Syphilis(acquired)- pathology,clinical course, types, diagnosis, treatment

1. "He who knows syphilis,
knows medicine"
Sir William Osler
SYPHILIS
NIBIN M
MBBS Student
Calicut Medical College

2. INTRODUCTION
 Syphilis is a chronic sexually
transmitted disease with varied
clinical and pathological
manifestations
Causative org: Treponema
pallidum
 Transmission: Sexual and
vertical

3. SPIROCHETES
Long, slender, helically tightly coiled bacteria
Gram-negative
Corkscrew motility
Can be free living or parasitic
Best-known are those which cause disease: Syphilis
and Lyme’s disease

4. TRYPONEMA PALLIDUM
Microaerophilic spirochete
Not seen in gram stain
By silver stains and
immunofluorescence or dark-
field microscopy

5. PATHOGENESIS
 Penetration
• Via skin and mucuos membrane
through abrasions during sexual contact
•Also transplacentally
Dissemination
• Lymphatic and haematological

6. PATHOLOGY
 Proliferative endarteritis
 Ischaemia produced by vascular lesions
 Immune response
 Chancres and rashes – T-cells, plasma cells and
macrophages
 TprK – structural diversity by gene recombination

8. PRIMARY SYPHILIS
 3 weeks after infection
 CHANCRE : Single firm non-tender, raised, red
lesion •Progresses from macule to papule to ulcer
• Plasma cells , scattered macrophages,
lymphocytes
• Proliferative endarteritis
• Endothelial cell activation to proliferation to
fibrosis
Regional lymphadenopathy: classically rubbery,
painless, bilateral
 Serologic tests for syphilis may not be positive during
early primary syphilis

10. SECONDARY SYPHILIS
 2-10 Weeks after
primary chancre
Painless
mucocutaneous lesions
Skin lesions on palms
and soles
Same plasma cell
infiltrate as primary
chancre

11. SECONDARY SYPHILIS
 Condylomata lata – broad based elevated
plaques
- in moist areas of skin

12. Other manifestations of
secondary syphilis
- lymphadenopathy,Rashes,
-Malaise, fever,weight loss
- Alopecia
- Neurosyphilis
 Serological tests – highest
especially in red lesions in vagina
or mouth

13. 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: 1 year duration

14. TERTIARY SYPHILIS
CARDIOVASCULAR SYPHILIS
NEUROSYPHILIS
BENIGN TERTIARY SYPHILIS

15. CARDIOVASCULAR SYPHILIS
 Syphilitic aortitis
 Immune response
 Aortitis dilation
valve incompetence
aneurysm

16. CARDIOVASCULAR SYPHILIS –
MORPHOLOGIC CHANGES
 Aortitis – endarteritis of vaso vasorum of proximal
aorta
 Occlusion of vaso vasorum- scaring of media of
proximal aortic wall
- loss of elasticity
Narrowing of coronary artery ostia – subintimal
scarring

17. NEUROSYPHILIS
SYMPTOMATIC
• 10% untreated individuals
•Meningovascular, paretic, tabes dorsalis
•Taboparesis
•AIDS patients - meningovascular

18. Meningovascular neurosyphilis
• Chronic meningitis
• obliterative endarteritis
Paretic neurosyphilis
• progressive mental deficits leading to
dementia
• parenchymal damage in cerebral cortex
Tabes dorsalis
• Damage to sensory nerves – loss of
position&pain sense
• loss of axons and myelin in dorsal roots

19. ASYMPTOMATIC NEUROSYPHILIS
• One third of neurosyphilic cases
CSF shows:
•Lymphocytic pleocytosis
•Elevated protein and usually normal
glucose concentrations
•VDRL test is usually reactive.
• It can mimic tuberculous or fungal
meningitis or aseptic meningitis of
various causes.
• Often involves the base of the brain
and may result in unilateral or bilateral
cranial nerve palsies.
• Without treatment, syphilitic meningitis
usually resolves, like the other
manifestations

20. BENIGN TERTIARY SYPHILIS
 Gummas in bone, skin , and mucous membrane
 Gummas – nodular lesions
- delayed hypersensitivity
 Bone – pain, tenderness, swelling, pathologic
fractures
 Skin & mucuos membrane – Nodular lesions
- ulcerative lesions

22. Syphilitic gummas
 White, gray, and rubbery
 single or multiple, vary in size
 In liver – scarring causes hepar lobatum
 Histologically, centre- coagulated necrotic material
margins - macrophages, fibroblasts,
- large no. of MNL
• Treponemes are scanty

23. Syphilis Diagnosis And
Treatment

24. Aspects of Syphilis Diagnosis
1. Clinical history
2. Physical examination
3. Laboratory diagnosis

25. Clinical History
Assess:
 History of syphilis
 Known contact to an early case of syphilis
 Typical signs or symptoms of syphilis in the past
12 months
 Most recent serologic test for syphilis

26. Physical Examination
 Oral cavity
 Lymph nodes
 Skin
 Palms and soles
 Genitalia and perianal area
 Neurologic examination

27. Laboratory Diagnosis
 Identification of Treponema pallidum in lesions
 Darkfield microscopy
 Direct fluorescent antibody - T. pallidum (DFA-TP)
 Serologic tests
 Nontreponemal tests
 Treponemal tests

28. Nontreponemal Serologic Tests
 Principles
 Measure antibody directed against a cardiolipin-lecithin-
cholesterol antigen
 Not specific for T. pallidum
 Titers usually correlate with disease activity and results are
reported quantitatively
 May be reactive for life
 Nontreponemal tests include VDRL, RPR
Diagnosis

29. Treponemal Serologic Tests
 Principles
 Measure antibody directed against T. pallidum antigens
 Qualitative
 Usually reactive for life
 Treponemal tests include , FTA-ABS, EIA

30. Usefullness
 Primary syphilis – both moderatively sensitive
 secondary – very sensitive
 Tertiary and latent – Treponemal sensitive
- non treponemal less
 To monitor therapy – non –treponemal
 Good for screening ,confirmatory test req
 False positive results – Pregnancy, autoimmune
diseases, infections

31. TREATMENT
 PENICILLIN
 Intramuscularly or
intravenously
 Treatment at any stage

32. PREVENTION
 Abstinance is the most effective way to
prevent the contraction of the disease
 practice safe sex
 be tested regularly for syphilis if married or
sexually active
 avoid direct contact with blood, sores or bodily
fluid
learn about safe sex and injection practices
 get tested for syphilis if pregnant
