2. SYPHILIS
Syphilis - infectious treponematoses caused by
Treponema pallidum transmitted usually by sexual
intercourse
Discovered by Schaudinn and Hoffmann(1905)
Affects most of the organs
Marked by florid manifestations on the one hand
And years of asymptomatic latency on the other hand
Affects both man & women in age group of 20-40
years
6. Pathogenesis
Mode of transmission
1. Sexual intercourse
2. Blood transfusion
3. Contaminated needles
4. Vertical transmission
5. To hospital personnel by indiscriminate
handling of infected lesions
7. 1.ATTACHMENT, INVASION AND DISSEMINATION
2. INNATE HOST RESPONSE – TLR2
3. ACQUIRED IMMUNITY - clinical manifestations caused
by inflammatory and immune responses rather than by
any direct cytotoxic effect of T. pallidum
4. BACTERIAL CLEARANCE- phagocytosis of treponemes
by macrophages
Predominant cytokine –Th1
Predominant mediator- IFN-γ
5. ANTIBODIES IN SYPHILIS
6. INVASION OF HOST IMMUNITY AND
ESTABLISHMENT OF LATENT INFECTION
7. PROTECTIVE AND LONG-LASTING IMMUNITY
Pathogenesis
8. Classification of Syphilis
Clinical course of acquired syphilis is divided in to
early &late syphilis.
1. Early-duration is 1 yrs.
Includes primary and secondary stage and early latent syphilis
2. Late-after 1 yrs.
Include late latent & tertiary syphilis
Congenital Syphilis
COLLES’S LAW(1837)
Syphilitic infants could transmit the disease to previously healthy wet
nurses but never to their own mother
KASSOWITZ’S LAW(1876)
Untreated syphilitic mother tends to improve on her past performance
9. Primary Syphilis
It’s the first stage after infection
Painless & localized ulcer with rolled edge
(chancres).
Single or multiple.
Appear 2-3 weeks after contact.
Most common site are cervix , vagina , vulva
, anus and mouth.
Regional L.N become enlarged.
11. SECONDARY SYPHILIS
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
12. Systemic
1-6 months after contact
Fever, malaise, general adenopathy and
nonitchy maculopapular skin rash “money
spot” .
Involve the palms of the hands and the soles
of the feet.
Mucous patches and linear (snail track)
ulcers are seen on the mucosal surfaces.
SECONDARY SYPHILIS
17. 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.
18. 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.
Late latent:
Usually not infectious, except for the pregnant
woman, who may transmit infection to her fetus.
LATENT SYPHILIS
20. TERTIARY SYPHILIS
Morbidity and mortality of syphilis in adults in
past years were due to late manifestations of illness
There may be an interval of 1 - 20 yrs from acute
infection to clinical onset of late or tertiary stages
of disease
Tertiary syphilis conveniently divided into three
main groups
Late benign syphilis
Cardiovascular syphilis
Neurosyphilis
26. Congenital Syphilis
Mode of transmission:
Trans placental passage from infected mother
At birth
Congenital infection is associated with several
adverse outcomes including:
Low birth wt
Congenital anomalies
Premature birth
Miscarriages or death of baby
27. Lab diagnosis of syphilis
Tests are divided in four categories :
Direct microscopic exam - used when
lesions are present
Non treponemal tests - used for screening
Treponemal tests - are confirmatory
Direct antigen detection tests - used in
research settings and as gold standards for
test evaluation
28. TREATMENT
Early infections
The first-line treatment for uncomplicated syphilis remains
a single dose of intramuscular benzathine benzylpenicillin.
Doxycycline and tetracycline are alternative choices for
those allergic to penicillin; due to the risk of birth defects,
these are not recommended for pregnant women.
Resistance to macrolides, rifampicin, and clindamycin is
often present.
Ceftriaxone, a third-generation cephalosporin antibiotic,
may be as effective as penicillin-based treatment.
It is recommended that a treated person avoid sex until the
sores are healed.
29. Late infections
For neurosyphilis, due to the poor penetration of
benzathine penicillin into the central nervous system, those
affected are given large doses of intravenous penicillin for a
minimum of 10 days.
If a person is allergic to penicillin, ceftriaxone may be used
or penicillin desensitization attempted.
Other late presentations may be treated with once-weekly
intramuscular benzathine penicillin for three weeks.
Treatment at this stage solely limits further progression of
the disease and has a limited effect on damage which has
already occurred.
TREATMENT
30. Jarisch-Herxheimer reaction
One of the potential side effects of treatment is
the Jarisch-Herxheimer reaction.
It frequently starts within one hour and lasts for 24
hours, with symptoms of fever, muscle pains,
headache, and a fast heart rate.
It is caused by cytokines released by the immune
system in response to lipoproteins released from
rupturing syphilis bacteria.
TREATMENT
31. Pregnancy
Penicillin is an effective treatment
for syphilis in pregnancy but there
is no agreement on which dose or
route of delivery is most effective.
TREATMENT
