Syphilis – Clinical Aspects of Primary Syphilis

1. Syphilis – Clinical Aspects of Primary Syphilis Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health

3. Why a lecture on syphilis? Although syphilis is an eminently treatable disease, its continuing occurrence illustrates that our control efforts still need to be improved. The disease remains elusive clinically even today, and unless thought of and sought for can silently cause disease as it has for centuries. Further, control of syphilis is vital because of its interactions with HIV. This lecture will focus on primary syphilis.

4. Objectives • To review the pathogenesis of primary syphilis • To demonstrate the clinical features of primary syphilis • To illustrate clinical variants of primary syphilis

5. Clinical Stages • Syphilis is conventionally divided into several stages: • Primary • Secondary • Latent • Late, or tertiary • This lecture will focus on primary syphilis

6. Treponema pallidum

7. Pathogenesis • Infectious dose unknown in humans • In rabbits, experimental infection induced with as few as 4 spirochetes • Estimated average inoculum 500-1000 in humans • Inoculation may occur at any body site • Eternal genitalia most frequent • Mouth, anus, cervix quite common • Other sites also well described

8. Pathogenesis • T. pallidum divides every 30-33 hrs • Incubation period • Primary syphilis – median 21 days, range 3-90 days • The most prominent histopathological findings are arteritis and periarteritis in affected tissues

9. Primary syphilis - chancre

10. Chancre characteristics • Indolent, “punched out” appearance • Indurated • Painless • Raised border • Red, smooth base • Scant serous secretions

11. Chancre characteristics • Chancre usually solitary, but multiple lesions can occur • May occur at any site in the genital tract: • coronal sulcus, glans, frenum, prepuce, shaft of penis, anorectal area, fourchette, vulva, cervix • May occur in the oropharyngeal area: • lip, tongue, tonsil • And may occur wherever treponemes are inoculated

12. Penile Chancre

13. Penile Chancre

14. Penile Chancre

15. Rolled Edges

16. Crusted Chancre

17. Chancres – 18th Century

18. Multiple Chancres

19. Primary Chancre - Labial

20. “Kissing” Chancres

21. “Kissing” Chancres

22. Perianal Chancre

23. Chancre of the Tongue

24. Oral Chancre - Lip

25. Chancre of Hard Palate

26. Chancre of the Lip

27. Facial Chancre

28. Facial Chancre

29. Digital Chancre

30. Conclusions • The typical primary syphilitic chancre is solitary, indurated, and painless, but many clinical variants occur • Most chancres are genital, oral, or perianal, but may occur anywhere T. pallidum is inoculated • The primary histopathology seen in syphilis is arteritis and periarteritis

31. Sources of Information The following sites are useful if more information on syphilis is sought: www.cdc.gov Centers for Disease Control www.who.int World Health Organization www.ashastd.org American Social Hygiene Assoc www.vnh.org Virtual Naval Hospital