SYPHYLIS
Definition
Chronic systemic infection caused by Treponema
pallidum.
Usually sexually transmitted and is characterized by
episodes of active disease interrupted by periods of
latency. After an incubation period averaging 2 to 6
weeks, a primary lesion appears, often associated with
regional lymphadenopathy.
A secondary bacteremic stage, associated with
generalized mucocutaneous lesions and generalized
lymphadenopathy, is followed by a latent period of
subclinical infection lasting many years.
In about one-third of untreated cases, the tertiary stage is
characterized by progressive destructive mucocutaneous,
musculoskeletal, or parenchymal lesions; aortitis; or
symptomatic central nervous system (CNS) disease.
ETIOLOGY
The Spirochaetales include three
a) Leptospira, which causes human leptospirosis;
b) Borrelia, which causes relapsing fever and
Lyme disease
c) The genus Treponema includes
 T. pallidum pallidum, which causes
venereal syphilis
 T. pallidum pertenue, which causes
yaws
 T. pallidum endemicum, which
causes endemic syphilis or bejel
 T. carateum, which causes pinta
MANIFESTATIONS
Primary Syphilis
Painless chancre
The typical primary chancre usually begins as a single
painless papule that rapidly becomes eroded and usually
becomes indurated, with a characteristic cartilaginous
consistency on palpation of the edge and base of the
ulcer .Usually located on the penis, whereas in
homosexual men it is often found in the anal canal or
rectum, in the mouth
In women, common primary sites are the cervix and
labia.
The genital lesions must be differentiated from those of
include
 Traumatic superinfected lesions.
 Lesions of herpes simplex virus infection
 Lesions of chancroid.
Primary genital herpes may produce inguinal
adenopathy, but the nodes are tender of multiple painful
vesicles
Chancroid produces painful, superficial, exudative, non-
indurated ulcers, more often multiple than in syphilis
adenopathy is common, can be either unilateral or
bilateral, is tender, and may be suppurative.
Regional lymphadenopathy
Regional lymphadenopathy usually accompanies the
primary syphilitic lesion, appearing within 1 week of the
onset of the lesion. The nodes are firm, nonsuppurative,
and painless.
Latent Syphilis
Positive serologic tests for syphilis, together with a
normal CSF examination and the absence of clinical
manifestations of syphilis, indicate a diagnosis of latent
syphilis.
The diagnosis is often suspected on the basis of
 History of primary or secondary lesions
 History of exposure to syphilis
 Delivery of an infant with congenital syphilis
The chancre generally heals within 4 to 6 weeks (range,
2 to 12 weeks), but lymphadenopathy may persist for
months.
Secondary Syphilis
a)Localized or diffuse symmetric mucocutaneous
lesions
The skin rash consists of macular, papular, papulo-
squamous, and occasionally pustular syphilides; often
more than one form is present simultaneously.
Initial lesions are bilaterally symmetric, pale red or pink,
nonpruritic, discrete, round macules that measure 5 to 10
mm in diameter and are distributed on the trunk and
proximal extremities.
These lesions, which may progress to necrotic lesions
(resembling pustules) in association with increasing
endarteritis and perivascular mononuclear infiltration,
are distributed widely, frequently involve the palms and
soles and may occur on the face and scalp.
Tiny papular follicular syphilides involving hair follicles
may result in patchy alopecia (alopecia areata), with loss
of scalp hair, eyebrows, or beard.
In warm, moist, intertriginous body areas, including the
perianal area, vulva, scrotum, inner thighs, axillae, and
skin under pendulous breasts, papules can enlarge and
become eroded to produce broad, moist, pink or gray-
white, highly infectious lesions called condylomata lata
Superficial mucosal erosions, called mucous patches, the
lips, oral mucosa, tongue, palate, pharynx, vulva and
vagina, glans penis, or inner prepuce.
b)Generalized nontender lymphadenopathy
c)Constitutional symptoms
May accompany or precede secondary syphilis include
 Sore throat
 fever
 weight loss
 malaise and anorexia
 headache and meningismus
Acute meningitis occurs in only 1 to 2% of cases.
However, T. pallidum has been recovered from CSF
during primary and secondary syphilis in 30% of cases;
this finding is often but not always associated with other
CSF abnormalities.
Less common complications of secondary syphilis
include
 Hepatitis
 Nephropathy-AGN, Nephrotic syndrome
 GIT-hypertrophic gastritis, patchy proctitis,
ulcerative colitis, or a rectosigmoid mass.
 Arthritis
 Periostitis.
 Ocular findings -unexplained pupillary
abnormalities, optic neuritis, and a retinitis
pigmentosa syndrome, classic iritis (especially
granulomatous iritis) or uveitis.
The diagnosis of secondary syphilis is in eye often
considered only after the patient fails to respond to
steroid therapy. T. pallidum has been demonstrated in the
aqueous humor from these patients.
General paresis
Reflect widespread parenchymal damage and include
abnormalities corresponding to the mnemonic paresis:
 P-personality
 A-affect
 R-reflexes (hyperactive)
 E- Eye (e.g., Argyll Robertson pupils)
 S-sensorium impaired (illusions, delusions,
hallucinations)