Early syphilis

Includes :-Primary , secondary and latent stage

KEERTHI NS

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Syphilis:-

A venereal disease caused by spirochaetes, treponema pallidium .

Evidence and Information for Policy

HISTORICAL ASPECTSHISTORICAL ASPECTS

The exact origin of syphilis is unknown.

2 PRIMARY HYPOTHESIS:

COLUMBIAN HYPOTHESIS

SYPHILIS WAS CARRIED TO EUROPE

BY RETURNING CREWMEN FROM

AMERICA BY CHRISTOPHER

COLUMBUS’S VOYAGES PRE-COLUMBIAN HYPOTHESISPROPOSES SYPHILIS

EXISTED IN EUROPE PREVIOUSLY’BUT WENT

UNRECOGNIZED

• Italian physician and poet • 1530• Latin poem ‘syphilis sive

morbus gallicus’ describing the ravages of the disease in Italy.

• Coined the name from the legend of a shepherd called Syphilus who had purportedly gotten the illness as a punishment for defying the god APPOLO

Girolamo Fracastoro

JHON HUNTER• The notorious self

experimentation of hunter by inoculating himself with gonococcal pus to see if gonorrhoea and syphilis were manifestation of same infection.

• Later he developed classical syphilitic heart disease due to which he died in 1739.

PHILLIPPE RICORDHe classified syphIlis into primary ,secondary and tertiary stages.

He distinguished gonorhoea from syphilis after carrying out over 2500 inoculations in humans.

Etiology

Treponema pallidum• A spirochete; corkscrew

shaped• Motile with characteristic

movements like angulation,bending,rotatory motion and back and forth squiggle

Transmission

Acquired

Mainly sexual

Rarely via blood

Accidental

Congenital

Trans placentally

Mode of transmission

syphilis

Early syphilis

Infections < 24 months; highly infectious

Late syphilis

Infection > 24months; not infectious

Classification of syphilis

9-90 days

3-12 weeks EARLY SYPHILIS;Highly infectious

24 MONTHS

LATE SYPHILIS

Stages of syphilis

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Different manifestations occur depending on the

stage of the disease

Signs&

symptoms

primary

secondary

latent

tertiary

Congenital* Early* late

Clinical features:-

Primary syphilis

Morphology of lesion Location of lesion Lymphadenopathy

Morphology

• In 50% of patients ,the typical lesion is called Hunterian chancre

• Features:-

Single,painlessRegular,indurated(button

like)Reddish

plaque;frequently ulcerates

Ulcer:-oozes clear serum on pressure

Heals spontaneously (4-6 weeks) or on treatment

Primary syphilis

• In the rest 50%,the ulcers are atypical o Painfulo Multipleo Indurated

Location of ulcers

Male genital areas:-

Coronal sulans

Glans

Prepuce

Shaft of penis

Perianal areas in homosexual males

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Females:-

Labia minora

Labia majora

Mons pubis

Sometimes in vagina or cervix

Extra genital lesions:-• Lips• Nipples• Fingers

Lymphadenopathy in PS

Inguinal:-• Multiple• Small• Firm

Secondary syphilis

• Systemic disease with cutaneous as well as extracutaneous manifestations.

• It manifest itself 3- 12 weeks after the appearance of primary chancre.

Cutaneous lesion in SS

• Skin lesions may be a few or numerous

• Lesions are symmetrical early , become asymetrical later

• Rashes; of any morphologyMacular Papular Papulo squamousNodular

Types of rashes in SS

Roseolar syphilide

Papular syphilide

Psoriasiform lesion

Malignant syphilide

Roseolar syphilide

Symmetrical erythematous macular rashes

Papular syphilide

Most common rash of SS

Dull red papules, initially discrete

Later coalesce to form annular lesions

Psoriasiform lesion

• When scaling is predominant

Malignant syphilide

• Pustular• Necrotic • Rupioid lesions

in Immuno compromised patients.

•Hyper pigmented, coppery red, scaly lesions

Palm and sole

lesions

• In intertriginous area, the papules may erode superficially

Condyloma lata:

Mucosal lesions

•Dull erythematous plaques with grayish slough

Mucosal

patches:

•Mucous patches with serpiginous erosions

Snail-track

ulcers:

Lymphadenopathy in SS

• Generalised, symmetrical, and rubbery

AxillaryCervicalInguinal

Systemic involvement in SS

• SS is a systemic disease with invovement of many organ

system:• Musculo-skeletal system:

• Periostitis , arthritis• Ocular:

• Iridocyclitis, uveitis, choroidretinitis• Renal:

• Nephrotic symdrome• CNS:

• CSF Abnormalities

Latent syphilis• Patient has only serological

evidence of syphilis without any clinical evidence.

• Depending on the number of of years passed :Early latent (<2 yrs)Late latent syphilis(>2yrs)

TERTIARY SYPHILIS

• It manifest 3-10 years after the primary stage

TERTIARY SYPHILIS• Mucocutaneous tertiary

– Gumma*(well defined punched out ulcer)

• Neurosyphilis– Asymptomaticparenchymatous

/meningeal

• CVS syphilis– Aortitis– coronary stenosis– aneurysm

CONGENITAL SYPHILIS

CONGENITAL SYPHILIS

• T.Pallidum can be transmitted by an infected mother to foetus in utero

EARLY CONGENITAL SYPHILIS

.Appear with in first 2 yearof life Signs First appear 3rd-8th week of lifeA form of rhinitis is the first specific finding. In severe infection there is classic picture of marasmic syphilis-wrinkled pot bellied old man.

Cutaneous eruptions,hepatosplenomegaly,bone and joint involvement are common.C/F similar to acquired SS but visceral and bone involvement are more common.

Cutaneous lesions:bullous,

fissuring of lips,nasolabial

folds

Late congenital syphilis

• Hutchison’s triad– Hutchinson’s teeth– Interstitial keratitis– 8th nerve deafness.

• Other manifestations – Saddle nose– Frontal bossing– Cluttons joint(painless

swelling of joint

DIAGNOSIS

Demonstration of T.pallidumDark ground microscopyDirect immunofluroscent

stainingRecent method-ELISA and

PCR have failed to improve diagnostic detection rates.

Serological testing

• VDRL[Non treponemal/Reaginic test] is good screening test and + in case of most SS & also in tertiary syphilis.

• Confirmatory test (treponemal)-TPHA,TPI, FTA - ABS

Csf examination and chest radiography:- in tertiary syphilis.

Skin biopsy may be used for histopathologic changes and organisms in tissue can be demonstrated by silver staining.

Chancre – IP:9-90 days– Painless, single

– Margin: regular– inflammatory zone: absent– Button-like; induration– Lymphadenopathy :shotty;

may be b/l, nontender– nonsuppurative – VDRL: +/_ve– DG M/S:+VE

Chancroid– 3-5 days– Very painful,Ulcer

inflamed,multiple

– Irregular– present– Soft, covered by a

membrane– Lymphadenopathy:bubo;

u/l, tender– suppurative– _ve– _VE

Differential diagnosis

TREATMENT

COUNSELING• Advice on safe sex:Use of

condoms.• Sex avoidance till healing

of lesions• Follow up testing for

HIV;hep B virus & VDRL at 3 months & further if necessary

TREATMENTEarly syphilis

-Benzathine penicillin(2.4 mega dose)

Late syphilis– Three week i/m

injection of benzathine penicillin