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Syphilis

Syphilis. Prof. Ashraf Al- Sawy. Definition. Syphilis is an infectious disease caused by the spirochete Treponema pallidum. It is almost always transmitted by sexual contact with infectious lesions. But can be transmitted in utero and via blood transfusion.

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Syphilis

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  1. Syphilis Prof. Ashraf Al-Sawy

  2. Definition • Syphilis is an infectious disease caused by the spirochete Treponema pallidum. • It is almost always transmitted by sexual contact with infectious lesions. • But can be transmitted in utero and via blood transfusion.

  3. Can mimic many other infections and immune-mediated processes in advanced stages • "The physician who knows syphilis knows medicine." Sir William Osler

  4. Origin Of Syphilis • Europe disease: Venetian, Naples, or French disease. • New world origin, and holds that sailors who accompanied Columbus and other explorers brought the disease back to Europe. • Old world but was not identified as a separate disease from leprosy before about A.D. 1500. • Developed in both hemispheres from the related diseases bejel and yaws.

  5. Syphilis Acquired Congenital Primary Secondary Tertiary Clinical Presentation

  6. Clinical Presentation 1ry Stage 2ry Stage Cngenital Syphilis 3ry stage

  7. Treponema Pallidum • Treponemes are helically coiled, corkscrew-shaped cells, 6 to 15 µm long and 0.1 to 0.2 µm wide.

  8. Epidemiology • Man is the only known host and transmission is always by direct sexual contact. • The incidence is highest in sexually active people (20-29 year old group). • 30% of exposed people contract the disease. • 30,000 new cases of 1° and 2° syphilis diagnosed per year and approximately 30,000 new cases of early latent syphilis diagnosed per year.

  9. Pathology and Pathogenesis of Syphilis • Enterance: minute abrasions, m. m. or via hair follicles. • Systemic spread via the blood and lymphatics. • The most prominent histologic features are vascular changes caused by endarteritis and periarteritis (perivascular cuffing).

  10. Acquired Syphilis Primary Stage

  11. Primary Stage • Incubation period: 10 - 90 days. • Extensive multiplication of treponemes at the site of entry produces erythema and induration. • Papule eventually progresses to a superficial ulcer with a firm base called a hard chancre. • Numerous treponemes are present in this highly contagious, open lesion.

  12. Syphilitic Chancres • Genital (95%) and extragenital (5%). • Highly infectious. • Usually single. • Indurated. • Painless. • Edge regular. • Floor clean. • Heal in 3-6 weeks.

  13. Regional lymphadenopathy • Firm, discrete, mobile, nonsuppurative and painless without overlying skin changes • It may persist for months, despite healing of the chancre.

  14. Chancre on Female Genitalia

  15. Multiple Chancre

  16. Diagnosis • Clinical picture. • Dark ground examination. • STS: +ve in 50% of cases after 2 weeks of infection.

  17. Differential Diagnosis • 1- Chancroid: (Haemophilus Ducreyi) • Soft chancre, painful, multiple, bleed easily, L.N. painful and may suppurate. • Short IP (2-5 days). • 2- LGV: (Chlamydia trachomatis) • Ulcer transient, rapidly disappear • LN enlarged, painful, matted may fistulate

  18. 3- Genital herpes: • Recurrent, shallow and painful ulcers. • LN: may enlarged and tender. • 4- Other ulcers: • Traumatic ulcer, tumors, pyogenic ulcers.

  19. Secondary Syphilis • Begin 6-8 weeks after the appearance of the initial chancre • May overlap the time when the chancre is still present. • The principal manifestations of 2° syphilis are skin and mucous membrane lesions, as well as manifestations of systemic disease.

  20. Secondary Stage • After an asymptomatic period of 2 to 24 weeks, the secondary or disseminated stage begins • Organisms multiply in many different tissues • Clinical manifestations include slight fever, generalized lymphadenopathy, malaise, and a mucocutaneous rash

  21. Macular Papular Follicular Papulosquamous Pustular. Round Discrete Nonpruritic Symmetric on the trunk and proximal extremities. Skin Rash

  22. Macular

  23. Papular

  24. Maculo-papular

  25. Papulo-squamous

  26. Pustular

  27. M.M. Lesions • Mucous patches: moist, flat, confluent plaques on mouth, vagina, or anus • Painless superficial mucosal erosions, that may develop on the tongue, oral mucosa, lips, vulva, vagina and penis.

  28. Mouth

  29. Condylomata lata: • wart-like lesions in moist intertriginous areas. • Sessile • don’t bleed easily. • D.D.: Condyloma accuminata: • Pedunculated • Bleed easily. • All of these lesions teem with treponemes and are highly contagious.

  30. Anus

  31. Naso-Labila fold

  32. Generalized lymphadenopathy • Discrete. • Rubbery. • Not tender.

  33. Systemic Manifestations: • Malaise • Anorexia • Headache • Sore throat • Arthralgia • Low grade fever • Nephrotic syndrome.

  34. 2-6 weeks after the onset of secondary syphilis, host defenses bring about healing. • About 25 % of untreated patients experience recurrences of this secondary stage in the first several years following infection.

  35. Less Common • Retinitis. • Patchy alopecia (moth eaten alopecia). • Hepatitis. • Epidedimyitis.

  36. Diagnosis • Dark ground examination: +ve from m.m. batches & conyloma lata. • Serological tests: +ve in 100% of cases.

  37. Latent Syphilis

  38. The period between secondary and tertiary syphilis. • Early latency: the first 4years when secondary relapses may occur. • Late latency is the asymptomatic period beyond 4 years. • During this latter period, the patient harbors infectious organisms, especially in the spleen and lymph nodes and blood serology remains positive.

  39. a positive serological test for syphilis in the absence of any clinical disease symptoms • Approximately 25% of patients experience a relapse of 2° syphilis. • Only about 1/3 of latent cases progress to 3° syphilis.

  40. Tertiary syphils

  41. is a noncontagious but highly destructive phase of syphilis which may take many years to develop; it may manifest itself in several forms:

  42. Gummas • Neuro-syphilis • Cardiovascular Syphils

  43. Gummas • It develops in 15% of untreated cases within 1-10 years after infection. • highly destructive tertiary syphilitic lesions that usually occur in skin and bones but may also occur in other tissues.

  44. Gummas • Slowely progressive, painless, dull red nodule or plaque. • Breakdown into ulcer with wash-leather floor. • Regional Ln are not enlarged. • Not infectious.

  45. Cardiovascular Syphilis • 10% of untreated syphilis cases develop CDS 10-40 years after initial infection. • Heart: CDS occurs due to localized affection (gumma) or generalized affection that leads to heart failure.

  46. Aorta: aortic regurge, aneurysm or coronary osteal stenosis.

  47. Cardiovascular Syphilis • Approximately 80 percent of fatalities are caused by cardiovascular involvement, while most of the remaining 20 percent are from neurologic involvement.

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