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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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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
slide6
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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