Syphilis is a bacterial infection spread through sexual contact or skin-to-skin contact with sores caused by the spirochete Treponema pallidum. It progresses through primary, secondary, latent, and tertiary stages if left untreated. Primary syphilis causes painless sores, usually on the genitals or mouth. Secondary syphilis symptoms include a rash, swollen lymph nodes, and general symptoms. Without treatment, syphilis can spread to the nervous system causing neurosyphilis. Diagnosis involves dark-field microscopy of sores or serological tests detecting antibodies. Penicillin is the treatment of choice and can cure syphilis if given early enough in the infection.

1. Syphilis
Presented by :- Rudraksha
pratap singh
Phamacotherapeutics
Pharm.D 2nd year

2. Introduction
 Syphilis is a bacterial infection usually spread
by sexual contact.
 The disease starts as a painless sore – typically
on the genitals, rectum or mouth.
 Syphilis spreads from person to person via
skin or mucous membrane contact with these
sores.
 After the initial infection, the bacteria can
remain inactive in the body for decades
becoming active again.

4. Causative agent :
 Treponema pallidum.
 Spiral spirochete that is mobile of spirals
varies from 4 to 14 length 5 to 20 microns and
very thin 0.1 to 0.5 microns. Can be seen on
fresh primary or secondary lesions by dark
field microscopy or fluorescent antibody
techniques

5. Stages of syphilis
Primary Syphilis
 Chancre :
 Appears 10-90 days after infection
 Typically single, painless, clean-based lesion with
rolled edges

6. Secondary Sphilis
Sign and symptoms
 Usually occurs 3-6 weeks after primarily chancre
• Rash (75-90%)
• Generalized lymph node swelling (70-90%)
• Constitutional symptoms (50-80%)
• Mucous patches (5-30%)
• Condyloma lata (5-25%)
• Patchy alopecia or hair loss (10-15%)
• Symptoms of neurosyphilis (1-2%)
• Less common: meningitis, hepatitis, arthritis,
nephritis

7.  The symptoms of secondary syphilis will go
away with or without treatment. However,
without treatment, the infection will progress
to the latent and possibly tertiary stage of
disease.

8. Latent syphilis
 No clinical manifestations: only evidence is positive
serologic tests
 60-80% remain asymptomatic for years without
treatment
 Divided into two stages for treatment purposes:
oEarly latent syphilis: <1yr duration
oLate latent syphilis: >1yr duration

9. Tertiary Syphilis
 70% of untreated patients remain asymptomatic
 30% of untreated patients progress to tertiary stage
in 5-20 years
oGummas: destructive lesions of soft tissue, cartilage ,
internal organs and bone
oCardiovascular involvement : aortic aneurysm, aortic
insufficiency
oCentral nervous system involvement: general paresis,
tabes dorsalis, optic atrophy
 Progressive inflammatory disease

10. Neurosyphilis
 Central nervous system invasion occurs early
in infection in 30-40% of patients
 Asymptomatic neurosyphilis can occur at any
stage of syphilis
 Early symptomatic forms (months to a few
years)
o Acute meningitis
o Meningovascular (stuttering stroke)
 Late symptomatic forms ( >2 years )
o General paresis
o Tabes dorsalis

11. Diagnostic Tests
Direct identification of
T.pallidum
 Direct microscopic
identification of T.pallidum
by dark field microscopy
 Direct antigen detection
tests
 Nucleoside amplification
techniques (PCR)
Serological tests to
detect igG/igm
antibodies
 N0nTreponemal
tests(for determining
the disease activity)
 Treponemal tests(for
disease confirmation)
 Detection of
Treponemal igM
antibodies( to detect
early infection )

12. Dark Field Microscopy
 This method is traditionally used to
demonstrate T.pallidum in the exudate from
mucocutaneous lesions in early acquired and
early congenital syphilis
 One of the most specific and easiest method
for diagnosis of infectious syphilis when
lesions are present.

13.  Blood : Blood tests can confirm the presence
of antibodies that the body produces to fight
infection. The antibodies to the syphilis –
causing bacteria remain in your body for
years, sot the test can be used to determine a
current or past infection.
 Cerebrospinal fluid : if it’s suspected that you
have nervous system complications of
syphilis, your doctor may also suggest
collecting a sample of cerebrospinal fluid
through a lumbar puncture.

14. Treatment
 Late Latent and Unknown Duration
• Recommended regimen:
Benzathine Penicillin G 7.2 million units total,
given as 3 doses of 2.4 million units each at 1
week intervals
• Non-pregnant penicillin-allergic adults:
 Doxycycline* 100mg orally two times a day for 4
weeks or
 Tetracycline* 500mg orally four times a day for 4
weeks

15. Treatment Neurosyphilis
 Recommended regimen:
o Aqueous Crystalline Penicillin G 18-24 million units
IV daily administered as 3-4 million IV every 4 hrs
for 10-14 days
 Alternative regimen:
o Procaine Penicillin G 2.4 million units IM daily plus
Probenecid 500 mg PO daily, both for 10-14 days

16. Treatment Pregnancy
 Penicillin is the only adequate bform of
treatment for syphilis in pregnancy.
 Penicillin-allergic patients ->
Hospitalize,desensitise & treat with penicillin
 Erythromycin is not accepted as alternative drug in
penicillin-allergic patients

17. Harm reduction
 Abstain from sex until treatment is finished
and until partners have been evaluated and
treated
 Use condoms consistently and correctly
 Minimize # of sex partners
 Avoid sex while under the influence of alcohol
or drugs to decrease risky behavior
 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

18. Thank You