Syphilis
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SYPHILIS. SYPHILIS. The term syphilis derived from poem written by Fracastorius describing the legend of a shepherd named Syphilus One of the sexually transmitted disease bad blood. Contd…. Syphilis is a bacterial infection Causative agent : Treponema pallidum

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Syphilis

SYPHILIS


Syphilis1

SYPHILIS

  • The term syphilis derived from poem written by Fracastorius describing the legend of a shepherd named Syphilus

  • One of the sexually transmitted disease

  • bad blood


Contd

Contd…

  • Syphilis is a bacterial infection

  • Causative agent: Treponema pallidum

  • Infection occurs only in humans

  • Syphilis can be classified as

  • Acquired syphilis

  • Venereal syphilis

  • Non venereal syphilis

  • Congenital syphilis


Pathogenesis

PATHOGENESIS

  • Venereal syphilis acquired mainly by sexual contact

  • Sourceofinfection :Infected person

  • Siteof entry : Minute abrasions in skin & mucous membrane

  • Infective dose : 60 Treponemes

  • Generation time : 33hours

  • Incubation period : 10 -90 days


Natural course of untreated syphilis

Treponemes penetrates skin

Lymphatic

Blood stream

Infection

(10 – 90 days)

chancre

Natural course of untreated syphilis


Syphilis

Secondary syphilis

Latent syphilis

Natural cure tertiary syphilis


Clinical manifestations

CLINICALMANIFESTATIONS

  • Untreated case of syphilis manifests in 4 stages

  • Primary syphilis

  • Secondary syphilis

  • Latent syphilis

  • Tertiary syphilis


Primary syphilis

Primary syphilis

  • Primary lesion is CHANCRE

  • Site –GENITILIA

  • Other sites -mouth, nipples

  • Also called Hunterian chancre

  • Chancre is painless , avascular & circumscribed

  • It is indurated & superficially ulcerated lesion


Contd1

Contd…

  • Also called Hard chancre

  • The lesion is covered with thick glairy exudate

  • Chancre heals within 10-40days

  • Persistent or multiple chancres are seen in HIV or immunodeficient patients

  • The regional LN’s are swollen discrete & nontender


Secondary syphilis

Secondary syphilis

  • Most infective stage of syphilis

  • Occurs 1-3 months after primary lesion heals

  • Characteristic lesions

  • Roseolar (or) Papular skin rashes

  • Mucous patches in oropharynx

  • Condylomata at mucocutaneous junctions


Contd2

Contd…

  • Spirochetes are abundant in the lesions

  • Great imitator as the above lesions can be seen in many other infetions

  • Systemic involvement like ophthalmic, osseous & meningeal involvement

  • Secondary lesions heal spontaneously (or) take 4-5years to heal


Latent syphilis

Latent syphilis

  • Period of quiescence

  • asymptomatic

  • No clinical manifestations

  • Diagnosis is only by serological tests

  • This stage is followed by natural cure (or) manifests as tertiary syphilis after several years


Tertiary syphilis

Tertiary syphilis

  • The lesions occuring in this stage involve :

  • Gummatous syphilis

  • Cardiovascular syphilis

  • Neurosyphilis occurs in late tertiary (or) quaternary syphilis


Contd3

Contd…

  • Neurosyphilis may be symptomatic (or) asymptomatic

  • Asymptomatic neurosyphilis

  • No signs & symptoms

    But CSF abnormalities like-pleiocytosis

    Elevated protein

    Decreased glucose

  • reactive CSF VDRL Test is demonstrable


Contd4

Contd..

  • Symptomatic neurosyphilis manifests as

  • Syphilitic meningitis-typical symptoms of meningitis ,head ache ,nausea , vomitings & photophobia

  • Meningiovascular syphilis

  • Parenchymatous neurosyphilis


Nonvenereal syphilis

Nonvenereal syphilis

  • By direct contact with lesion

  • Usually seen in Doctors ,nurses

  • Natural evolution of disease is same as venereal syphilis

  • Primary chancre is extragenital

  • By blood transfusion


Congenital syphilis

CONGENITAL SYPHILIS

  • Infant usually infected in utero bytransplacental passage ofTreponema pallidumfrom infected mother at any time

    .

  • Infection may also occur from contact with aninfectious Lesion during passage through the birth canal


Contd5

Contd….

  • Woman in early syphilis is more infective to foetus than after 2 years of infection

  • Infection to foetus occurs in 4 month of gestation

  • Complications involve

  • Abortions

  • Still births

  • Live birth with stigmata of syphilis


Clinical manifestations1

CLINICAL MANIFESTATIONS

  • Clinical manifestations after birth are divided in:

    -early CS <= 2 years

    -late CS >2 years


Clinical manifestations of early cs

Clinical manifestations of early CS

  • The earliest sign of CS is nasal discharge (snuffles) that occurs 1-2 weeks before the onset of the rash.


Contd6

Contd..

  • The vesiculobullous eruption, known as pemphigus syphiliticus,. When the bullae rupture, they leave a macerated, dusky red surface that readily dries and crusts


Clinical manifestations of late congenital syphilis

Clinical manifestations of late congenital syphilis

  • Frontal bossae

  • Saddle nose

  • Defect of hard palate

  • Clutton’sjoint (bilateral painless swelling of the knees)

  • Saber chins

  • Short maxillas

  • Protruding mandible


Contd7

Contd….

  • Hepatospleenomegaly

  • Maculopapular rash


Endemic syphilis

ENDEMIC SYPHILIS

  • Syphilis that is transmitted non venereally endemic in several foci

  • Causative agent:T.pallidum endemicum

  • OTHER NAMES:

  • Sibbens-scotland

  • Bejel-middle east

  • Siti-gambia


Contd8

CONTD…

  • primary chancre usually not seen

    CLINICAL MANIFESTATIONS:

  • Mucous patches & skin eruptions as in secondary syphilis

  • Tertiary lesions-like gummatous lesion

  • Cardiovascular & neurological involvement is rare


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