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Syphilis

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Syphilis

  1. 1. "He who knows syphilis, knows medicine" Sir William Osler SYPHILIS NIBIN M MBBS Student Calicut Medical College
  2. 2. INTRODUCTION  Syphilis is a chronic sexually transmitted disease with varied clinical and pathological manifestations Causative org: Treponema pallidum  Transmission: Sexual and vertical
  3. 3. SPIROCHETES Long, slender, helically tightly coiled bacteria Gram-negative Corkscrew motility Can be free living or parasitic Best-known are those which cause disease: Syphilis and Lyme’s disease
  4. 4. TRYPONEMA PALLIDUM Microaerophilic spirochete Not seen in gram stain By silver stains and immunofluorescence or dark- field microscopy
  5. 5. PATHOGENESIS  Penetration • Via skin and mucuos membrane through abrasions during sexual contact •Also transplacentally Dissemination • Lymphatic and haematological
  6. 6. PATHOLOGY  Proliferative endarteritis  Ischaemia produced by vascular lesions  Immune response  Chancres and rashes – T-cells, plasma cells and macrophages  TprK – structural diversity by gene recombination
  7. 7. PRIMARY SYPHILIS  3 weeks after infection  CHANCRE : Single firm non-tender, raised, red lesion •Progresses from macule to papule to ulcer • Plasma cells , scattered macrophages, lymphocytes • Proliferative endarteritis • Endothelial cell activation to proliferation to fibrosis Regional lymphadenopathy: classically rubbery, painless, bilateral  Serologic tests for syphilis may not be positive during early primary syphilis
  8. 8. SECONDARY SYPHILIS  2-10 Weeks after primary chancre Painless mucocutaneous lesions Skin lesions on palms and soles Same plasma cell infiltrate as primary chancre
  9. 9. SECONDARY SYPHILIS  Condylomata lata – broad based elevated plaques - in moist areas of skin
  10. 10. Other manifestations of secondary syphilis - lymphadenopathy,Rashes, -Malaise, fever,weight loss - Alopecia - Neurosyphilis  Serological tests – highest especially in red lesions in vagina or mouth
  11. 11. Latent Syphilis  Host suppresses the infection enough so that no lesions are clinically apparent  Only evidence is positive serologic test for syphilis  May occur between primary and secondary stages, between secondary relapses, and after secondary stage  Categories:  Early latent: <1 year duration  Late latent: 1 year duration
  12. 12. TERTIARY SYPHILIS CARDIOVASCULAR SYPHILIS NEUROSYPHILIS BENIGN TERTIARY SYPHILIS
  13. 13. CARDIOVASCULAR SYPHILIS  Syphilitic aortitis  Immune response  Aortitis dilation valve incompetence aneurysm
  14. 14. CARDIOVASCULAR SYPHILIS – MORPHOLOGIC CHANGES  Aortitis – endarteritis of vaso vasorum of proximal aorta  Occlusion of vaso vasorum- scaring of media of proximal aortic wall - loss of elasticity Narrowing of coronary artery ostia – subintimal scarring
  15. 15. NEUROSYPHILIS SYMPTOMATIC • 10% untreated individuals •Meningovascular, paretic, tabes dorsalis •Taboparesis •AIDS patients - meningovascular
  16. 16. Meningovascular neurosyphilis • Chronic meningitis • obliterative endarteritis Paretic neurosyphilis • progressive mental deficits leading to dementia • parenchymal damage in cerebral cortex Tabes dorsalis • Damage to sensory nerves – loss of position&pain sense • loss of axons and myelin in dorsal roots
  17. 17. ASYMPTOMATIC NEUROSYPHILIS • One third of neurosyphilic cases CSF shows: •Lymphocytic pleocytosis •Elevated protein and usually normal glucose concentrations •VDRL test is usually reactive. • It can mimic tuberculous or fungal meningitis or aseptic meningitis of various causes. • Often involves the base of the brain and may result in unilateral or bilateral cranial nerve palsies. • Without treatment, syphilitic meningitis usually resolves, like the other manifestations
  18. 18. BENIGN TERTIARY SYPHILIS  Gummas in bone, skin , and mucous membrane  Gummas – nodular lesions - delayed hypersensitivity  Bone – pain, tenderness, swelling, pathologic fractures  Skin & mucuos membrane – Nodular lesions - ulcerative lesions
  19. 19. Syphilitic gummas  White, gray, and rubbery  single or multiple, vary in size  In liver – scarring causes hepar lobatum  Histologically, centre- coagulated necrotic material margins - macrophages, fibroblasts, - large no. of MNL • Treponemes are scanty
  20. 20. Syphilis Diagnosis And Treatment
  21. 21. Aspects of Syphilis Diagnosis 1. Clinical history 2. Physical examination 3. Laboratory diagnosis
  22. 22. Clinical History Assess:  History of syphilis  Known contact to an early case of syphilis  Typical signs or symptoms of syphilis in the past 12 months  Most recent serologic test for syphilis
  23. 23. Physical Examination  Oral cavity  Lymph nodes  Skin  Palms and soles  Genitalia and perianal area  Neurologic examination
  24. 24. Laboratory Diagnosis  Identification of Treponema pallidum in lesions  Darkfield microscopy  Direct fluorescent antibody - T. pallidum (DFA-TP)  Serologic tests  Nontreponemal tests  Treponemal tests
  25. 25. Nontreponemal Serologic Tests  Principles  Measure antibody directed against a cardiolipin-lecithin- cholesterol antigen  Not specific for T. pallidum  Titers usually correlate with disease activity and results are reported quantitatively  May be reactive for life  Nontreponemal tests include VDRL, RPR Diagnosis
  26. 26. Treponemal Serologic Tests  Principles  Measure antibody directed against T. pallidum antigens  Qualitative  Usually reactive for life  Treponemal tests include , FTA-ABS, EIA
  27. 27. Usefullness  Primary syphilis – both moderatively sensitive  secondary – very sensitive  Tertiary and latent – Treponemal sensitive - non treponemal less  To monitor therapy – non –treponemal  Good for screening ,confirmatory test req  False positive results – Pregnancy, autoimmune diseases, infections
  28. 28. TREATMENT  PENICILLIN  Intramuscularly or intravenously  Treatment at any stage
  29. 29. PREVENTION  Abstinance is the most effective way to prevent the contraction of the disease  practice safe sex  be tested regularly for syphilis if married or sexually active  avoid direct contact with blood, sores or bodily fluid learn about safe sex and injection practices  get tested for syphilis if pregnant 

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