Syphilis

 Syphilis

•       Syphilis usually is acquired by sexual contact with infected mucous membranes or cutaneous lesions

•       It can be acquired by nonsexual personal contact, accidental inoculation, or blood transfusion.

•       Treponema pallidum spirochete

•       penetrates the intact mucous membrane or a break in the cornified epithelium

•       Spirochetemia occurs

Treponema pallidum spirochete

Primary Syphilis

•       Primary lesion develops at the site of inoculation

–      Progresses from macule to papule to ulcer

–      Typically painless, indurated, and has a clean base

–      Highly infectious

–      Heals spontaneously within 1 to 6 weeks

–      25% present with multiple lesions

•       Regional lymph adenopathy: classically rubbery, painless, bilateral

•       Serologic tests for syphilis may not be positive during early primary syphilis

Secondary Syphilis

•       Secondary lesions occur 3 to 6 weeks after the primary chancre appears

•       May persist for weeks to months

•       Primary and secondary stages may overlap

•       Mucocutaneous lesions most common

•       Manifestations

•       Rash (75%-100%) 

•       Lymphadenopathy (50%-86%)

•       Malaise

•       Mucous patches (6%-30%)

•       Alopecia (5%)

Latent Syphilis

•       Host suppresses the infection enough so that no lesions are clinically apparent

•       Only evidence is positive serologic test for syphilis

•       May occur between primary and secondary stages, between secondary relapses, and after secondary stage

•       Categories: 

–      Early latent:  <1 year duration

–      Late latent:  ³1 year duration

Congenital Syphilis

•       T. pallidum is transmitted from a pregnant woman with syphilis to fetus

•       Stillbirth, neonatal death, and infant disorders

•       deafness, neurologic impairment, and bone deformities

•       Fetal infection can occur during any trimester of pregnancy

–      Early lesions (most common):  Infants <2 years old; usually inflammatory

–      Late lesions:  Children >2 years old; tend to be immunologic and destructive

Summary

•       Syphilis usually is acquired by sexual contact with infected mucous membranes or cutaneous lesions

•       Causative organism include Treponema pallidum spirochete

•       Syphilis is classified as primary, secondary, latent and congenital