Syphilis

The word ‘Syphilis’ is derived from the Latin word “Syphilus”- a character in aLatin poem (1530) , supposed first the sufferer from the disease.

Infectious disease of great chronicity, systemic from onset , capable of involving  any structure of the body

 àstimulates every other disease

v  Causative agent : Treponema pallidum(Spirochete – Cork screw like organism)

Incubation period : 9 to 90 days ( Ave. 21 days)

Mode of Transmission :

Inoculation – sexual exposure (STD)

I/V Blood Transfusion

Transplacental ( From 4th month of gestation)

STAGES OF SYPHILIS

                Contact exposure (1/3rd become infected)

            Incubation period    Ò湯 average 3 weeks

                                  Primary Chancre

                                                       Ò† 3 to 12 weeks

    Secondary (mucocutaneous, organ involvement)

                                                       Ò† 4 to 12 weeks

                                    Early latent à Relapsing (25%)

                                                       Ò敒

                           Late latent (more than 1 year)

             Ú                                                              Ú

    Remission                                                 Tertiary stage

   (2/3 cases   )                                                  (1/3 cases)

CLASSIFICATION OF SYPHILIS

Congenital syphilis

Acquired syphilis

Primary Chancre:

Usually single (but may be multiple)

Rounded  or oval with well defined border

Indurated

Singly elevated

Exudes a serous fluid (nonsuppurative)

Usually painless (nontender); may be painful if secondary infected

Does not bleed on touch

Cartilage like firm feeling on palpation

Usually heals with or without treatment and leaves no scars (3 weeks to 3 months)

Usually bilateral lymphadenopathy

Sites :

Male – Glans penis, under surface of prepuce, frenulum, coronal sulcus, shaft of penis, scrotum, Intra-urethral

Female : Labia, Fourchette

Extragenital : Lips, tongue, tonsil, female breast, index finger, anus, etc

r Cutaneous manifestations of secondary syphilis

            Average 8 weeks  after infecting exposure

Patient with secondary syphilis  may be ill with the flu like symptoms that includes malaise, appetite loss, fever, headache, stiff neck, nasal discharge, myalgia, arthralgia, etc.,

However the majority of the patients present with only  skin eruptions.

The skin manifestations of secondary syphilis  are called – SYPHILIDS

 Occurs in 80% of cases

Rashes in secondary syphilis have 3 common features

            1. They do not itch usually

            2. Coppery red in color

            3. The lesions are symmetrically distributed

¢           Common sites

            Face, shoulder, flanks,  palm,  soles , anal and genital organs

TYPES OF SKIN LESIONS :

þMacular Eruption (earliest form) → Roseola syphilitica 1st appears  on the sides of the flanks  about the navel  and inner surface of the extremities.

þMaculo-papular Eruption: Genitalia, face, palm & sole mostly

þPapular Eruptions: Papule is tender to touch with a blunt                                probeà Ollendorf sign (+)

 Papulo squamous à palm, solesàmimic tinea pedis

 Follicular à Lichen syphiliticus (extremities)

 Lenticular àPinhead to lentil size

 Corymbose                          z Leucoderma syphiliticus

 Nodular                                             (Necklace of Venus)

Annular type

◙ LABORATORY DIAGNOSIS OF SYPHILIS

            (Written) Investigations

Direct (Collection of specimen→ from the lesion serous exudate

            1. Direct Microscopic Examination (DG I) (Dark ground  illumination)  à    Cork screw like organism found (Confirmatory)

            2. Direct Fluorescent Antibody Test (TP)

B. Indirect (Serological Test)- Specimen à Serum

            Non specific test                      Specific test

VDRL (Q& Q)                            TPHA

     Venereal Disease Research

     Laboratory test

(For Screening &                     FTA-ABS (Fluorescent Treponemal Prognostic value)                        Antibody Absorption Test

RPR (Rapid Plasma Reagin)  MHA-TP Micro Haem Agglutination Assay                                           for Treponama pallidum

                                                                PCR

                                                                PaGIA (Particle Gel ImmunAssay}

☻MANAGEMENT OF SYPHILIS

General Measures

  F Reassurance

  F Isolation of Patient  or avoidance of close contact  with non-infected person –     since it is highly infectious

Specific treatment

   S Parental Penicillin is the treatment of choice for all stages of syphilis

   SInj. Benzathin Penicillin (2.4 million) I/ M Stat (after skin sensitivity test)

 In primary syphilis  à Single dose

  In secondary syphilis à  2 doses (one week later)

 In Tertiary syphilis  à 3 doses ( 1 week interval )

            If the patient is allergic to penicillin – Cap Tetracycline (500 mg)  6 hourly for 2 weeks or

            Cap Doxycycline (100 mg) 12 hourly for 2 weeks

Incubating Syphilis —- Tab. Azithromycin 1 gm as a single dose.

COMMON CAUSES OF GENITAL ULCER

1.Primary syphilis (Chancre)

2. Chancroid

3. LGV (Lympho-granuloma Venereum)

4. GI (Granuloma Inguinale)/ Donovanosis

5. Genital scabies   

6. Herpes progeritalis

7. Candidal balanitis (male) / Candidal vulvovaginitis (female)

8. Trauma      9. FDE (fixed  drug eruption) 10.Tubercular ulcer.

11. Bechet’s syndrome (Oculo-oral-genital syndrome)

12. Erythroplasia of Queyrat (Premalignant condition)

13. Malignant ulcer ( SCC à Squamous cell carcinoma)

Common STD in Bangladesh

Gonorrhoea ( Neisseria gonorrhoeae)

Syphilis ( Treponema pallidum )

Chlamydial urethritis

Chancroid ( Haemophilus ducreyi )

LGV (Lymphogranuloma venereum)

GI ( Granuloma inguinale )

7. Genital Herpes / Herpes progenitalis ( Herpes simplex virus type 2 & 1 )

8. HPV infection ( Human Papilloma Virus )

9. HBV , HCV  infection

10. AIDS ( HIV infection )

11.Genital scabies ( Sarcoptes scabiei)

12.Trichomoniasis (Trichomonas vaginalis)

13. Candidal vulvovaginitis (Candida albicans)

Common causes of urethral discharges :

Physiological : Sexual  stimulation ( spermatorrhoea / prostatorrhoea )

Pathological :  Specific causes – Urethritis (75%)

Gonococcal :          Neisseria gonorrhoeae

Non-gonococcal : Chlamydia trachomatis

                                Mycoplasma hominis

                                Ureaplasma urealyticum

                                Trichomonas vaginalis

                                Candida albicans

                                Herpes simplex (Herpes progenitalis)

                                Treponema pallidum (Intra-urethral chancre)

Non-specific cause:

Trauma , foreign bodies , Chemicals(Bladder wash) etc.

COMMON CAUSES OF VAGINAL DISCHARGE

Physiological :  v Premenstrual  (á vascularity and  pelvic congestion)

                                   vPregnancy (á Vascularity ) v Sexual arousal /stimulation

Pathological :

Physiological :  v Premenstrual  (á vascularity and  pelvic congestion)

                         vPregnancy (á Vascularity ) v Sexual arousal /stimulation

Pathological :