Kenya Medical Training College

Department of Orthopeadics and Trauma

Medicine
March 2022 Upgrading Class
Syphilis
By Mr. Andrew
 Causes
Caused by the spirochaete Treponema
pallidum.
 Mode of Transmission

 Acquired during sexual activity by direct contact with infectious lesions of the
skin or mucous membranes.
 The infection spreads to the regional lymph nodes and then to the bloodstream.
 The organism can also cross the placental barrier and enter the fetal blood
stream directly, giving rise to congenital syphilis.
 Clinical features of Acquired Syphilis_
Early features

 Pain
 Swelling and tenderness of the bones.
 Periostitis and thickening of the cortex.
 Osteitis and septic arthritis are less common.
 Polyarthralgia or polyarthritis.
 History of sexually transmitted disease
 Late features

 Syphilitic gumma,
 A dense granulomatous lesion
 Local bone resorption and adjacent areas of sclerosis.
 Thick periosteal new bone formation
 Neuropathic arthropathy due to loss of sensibility in the joint
 Tabes dorsalis and ‘general paralysis of the insane’ (GPI)
 Clinical features of congenital syphilis_
Early

 The baby is sick and irritable

 Skin lesions, hepatosplenomegaly and anaemia
 Joint swelling and ‘pseudoparalysis’
 Several sites may be involved, often symmetrically
 Slight swelling and tenderness at the ends or along the shafts of the tubular
bones.
 Osteochondritis (‘metaphysitis’) – trabecular erosion in the juxta-epiphyseal
regions of tubular.
 Periostitis – diffuse periosteal new bone formation along the diaphysis
 Late congenital syphilis

 Gummata appear either as discrete, punched-out radiolucent areas in the

medulla or as more extensive destructive lesions in the cortex.
 The surrounding bone is thick and sclerotic.
 Dense endosteal and periosteal new bone formation affecting almost the entire
bone
 Dental malformations (‘Hutchinson’s teeth’),
 Erosion of the nasal bones,
 Thickening and expansion of the finger phalanges (dactylitis)
 Painless effusions in the knees or elbows (‘Clutton’s joints’)
 Treatment

 Early lesions will usually respond to intramuscular injections of benzylpenicillin

given weekly for 3 or 4 doses.
 Late lesions will require high-dosage intravenous penicillin for a week or 10
days,
 Some forms of tertiary syphilis will not respond at all.
 Third generation cephalosporins
 Yaws

 Non-venereal spirochaetal infection caused by Treponema pertenue.

 Seen mainly in the poorer tropical parts of Africa, Asia and South America
 Mode of Transmission

 Contracted by skin-to-skin contact.

 Clinical features

 Typical skin lesions and an associated lymphadenopathy

 Deformities
 Bone tenderness.
 Cortical erosion,
 Joint destruction
 Periosteal new bone formation
 Treatment

 Benzylpenicillin, preferably given by intramuscular injection

 For those who are hypersensitive to penicillin, erythromycin is a satisfactory.