Syphilis

  • sexually-transmitted disease caused by Treponema pallidum
  • enters host through breaches of squamous or columnar epithelium
  • chronic systemic disease
  • can be transmitted transplacentally

Stages

Primary

  • 10-90 days (mean 21) after exposure to pathogen
  • papule at site of infection - may be unnoticed if on cervix or in rectum
  • ulcerates to firm painless chancre
  • painless regional lymphadenopathy
  • healing in 2-3 weeks

Secondary

  • 4-10 weeks later
  • constitutional symptoms
    • fever
    • sore throat
    • malaise
  • any organ
    • hepatitis
    • nephritis
    • arthritis
    • meningitis
  • generalised lymphadenopathy (50%)
  • generalised skin rashes
    • whole body
      • excludes face
      • includes palms and soles
    • from pink macules through coppery papules to  pustules
    • rarely itches
  • condylomata lata
  • superficial confluent ulceration of mucosal surfaces
    • "snail track ulcers"
  • acute neurological signs (<10%)

Latent

  • signs and symptoms abate over 3-12 weeks
  • may recur over 2 year period (early latency)
  • after 2 years without symptoms is late latency

Tertiary

  • Late benign syphilis
    • because of response to therapy
  • gumma
    • granulomatous sometime ulcerates
    • occurs anywhere in skin
    • frequently occurs at sites of trauma
    • skull, tibia, fibula, clavicle
    • visceral - liver, testes

Investigations

Clinical condition Sample VDRL TPHA FTA-Abs
Primary syphilis Serum -/+ -/+ usually +
Secondary syphilis Serum + (strongly) + +
Latent syphilis Serum usually + + +
Late syphilis Serum -/+ + +
Neurosyphilis CSF usually + + +
Recently treated syphilis Serum -/weakly + + +

Biological false positives

  • Acute
    • Recent immunization
    • Pneumonitis
    • malaria
  • Chronic
    • SLE and other AI diseases
    • raised IgM titres
    • acquired haemolytic anaemia
    • leprosy

Complications

Neurosphilis

  • Meningovascular
    • vasculitis may affect any part of CNS
  • Tabes dorsalis
    • dorsal column loss
    • loss of joint position sense, vibration, deep pain
    • broad based, high stepping gait
    • Charcot joints
    • Bladder insensitivity
    • Lightning pains
    • Hypotonia
  • General paresis of the insane (GPI)
    • dementia
    • fits
    • tremor 
      • lips
      • tongue
  • Taboparesis
    • Tabes dorsalis + GPI + UMN  signs

Cardiovascular syphilis

  • uncomplicated aortitis
  • aortic aneurysms
    • usually ascending
  • aortic valvulitis
  • stenosis of coronary ostia