatment, though some areas have reported resistance to azithromycin. Partner management and consistent condom use can help reduce transmission of the disease.

1. SYPHILIS
“THE GREAT PRETENDER”
By
Dhananjay A. Desai
Research Scholar
Department of Microbiology
N. A. C. & Sc. College, Ahmednagar
dhananjayashokdesai@gmail.com

3. Overview
• History of Syphilis.
• Transmission pathogenesis and stages of syphilis.
• Diagnostic tests.
• Treatment and partner management.
• Epidemiology.

4. The great pox
• Epidemic in 15 century Europe.
• Rapid spread and served symptoms in early stages.
• Epidemic coincide with Columbus return from america in
1493.
• Endemic but unrecognized.
• A gift from new world.

5. Syphilis Discovery of its causes
• 1903: Infection successfully transmitted to
monkeys.
• 1905: Identification of the bacterium Treponema
pallidum.
• 1906: Dark field microscopy.

6. Taxonomy
• Domain: Bacteria
• Phylum: Spirochaetes
• Order: Spirocheteles
• Family: Spirochetacae
• Genus: Treponema
• Species: pallidum

7. Characteristics
• Helical, tightly coil, Mobile.
• 5-10 µm in length and 0.1-0.4 µm diameter.
• Pathogenic Treponema associated with ten Diseases.
• Veneral syphilis- Pallidum
• Endemic- Endemicum
• YAWS- Pertenue
• Pinta- Carateum
• Obligatory parasite of human.

8. Epidemiology
and
Aspects of
Syphilis Prevention

9. Primary and secondary syphilis — Rates by state:
United States and
outlying areas, 2007

10. Distribution of Reported STD in
World, 2008

11. Method of Infection
• Viable bacteria from chancre enter through the fissure or
mucous membrane.
• Bacteria multiply locally and causes painless chancre.
• Spared via blood stream and lymphatic system.
• Can almost infect many organ and tissue.
• Continuous in vitro culture yet Not to be achieved.

13. Symptoms
(some have no symptoms for years)
• 3 Stages:
 Primary
 Secondary
 Late or latent
• Congenital (passed from a mother to her child)

14. Pathogenesis
• Multiple at the site of inoculation and form chancre.
• Spread to local lymph nodes and then to blood
stream.
• Can involve of many body organs.
• Infection and inflammation of blood vessels.

15. Primary Stage
• Appearance of a single sore or chancre (about 21 day
after infection).
• Chancre lasts 3-6 weeks and heal by treatments.
• If untreated disease progress to next stage.

16. Secondary stage
• Occur as chancre is healing or few weeks after.
• Skin rash developed on one or more areas.
• appear like other disease (usually doesn’t cause itching).
• Other symptoms: fever, swollen lymph gland, sore throat,
patchy hair loss, headaches, weight loss.
• Without treatment disease progress to next late stage.

17. Late stage
(Hidden stage)
• Person continues to have syphilis even through they
are no symptoms.
• Disease can damage eyes, brain, nervous system,
liver, bones, joints.
• Sign include: difficulty coordinating muscle
movement, paralysis, numbness, gradual blindness,
even death.

18. Diagnostic Tests
• Dark field
• PCR
• VDRL/RPR
• EIA

19. T. pallidum on Dark field

20. T. pallidum by DFA-TP

21. Syphilis Serology
• Non-Treponema tests
 VDRL (Venereal Disease
Research Laboratory)
 RPR (Rapid Plasma Reagin)
 TRUST (Toluidine Red
Unheated Serum Test)
 USR (Unheated Serum
Reagin)
• Treponema tests
 TP-PA (Treponema Pallidum
Particle Agglutination)
 FTA-abs (Fluorescent
Treponema Antibody -
Absorbed)
 EIA (Enzyme Immunoassay)

22. Treponemal Tests
• Specific for T. pallidum
• Measure antibody (IgM & IgG) directed against T.
pallidum antigens by particulate agglutination (TP-
PA) or immunofluorescence (FTA-abs)
• May remain positive after treatment
• More sensitive and specific than non-trep. tests
• More expensive and labour intensive
• Can not quantitate…not useful for following response
to treatment

23. FTA-ABS

24. Non-Treponemal Tests
• VDRL and RPR are most commonly used.
• Detect Abs against cardiolipin-lecithin-cholesterol
antigens; not specific for T. pallidum.

25. Uses of Non-Treponemal Tests
• Screening.
• Evaluation of patients with symptoms or possible re-
infection.
• Follow-up assessment after treatment.

26. RPR Test for Syphilis

27. Non-Treponemal Tests
Advantages
• Rapid & inexpensive compared to treponemal tests.
• Easy to perform.
• Quantitative (can be tittered)
• Used to follow response to therapy.
• Can evaluate possible reinfection.

28. Non-Treponemal Tests
Disadvantages
• Biological false positive reactions (BFPs).
• Viral illnesses including HIV, recent immunizations, IDU,
autoimmune and chronic diseases.
• False negative reactions.
• Prozone effect.
• Early primary and late latent stages.

29. Sensitivity of Serologic Tests
According to Stage
• Test 1 2 Latent Tertiary
• VDRL/RPR 74-87% 100% 88-100% 37-94%
• FTA-ABS 70-100% 100% 100% 96%
• MHA-TP* 69-90% 100% 97-100% 94%
• *MHA-TP and TP-PA probably perform equivalently.

30. Serologic Pitfalls
in the Diagnosis of Syphilis
• Negative nontreponemal test may occur early in primary
or late in tertiary - check FTA-ABS or TP-PA.
• Prozone phenomenon: false negative due to lack of
agglutination with high antibody levels.
• Serofast: persistent, low-level positive titre after adequate
treatment.

31. Treatment
and
Partner Management

32. Treatment of Penicillin G
• Intravenous or intramuscular injection of penicillin G
is the preferred drug for treatment of all stages of
syphilis
• Benzathine penicillin G, aqueous procaine penicillin
or aqueous crystalline penicillin can be used

33. Syphilis Resistant to
Azithromycin?
• In San Francisco, the frequency of azithromycin-resistant T. pallidum
isolates increased from 4% during 2000–2002 to 37% during 2003.
• San Francisco STD clinic discontinued use of azithromycin for treating
syphilis infection.
• Notified San Francisco medical providers of azithromycin treatment
failures.
• Recommendation to use Benzathine penicillin G.
• Doxycycline as alternative in PCN-intolerant.
• National notification via MMWR.

34. Syphilis: Treatment
in Pregnancy
• Penicillin is the only adequate form of treatment for
syphilis in pregnancy.
• Penicillin-allergic patients - Hospitalize, desensitize
& treat with penicillin.
• Erythromycin is not accepted as alternative drug in
penicillin-allergic patients.

35. Management of Contacts
• Contacts to primary, secondary or early latent syphilis.
• Persons exposed within 90 days preceding the diagnosis
in a sex partner might be infected even if seronegative:
Treat presumptively.
• Persons exposed >90 days before the diagnosis should be
treated presumptively if serologic tests are unavailable or
follow up is uncertain; if serologic tests are negative no
treatment is needed.

36. Chances Reduction
• Abstain from sex until treatment is finished and until
partners have been evaluated and treated.
• Use condoms consistently and correctly.
• Avoid having sex with partners with genital ulcers/lesions
or rashes.
• Get check-ups every 6 months if engaging in sex with
more than one sex partner.

38. NOW TOPIC OPEN FOR DIOSCUSSION