Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH...
-
Upload
stewart-jefferson -
Category
Documents
-
view
225 -
download
0
Transcript of Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH...
![Page 1: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/1.jpg)
Syphilis – Clinical Syphilis – Clinical Aspects Aspects
of Late Syphilisof Late Syphilis
Thad Zajdowicz, MD, MPHMedical Director, STD/HIV ProgramMedical Director, STD/HIV Program
Chicago Dept of Public HealthChicago Dept of Public Health
![Page 2: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/2.jpg)
![Page 3: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/3.jpg)
Why a lecture on syphilis?Why a lecture on syphilis?
Although syphilis is an eminently treatabledisease, 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 forcenturies. Further, control of syphilis is vital because of its interactions with HIV. This lecture will focus on clinical manifestations of late syphilis.
![Page 4: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/4.jpg)
ObjectivesObjectives
•To review the clinical manifestations of late syphilis
![Page 5: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/5.jpg)
Clinical StagesClinical 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
![Page 6: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/6.jpg)
Natural History of Natural History of Untreated SyphilisUntreated Syphilis
![Page 7: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/7.jpg)
Syphlitic Aortic Syphlitic Aortic AneurysmAneurysm
![Page 8: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/8.jpg)
Aortic AneurysmAortic Aneurysm
![Page 9: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/9.jpg)
Syphilitic AortitisSyphilitic Aortitis
Tree-barkingTree-barking
![Page 10: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/10.jpg)
Ruptured Aortic Ruptured Aortic AneurysmAneurysm
Tree-barkingTree-barking ClotClot
![Page 11: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/11.jpg)
Stenosis of Coronary Stenosis of Coronary ArteriesArteries
![Page 12: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/12.jpg)
NeurosyphilisNeurosyphilis
• 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
![Page 13: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/13.jpg)
NeurosyphilisNeurosyphilis
• Meningeal neurosyphilis– includes acute syphilitic meningitis– headache, fever, CSF abnormalities
• Meningovascular neurosyphilis– “syphilitic stroke”– hemiparesis, hemiplegia, aphasia,
seizure• Parenchymatous neurosyphilis
– general paresis– tabes dorsalis
![Page 14: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/14.jpg)
Parenchymatous Parenchymatous neurosyphilisneurosyphilis
•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
![Page 15: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/15.jpg)
Parenchymatous Parenchymatous neurosyphilisneurosyphilis
•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
![Page 16: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/16.jpg)
Charcot JointCharcot Joint
![Page 17: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/17.jpg)
Gumma of FaceGumma of Face
![Page 18: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/18.jpg)
Gummas of the NoseGummas of the Nose
![Page 19: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/19.jpg)
Gumma - NoseGumma - Nose
![Page 20: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/20.jpg)
Gummas - ScalpGummas - Scalp
![Page 21: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/21.jpg)
Gmmas of ArmGmmas of Arm
![Page 22: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/22.jpg)
Gummas - ArmGummas - Arm
![Page 23: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/23.jpg)
Ulcerating GummaUlcerating Gumma
![Page 24: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/24.jpg)
ConclusionsConclusions
• 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
![Page 25: Syphilis – Clinical Aspects of Late Syphilis Thad Zajdowicz, MD, MPH Thad Zajdowicz, MD, MPH Medical Director, STD/HIV Program Chicago Dept of Public Health.](https://reader036.fdocuments.us/reader036/viewer/2022062500/56649ea25503460f94ba66db/html5/thumbnails/25.jpg)
Sources of InformationSources of Information
The following sites are useful if more information on syphilis is sought:
www.cdc.gov Centers for Disease Controlwww.who.int World Health Organizationwww.ashastd.org American Social Hygiene Assocwww.vnh.org Virtual Naval Hospital