SYPHILIS

Hannah Laraño
Introduction

Syphilis

- Chronic systemic infection caused by Treponema pallidum subspecies

pallidum
- Sexually transmitted infection
- Average incubation period of 2-6 weeks
- It has 4 stages: Primary, Secondary, Latent, Tertiary
Etiology

Treponema pallidum subsp. pallidum - only agent that causes venereal disease
T. pertenue - causes yaws
T. pallidum endemicum - causes endemic syphilis
T. carateum - causes pinta
- Human is the only host, no animal reservoir
- It can rarely be acquired via nonsexual contact, such as skin-to-skin contact, blood
transfer. Vertical transmission results in congenital syphilis.
Epidemiology

According to CDC, there were 88,042 reported new diagnoses of syphilis in

2016.

In 2016, most cases occurred among gay, bisexual, and other men who
have sex with men.

Men aged 20 to 29
Pathophysiology

Classic primary syphilis

- Solitary non-tender genital chancre in response to invasion by the T. pallidum

- Occurs at site of direct contact with the infected lesion

Secondary syphilis

- Results from hematogenous dissemination of the infection

Clinical Manifestations

PRIMARY SYPHILIS
- Appears 10-90 days after exposure
- Painless, indurated ulcer (chancre) at the site of infection
- Resolve without treatment in 3-6 weeks

SECONDARY SYPHILIS
- Appears 2-8 weeks after disappearance of chancre
- It has multiple systemic manifestations that can involve any system or body part
Clinical Manifestations

LATENT SYPHILIS
- Positive serologic tests, but negative clinical manifestations
TERTIARY SYPHILIS
- Late symptomatic syphilis that can manifest months or years after the initial
infection
CONGENITAL SYPHILIS
- Transplacental transmission or contact with the infectious lesions during birth
- Nasal cartilage destruction (saddle nose), frontal bossing, bowing of the tibia
Laboratory Evaluation

Dark-field Microscopy - Direct examinations of spirochetes from mucosal lesion

Serologic Tests:

A. Non-treponemal

VDRL & RPR - Screening tests that detect antibodies to cardiolipin in blood

B. Treponemal

FTA-ABS - Confirmatory test that detects antibodies to T. pallidum in blood

Treatment/Management

PRIMARY, SECONDARY, EARLY LATENT SYPHILIS

- Single dose of IM penicillin G benzathine 2.4 million units
LATE LATENT SYPHILIS & TERTIARY SYPHILIS
- IM penicillin G benzathine 2.4 million units once weekly for 3 weeks
NEUROSYPHILIS
- IV penicillin G aqueous 18-24 million units daily for 10-14 days
Patients need to be followed post-treatment at 3, 6, 12, and 24 months with serial
non-treponemal tests. 4-fold decline means successful treatment.
Syndromic Management
THANK YOU!