Today is our topic of discussion Definition of Syphilis
Definition of Syphilis
Definition:
Syphilis is a multisystemic infectious disease caused by the spirochete Treponema pallidum.
Distribution:
The prevalence of active syphilis among the susceptible is around 3%. In some cities the prevalence rate is > 5% and highest among the street based female sex workers in Chittagong.
Agent:
Treponema pallidum
Reservoir:
Cases and carriers
Source of infection:
1. Lesion over the skin and mucous membrane
2. Saliva
3. Semen
4. Vaginal secretion
5. Blood
Mode of transmission:
1. Sexual intercourse
2. Through broken skin or mucous membranes
3. Blood transfusion
4. Pregnant mothers with the disease → Pass it to the baby (congenital syphilis)
Incubation period:
2 to 4 weeks (may vary from 9 to 90 days)
Classification of syphilis:
Acquired syphilis:
1. Early stage – Primary and secondary syphilis
2. Late stage – Latent syphilis, tertiary & quarternary syphilis
Congenital syphilis:
Early & late
Clinical features:
Early stage:
Primary syphilis (infectious):
1. H/o exposure 2-4 weeks back.
2. ‘Chancre’: Painless ulcer on the glans or shaft of penis. Sores may inside the rectum or cervix which goes unnoticed.
3. Inguinal lymphadenopathy: Painless, rubbery, discrete, mobile & non-tender.
4. The sores disappear in about 4-6 weeks, even without treatment.
Fig 15-3: Syphilitic chancre over shaft (A) and glans (B) of penis
Secondary syphilis (infectious):
1. Develop 6-8 weeks after the ‘chancre’ with mild fever, malaise and headache.
2. Condylomata lata – Flat elevations around the anus.
3. ‘Snail track ulcers’: Mucosal ulceration of genitals, mouth and pharynx.
4. Maculopapular rash
5. Lymphadenopathy: May be generalized (axillary, inguinal, supracondylar etc.)
6. These symptoms will often go away without treatment.
Fig: Syphilitic punched out lesion of the skin behind the knee
Late stage:
Latent syphilis:
Latency may persist for years.
Tertiary syphilis (infectious):
1. At least 2 years to develop and affects skin, mucosa and bones (perforation of hard palate)
2. ‘Gumma’: Granulomatous lesion that heals slowly and leaves a scar.
Quarternary syphilis (not infectious):
Infection spreads to the brain, nervous system (neurosyphilis) & heart which may leads to death of the patient.
Investigation:
Non-specific tests:
1. VDRL test
2. RPR (Rapid Plasma Reagin) test
Specific treponemal antigen test –
1. FTA-Abs (Fluorescent Treponemal Antibody absorbed test)
2. TPHA (Treponema Pallidum Haemagglutination Test)
3. TPI (Treponema Pallidum Immobilization)
4. CSF study: For latent and cardiovascular syphilis
Treatment:
Early & latent syphilis:
a. Benzathine penicillin 2.4 million IU by I/M injection (at single session).
b. Penicillin-allergic non-pregnant patients: Doxycycline, 100 mg orally, twice daily for 14 days
Or
Tetracycline, 500 mg orally, 4 times daily for 14 days for 14 days
c. Penicillin-allergic pregnant patients: Erythromycin, 500 mg orally, 4 times daily
Latent syphilis ( two years’ duration):
a. Benzathine penicillin, 2.4 million IU by I/M injection, once weekly for 3 consecutive weeks
b. Penicillin-allergic non-pregnant patients:
Doxycycline, 100 mg orally, twice daily for 30 days
Or
Tetracycline, 500 mg orally, 4 times daily for 30 days
c. Penicillin-allergic pregnant patients: Erythromycin, 500 mg orally, 4 times daily for 30 days
Prognosis:
Late-stage syphilis can lead to long-term health problems, despite therapy.
Complications:
1. Damage to the skin, bones, heart and aorta (cardiovascular syphilis)
2. Neurosyphilis
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