SYPHILIS
INTRODUCTION:
✓ It is a chronic systematic sexually transmitted infectious disease caused by
Treponema pallidum.
✓ Myriad of presentations – mimic many other infections & immune-mediated
processes.
✓ Incubation period: 3 weeks.
ETIOLOGY:
✓ Spirochete T. pallidum
✓ Solely a human pathogen.
✓ Labile organism.
✓ Survive briefly outside the body – transmission requires direct contact with the
infectious lesion.
TRANSMISSION:
✓ Via penetration through mucosal membranes and abrasions on epithelial surfaces.
✓ Primarily through sexual contact.
✓ By exposure to blood products.
✓ In utero
PATHOPHYSIOLOGY:
Organism penetrates intact mucous membranes or microscopic
dermal abrasions.
In few hours, enters lymphatics & blood.
Produces systematic infection.
✓ During the first 5-10 years after the onset of untreated primary infection – principally
involves the meninges and blood vessels – meningovascular syphilis.
✓ Later parenchyma of the brain & the spinal cord – parenchymatous neurosyphilis.
✓ Histologic hallmarks – endocarditis & a plasma cell-rich infiltrate.
✓ CNS – invaded early in the infection – secondary syphilis.
, CLASSIFICATION:
✓ ACQUIRED SYPHILIS
• Primary syphilis
• Secondary syphilis
• Latent syphilis
• Late syphilis (Tertiary, Quaternary)
✓ CONGENITAL SYPHILIS
• Early
• Late
• Stigmata
CLINICAL FEATURES:
A. ACQUIRED SYPHILIS:
PRIMARY SYPHILIS:
• Primary chancre – begins as a single painless papule – rapidly becomes an
ulcerated & indurated lesion (hard chancre).
• Site of lesion:
Heterosexual men – glans penis
Homosexual men – anal canal, rectum, mouth & external genitalia.
Women – cervix, labia.
Other sites – finger, lip, tongue, tonsil, nipple & arms.
• Oral manifestations:
Chancre could be solitary or multiple & usually painful.
Site of lesion: Lip, tongue, palate.
Cervical lymphadenopathy (non-tender).
• Regional lymphadenopathy:
Appears within 1 week after the chancre.
Painless, non-suppurative, firm, bilateral depending on the type of
lesion.
Primary chancre heals within 4-6 weeks & lymphadenopathy may
Persist for many months.
HIV-positive patients – primary – often symptomless.
• Differential diagnosis:
Chancroid
Herpes genitalia
Steven-Johnson syndrome
BehCet’s syndrome
SECONDARY SYPHILIS:
o Develops 6-8 weeks after the appearance of the primary chancre.
o Constitutional symptoms: Malaise, headache & low-grade fever.
o Less common manifestations: meningitis, hepatitis, arthritis, gastrointestinal
movement.
INTRODUCTION:
✓ It is a chronic systematic sexually transmitted infectious disease caused by
Treponema pallidum.
✓ Myriad of presentations – mimic many other infections & immune-mediated
processes.
✓ Incubation period: 3 weeks.
ETIOLOGY:
✓ Spirochete T. pallidum
✓ Solely a human pathogen.
✓ Labile organism.
✓ Survive briefly outside the body – transmission requires direct contact with the
infectious lesion.
TRANSMISSION:
✓ Via penetration through mucosal membranes and abrasions on epithelial surfaces.
✓ Primarily through sexual contact.
✓ By exposure to blood products.
✓ In utero
PATHOPHYSIOLOGY:
Organism penetrates intact mucous membranes or microscopic
dermal abrasions.
In few hours, enters lymphatics & blood.
Produces systematic infection.
✓ During the first 5-10 years after the onset of untreated primary infection – principally
involves the meninges and blood vessels – meningovascular syphilis.
✓ Later parenchyma of the brain & the spinal cord – parenchymatous neurosyphilis.
✓ Histologic hallmarks – endocarditis & a plasma cell-rich infiltrate.
✓ CNS – invaded early in the infection – secondary syphilis.
, CLASSIFICATION:
✓ ACQUIRED SYPHILIS
• Primary syphilis
• Secondary syphilis
• Latent syphilis
• Late syphilis (Tertiary, Quaternary)
✓ CONGENITAL SYPHILIS
• Early
• Late
• Stigmata
CLINICAL FEATURES:
A. ACQUIRED SYPHILIS:
PRIMARY SYPHILIS:
• Primary chancre – begins as a single painless papule – rapidly becomes an
ulcerated & indurated lesion (hard chancre).
• Site of lesion:
Heterosexual men – glans penis
Homosexual men – anal canal, rectum, mouth & external genitalia.
Women – cervix, labia.
Other sites – finger, lip, tongue, tonsil, nipple & arms.
• Oral manifestations:
Chancre could be solitary or multiple & usually painful.
Site of lesion: Lip, tongue, palate.
Cervical lymphadenopathy (non-tender).
• Regional lymphadenopathy:
Appears within 1 week after the chancre.
Painless, non-suppurative, firm, bilateral depending on the type of
lesion.
Primary chancre heals within 4-6 weeks & lymphadenopathy may
Persist for many months.
HIV-positive patients – primary – often symptomless.
• Differential diagnosis:
Chancroid
Herpes genitalia
Steven-Johnson syndrome
BehCet’s syndrome
SECONDARY SYPHILIS:
o Develops 6-8 weeks after the appearance of the primary chancre.
o Constitutional symptoms: Malaise, headache & low-grade fever.
o Less common manifestations: meningitis, hepatitis, arthritis, gastrointestinal
movement.
