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Syphilis – Clinical Aspects of Late Syphilis. Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health. Why a lecture on syphilis?. Although syphilis is an eminently treatable

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syphilis clinical aspects of late syphilis

Syphilis – Clinical Aspects of Late Syphilis

Thad Zajdowicz, MD, MPH

Medical Director, STD/HIV Program

Chicago Dept of Public Health

slide3

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 clinical manifestations of late syphilis.

objectives
Objectives
  • To review the clinical manifestations of late syphilis
clinical stages
Clinical Stages
  • Syphilis is conventionally divided into several stages:
    • Primary
    • Secondary
    • Latent
    • Late, or tertiary
  • This lecture will focus on late syphilis – cardiovascular, neurosyphilis, and gummas
ruptured aortic aneurysm
Ruptured Aortic Aneurysm

Tree-barking

Clot

neurosyphilis
Neurosyphilis
  • Asymptomatic
    • no clinical manifestations
    • defined by presence of CNS abnormalities including:
      • WBC > 5/mm3, mostly lymphocytes
      • elevated protein
      • reactive CSF-VDRL (variable)
    • may progress to overt neurosyphilis
neurosyphilis1
Neurosyphilis
  • Meningeal neurosyphilis
    • includes acute syphilitic meningitis
    • headache, fever, CSF abnormalities
  • Meningovascular neurosyphilis
    • “syphilitic stroke”
    • hemiparesis, hemiplegia, aphasia, seizure
  • Parenchymatous neurosyphilis
    • general paresis
    • tabes dorsalis
parenchymatous neurosyphilis
Parenchymatous neurosyphilis
  • General paresis (dementia paralytica)
    • T. pallidum directly invades cerebrum
      • memory loss, personality changes, headache, delusions, seizure
    • neurologic findings include:
      • Argyll Robertson pupils
      • slurred speech
      • expressionless face
      • tremors
parenchymatous neurosyphilis1
Parenchymatous neurosyphilis
  • Tabes dorsalis
    • occurs after long latent period (20-25 yrs.)
      • early features: lightning pains, paresthesias, diminished DTRs, poor pupillary responses
      • late features: ataxia, bladder and rectal disturbances, Charcot joints, “visceral crises”
    • cranial nerve involvement often overlooked
    • “tabetic facies” due to ptosis and flabbiness of facial muscles
conclusions
Conclusions
  • Late complications of syphilis occurred in about 1/3 of patients in the preantibiotic era
  • Prompt penicillin therapy of early disease not only prevents infection in others, but also prevents late complications
  • Neurosyphilis may present and progress rapidly in patients co-infected with HIV
sources of information
Sources of Information

The following sites are useful if more

informationon 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