Syphilis

Background

• Syphilis is caused by the spirochete Treponema pallidum.
• Usually sexually transmitted
• Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency
• Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection

Pathogenesis

• Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions.
• Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation
• Blood from a patient with incubating or early syphilis is infectious.
• Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary

Clinical Features

Primary Syphilis

• Primary lesion appears after an incubation of 2-6 weeks
  • Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation
  • Minority of patients can have multiple lesions or atypical appearance
  • Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia
  • Heals in 4-6 weeks
• Regional lymphadenopathy that is painless and firm

Secondary Syphilis

• Characterized by generalized mucocutaneous lesions and generalized lymphadenopathy but can also be found in many tissues such as the CNS and aqueous humor
• Skin lesions are usually maculopapular, pale red or pink, non-pruritic, discrete, and distributed on the trunk and proximal extremities. They may be subtle.
• They progress to more wide spread papular lesions that frequently involve the palms and soles.
  • Appears 6-8 weeks after the chancre heals and subsides within 2-6 weeks
  • Healing chancre may still be present in ~15% of cases. The stages may overlap more frequently in HIV patients.
  • In intertriginous areas, papules can enlarge to produce broad, moist, pink or gray-white infectious lesions called condylomata lata
• CSF abnormalities are detected in as many as 40% during this stage. CNS involvement can be symptomatic or asymptomatic.
• Constitutional symptoms may accompany or precede secondary syphilis. Can include: sore throat, fever, weight loss, malaise, anorexia, headache, and meningismus
• Less common complications include: hepatitis, nephropathy, gastritis, proctitis, rectosigmoid mass arthritis, periositis, optic neuritis, iritis, uveitis, pupillary abnormalities

Differential Diagnosis

• Ulcerative STDs
• Proctitis

Management

• Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection)

See Also

• Ulcerative STDs

Source

• Emedicine