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Syphilis

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It can be transmitted through unprotected sex, blood, or from mother to child during pregnancy. Syphilis has four stages - primary, secondary, latent, and tertiary. Left untreated, it can spread throughout the body and cause serious long term complications. Diagnosis involves microscopic examination of lesions, blood tests, and lumbar puncture if neurosyphilis is suspected. Treatment consists of penicillin injections or oral antibiotics depending on the stage of infection. Congenital syphilis is prevented by adequately treating infected mothers before the fourth month of pregnancy.

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Kishor K Adhikari
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239 views22 pages

Syphilis

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It can be transmitted through unprotected sex, blood, or from mother to child during pregnancy. Syphilis has four stages - primary, secondary, latent, and tertiary. Left untreated, it can spread throughout the body and cause serious long term complications. Diagnosis involves microscopic examination of lesions, blood tests, and lumbar puncture if neurosyphilis is suspected. Treatment consists of penicillin injections or oral antibiotics depending on the stage of infection. Congenital syphilis is prevented by adequately treating infected mothers before the fourth month of pregnancy.

Uploaded by

Kishor K Adhikari
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Syphilis

Ajit Kumar Sah


3rd Batch
PAHS-SOM
Introduction
Sexually transmitted infection
Cause: Treponema pallidum
Host: Human
Mode of transmission:
Acquired
Unprotected sexual contact
Blood
Accidental (in health workers)
Congenital : Transplacentally or at the time of delivery
Infectivity of mother is high if
 she has early syphilis
 Before 5th month of gestation
Clinical features
Primary syphilis
◦ Incubation period - 9-90 days
◦ Lesion is hunterian lesion (single, painless, indurated , reddish
or brown ulcer)
◦ Inguinal lymphadenopathy
◦ Heals within 3-9 weeks
◦ Serological test: +ve 1-2 weeks after chancre
Location
 Male
◦ Coronal sulcus
◦ Glans
◦ Prepuce
◦ And shaft of penis
◦ Perianal region in homosexual
 Female
 Labia minora
 Labia majora
 Mona pubis
Extra genital
 Lips
 Nipple and and fingers
Secondary syphilis (widespread dissemination)
◦ Malaise, headache, loss of appetite, sorethroat, maculopapular rash
(palms and soles), adenopathy
◦ Condylomata lata (vulva, perianal area, upper thighs)
◦ 2-6 weeks

Latent phase : +ve serologic tests (2-10 weeks)


◦ Early latent
 2 year after the resolution of secondary lesion
 Infectious
◦ Late latent
 Non infectious except for pregnant woman
Tertiary syphilis

◦ 5-20 years after chancre has disappeared


◦ Neurosyphilis : Meningitis, tabes dorsalis or paresis, mental
disease
◦ Cardiosyphilis: Valvular disease, aortitis, aneurysm
◦ Skin: Gummas

◦ Pregnancy: late abortion, still birth


Syphilis in Pregnancy
STD with vertical transmission in primary (50%),
secondary (50%) and tertiary (10%)
Spirochate migrate transplacentally causing the
following effects:
◦ Abortion and still birth
◦ Preterm birth
◦ Non immune fetal hydrops (ascities, hepatomegaly)
◦ Delivery of highly infected baby with early neonatal death
◦ Congenital syphilis
Congenital syphilis
Transplacental transmission can take place at any stage of
pregnancy
Woman with early syphilis can infect her fetus much more
commonly ( 75-95%) than one with syphilis of over two years
(35%)
Lesion develops only after four months of gestation, the time
when fetal immune competence starts appearing
Congenital syphilis can be prevented if the mother is given
adequate treatment before the fourth month of pregnancy
Baby can present with low birth weight and anemia
Diagnosis
History of exposure to an infected person
Identification of organism
◦ Smear is taken from primary chancre and dipped to normal
saline which is examined under dark ground illumination
through microscope
◦ Motile bluish white cork screw shaped organism
Demonstration of spirochete under microscope
◦ Dark field microscopy
◦ Direct fluorescent antibodies
Serological tests
Specimen
◦ Epithelial scrapings from the margin of the lesion
◦ Exudates from lesion
◦ Blood (Serology)
◦ CSF (Neurosyphilis)
VDRL – positive after 6 weeks of initial infection
SPECIFIC TESTS
◦ TPHA test
◦ EIA
◦ FTA-abs test
◦ TPI test
Immunobloting and PCR
Laboratory Diagnosis
 Primary syphilis:
◦ Dark field microscopy of chancre scrapings reveals
spirochetes
◦ Serological test (VDRL test) at this stage is negative
 Secondary syphilis:
◦ Dark field microscopy of scrapings from condylomata lata
reveals spirochetes
◦ Serological test (VDRL test) is positive
 Tertiary syphilis:
◦ Serological test (VDRL test) is positive
◦ LP and CSF analysis is recommended in cases of suspected
neurosyphilis
Diagnosis contd..
Confirmatory tests
◦ Fluorescent titre antibody (FTA)
absorption test
◦ Microhaemagglutination assay for
antibodies to Treponema pallidum
(MHA-TP)
Biopsy may be needed to
differentiate it from tubercular
and cancerous ulcer
Management (CDC Recommended 2006)
Early syphilis ( Primary, Secondary and Early latent <2year)
◦ Benzathine penicillin G – 2.4 millions units IM single dose half to
each buttocks
◦ Penicillin allergic – Tetracycline 500mg QDS or Doxycycline 100
mg BID PO for 14 days
Late Syphilis
◦ Benzathine penicillin G - 2.4 million units IM weekly for 3 weeks
◦ Alternative regimen – Doxycycline 100 mg PO BDS or tetracycline
500mg PO QDS for 4 weeks
Pregnancy
◦ Mother
 As above except in penicillin allergic patients
 Early syphilis - Erythromycin, 500 mg, four times daily for 15 days
 Late syphilis - Erythromycin, 500 mg, four times daily for 30 days
◦ Baby
 +ve serology w/o clinical evidence – single IM penicillin G 50,000 units per kg
body weight
 Infected baby with +ve serological reaction – Isolation of mother and aqueous
procaine penicillin G 50,000 units per kg body weight each day for 10 days
 Healthy child of known syphilitic mother – serological test in 1st month and
monthly for 6 months
Management Continued..
Cardiovascular Syphilis • Follow up
• Serological test – 1, 3, 6, 12
◦ Aqueous procaine penicillin, months after treatment of early
1.2 million IU IM for 20 syphilis
consecutive days • Late symptomatic cases –
Neurosyphilis surveillance for life with
serological test annually
◦ Aqueous crystalline penicillin,
2 million IU, IV, every 4 hours
for 14 days
References
DC Dutta’s Textbook of Gynecology, 6th edition
Shaw’s textbook of Gynaecology, 16 th edition
National Guidelines on Case Management of Sexually
Transmitted Infections, Ministry of Health and
Population, 2009

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