Conf dr. Laura Gheuc ă Solovăstru Asist. univ. Dr. Gabriela Stoleriu

1. Conf dr. Laura Gheucă Solovăstru Asist. univ. Dr. Gabriela Stoleriu SIFILIS

2. History Christopher Columbus crew brought it from american continent 1493 Cpt. Martin Alonso Pinzon, was the first known european victim 1495: First epidemy in Europe – frenchtroops (Napoli) 1530: Girolamo Fracastoro – Syphilis sive morbus gallicus De Contagionibus

3. Treponema pallidum Etiology: Treponema pallidum: (Spirochaeta pallida), a spiral organism, evidentiated by dark field microscopy and other special methods.

4. 21 days 4-12 weeks Years (latent)

5. I. Sifilisul primar Şancrul sifilitic: eroziune rotundă sau ovalară, 0,5-2 cm diametru, margini netede, fundul curat, baza dură, nedureros aspecte atipice: pitic, gigant, ulceros, hipertrofic, fisurar, difteroid, papulo-eroziv, inflamator, gangrenos, multiplu

6. Clinical manifestations Acquired syphilis Primary syphilis incubation period: 10 – 90 days (average 3 weeks); the chancre (primary sore): developed at the point of inoculation; classically a single, painless erosion, 0.3-3 cm in diameter, round or oval, with regular borders, a smooth, red surface and an indurated base; common localisation: genital region; extragenital chancres: on the anus, lips, tongue, tonsil, eylids, fingers, nipple etc.

7. Clinical manifestations Acquired syphilis Primary syphilis evolution: spontaneously heals in 3-6 weeks. regional lymphadenopathy: accompanies the chancre within 7-10 days of the onset; genital lesions are accompanied by bilateral adenopathy, intraoral lesions by unilateral adenopathy; the affected lymph nodes are enlarged, hard free from fixation to skin and underlying tissue, non suppurating; may persist 2-3 months.

8. Diferentialdiagnosis –genital lesions traumaticlesion herpes simplex erozive balanitis softchancre lymphogranuloma venereum aftae scabieschancre Carcinoma (SCC) of penis

9. la 42-45 zile de la debutul şancrului erupţii cutaneo-mucoase generalizate, rezolutive, poliadenopatie, manifestări generale şi viscerale II. Sifilisul secundar

10. Secondary Syphilis develops at 6 weeks after the chancre skin lesions: the eruption, usually generalized, painless, nonpruritic, simetrically distributed; macular syphilide (roseolar rash): the earliest syphilide; symmetrical, round or oval, coppery-red macules, nonpruritic, non scaling; resolve in 2-3 weeks. papular syphilids: round or oval papules, 3 mm in diameter, non pruritic; on the skin with a fine scale like a collarette; on the mucous membranes erode; variants of papular syphilids: hypertrophic (condylomata lata), lichenoid, psoriasiform, seborrheic etc. other syphilids: pigmentary, ulcerative.

11. Secondary Syphilis syphilitic alopecia, nail’s lesons; generalized lymphadenopathy (cervical, epitrochlear, inguinal, axillary etc.) hard, nonsuppurative; constitutional symptoms: fever, headache, arthralgias, myalgias, malaise; neurological involvement; other organs: hepatitis, glomerulonephritis, cardiac involvement, periostitis, iritis.

12. lichen planus guttate psoriasis acne scabies prurigo seboreicdermatitis condyloma acuminatum Diferentialdiagnosis

13. Latent syphilis the stage of untreated disease in which there are no clinical signs serologic tests are reactive.

14. Tertiary syphilis (late syphilis) in one-third of patients with untreated syphilis; apparent tertiary disease in 3-20 years. skin lesions: nodular or tubercular syphilids: firm, coppery-red nodules, larger than 0.5 cm diameter; appear in groups with circinate arrangement; heal centraly with an atrophic scar and extend peripherally; common sites: arms, back, face. gummas: subcutaneous painless nodules with stadial evolution; slow healing with scarring; common sites: scalp, face, chest, palate, legs.

15. Tertiary syphilis (late syphilis) oral lesions: gummas of the tongue, chronic interstitial glossitis, leucoplakia, areas of loss of papillae; gummas of the palate with distruction and perforation. other tertiary manifestations: neurosyphilis. cardiovascular syphilis. lesions of the eyes.

16. Clinical manifestations Early congenital syphilis: thye onset in the first 2 years of life. Skin lesions: similar to those seen in acquired secondary syphilis: papular syphilids, pemphigus syphiliticus (bullae on the palms and soles); Mucous membrane lesions: rhinitis, laryngitis. choroiditis et al. Congenital syphilis (Prenatal syphilis)

17. Clinical manifestations Other manifestations: lymphadenopathy; hepatosplenomegaly; osteochondritis, periostitis; nephrotic manifestations; choroiditis et al. Congenital syphilis (Prenatal syphilis)

18. Congenital syphilis (Prenatal syphilis) Late congenital syphilis: appear after 2 years of life; active lesions corespond to lesions of acquired tertiary syphilis. Skin and mucous membrane lesions: nodular syphilis, gummata. Other manifestations: ocular, bone involvement, neurologic, cardiovascular et al.

19. Late congenital syphilis: appear after 2 years of life; active lesions corespond to lesions of acquired tertiary syphilis. Skin and mucous membrane lesions: nodular syphilis, gummata. Other manifestations: ocular, bone involvement, neurologic, cardiovascular et al. Congenital syphilis (Prenatal syphilis)

20. Stigmata: the teeth: deformity of the upper central incisor teeth (Hutchinson’s teeth: conical or barrel-shaped with a degree of notching at the free edge; mulberry molar: first molar with flat occlusive surface, et al. the nose: saddle-back nose; rhagades of the corner of the mouth; optic atrophy. Congenital syphilis (Prenatal syphilis)

21. Serological tests in syphilis Nontreponemal tests (lipoidal antigen tests): flocculation tests: VDRL RPR complement fixation tests: Kölmer Treponemal tests: Fluorescent treponemal antibody/ absorption test (FTA-ABS); Treponema pallidum haemaglutination test (TPHA); Treponemal imobilizing antibody (TPI); Histology: perivascular infiltration of lymphocytes and plasma cells, endarteritis obliterans.

22. Reacţii care au ca antigen Tr. pallidum: Reacţii de imunofluorescenţă indirectă (FTA-Abs, FTA-Abs-IgM, FTA-Abs-IgG, 19 S-FTA-Abs-IgM) Testul de hemaglutinare pasivă (TPHA, TPHA-IgM, 19 S-TPHA-IgM) Testul de imobilizare a treponemelor (TIT) Reacţia imunoperoxidazei Teste imunoenzimatice (ELISA) Metode de amplificare genică: PCR, LCR

23. Treatment Penicillin (0,03 UI/ ml) if allergic to penicillin: tetracycline hydrochloride, erythromycin, cephalosporins

24. Jarisch- Herxheimer reaction • fever • fatigue • mialgias • disapearsin 24hours