Syphilis Flashcards
overview of Syphilis
—organism : Treponema Pallidum
>Structure of Treponema Pallidum (TP)
* Slender, motile, regular spiral organism.
* The unstained organism can be visualized by dark field or phasecontrast
microscopy.
* Can’t be stained by ordinary bacterial stains and appears pale
(hence the name pallidum).
* It can be stained by silver impregnation methods or aniline dyes.
—Mode of infection:
Direct (common): acquired
1- Sexual intercourse with infected partner (90-95% of cases).
2- Close contact with syphilitic person e.g. kissing.
3- Touching syphilitic lesion e.g. doctors, nurses, etc.
4- Blood transfusion from a syphilitic donor.
- Congenital (transplacental passage of T P to fetus).
Clinical classification (stages) of acquired syphilis
–start with :
1-I. Primary syphilis:
1.1 asymptomatic
1.2 chancre (45 Days )
2-Secondry : Mc ( mico coutenous ) + systemic
3-Stage of recurrence (relapse)
4-Early latent syphilis
5-Late acquired syphilis
explain the Primary syphilis stage
–start with : between 9-90 days then start the first stage :
1- Primary : its goes to two pathway either
1.1 asymptomatic
1.2 chancer ( ulcer ) : local reaction > Treponemas >papule >syphilitic ulcer
-Num: Single.
-SITE : G-EXTRA G.
-Shape: round or oval
-Edge: sloping
-Floor: clean and fleshy red?
-base : indurated
-Pain: Painless if pain?
-LN: same + bilaterally
-Healing: 2-6 weeks - thin atrophic scar.
explain the Secondary stage
2- Secondary : This stage starts usually 6-8 weeks after appearance of chancre. It is characterized by:
1. Healing or healed chancre.
2. Skin rash (75-100%).
3. Generalized lymphadenopathy (50-86%).
4. Mucous membrane lesions (6-30%).
5. Condylomata lata.
6. Other signs (0-10%).
1) Healing or healed chancre: The chancre may still be present or
scar may be formed indicating its previous existence.
2) Skin rash:
* Widely spread, bilateral, symmetrical and more prominent on the
flexor surface.
* Rounded dull red in color, polymorphic but never vesiculates.
* No itching.
* The rash is chronic and may persist for weeks or months if
untreated. Usually heals without scarring but it may leave faintly
pigmented areas, leucoderma coli (depigmentation of the skin of
the neck).
3) Generalized lymphadenopathy:
* Painless, rubbery and discrete enlargement of lymph gland is
present in 50% of cases.
* Inguinal, sub-occipital, axillary and epicondylar or supratrochlear
glands are mostly involved.
4) Mucous membrane lesions:
* Mucous patch: painless, grayish white patch edged by dull red
border.
* Snail track ulcer: multiple mucous patches fuse together with
formation of polycyclic border and separation of the central
greyish white necrotic tissue leaving an erosion which is called
snail track ulcer.
5) Condyloma lata (moist syphilitic papules):
* Papules which attain special shape and large size due to their
location in moist and opposed skin surface e.g. perianal, between
buttocks and on the genitalia.
* They are flat topped, dull red or grayish white with broad base
and they are very infectious (the most infective syphilitic lesion).
explain the Stage of recurrence (relapse)
III. Stage of recurrence (relapse): Relapse means return of the disease (clinically or serologically)
after its disappearance with or without treatment. This usually occurs within the first two years of infection.
A- Clinical relapse: reappearance of lesions
B- Serological relapse: tests which had become negative turn to be
positive
explain the Early latent syphilis stage
IV. Early latent syphilis:
At this stage the patient is completely free of signs and symptoms
with positive blood tests for syphilis. This stage ends by the
beginning of the third year of infection.
explain Late acquired syphilis stage
—-Late acquired syphilis:
This phase includes 3 stages:
I. Late latent stage.
II. Tertiary stage.
III. Cardiovascular or Neurosyphilis syphilis.
I. Late latent stage :
* This is the continuation of the early latent stage.
* The disease in late latent stage may be discovered by chance, e.g.
premarriage check up, ante-natal care, before joining military or
governmental services.
* The diagnosis of this stage depends upon positive serological
tests for syphilis and should be confirmed by one of the specific
tests.
II. Tertiary stage:
* This stage starts usually 3-10 years after infection.
* The characteristic lesion of this stage is the Gumma which is a
localized swelling (rarely diffuse infiltration) which may be
single or multiple, vary in size from a pin-head to a bigger mass
several centimeters in diameter.
* The Gumma is characterized by being:
o Not symmetrical and painless.
o Single or in isolated groups.
o Destructive (forming punched out ulcer).
o Slow healing (forming thin atrophic scar).
* Sites affected:
I. Covering structures of the body e.g. skin, mucous
membrane and subcutaneous tissues.
II. Supporting structures of the body e.g. bones, joints,
muscles and ligaments.
III. Internal organs e.g. stomach, intestine, liver, spleen, lung
and testis.
—-Diagnosis of tertiary stage:
I) Clinically: any residual stigmata of early syphilis should be
looked for.
II) Serologically: serological tests for syphilis are positive in 90%
of cases (if negative specific tests should be done).
III. Cardiovascular and nervous system affection:
what is the alopecia and vitiligo in the differential diagnosis of syphilis
-Alopecia and vitiligo can be part of the differential diagnosis of syphilis, a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. While alopecia areata and vitiligo are common skin conditions, their presence along with other signs and symptoms can raise suspicion of secondary syphilis, a stage of the infection characterized by widespread rashes and other systemic symptoms.
1-Alopecia areata is an autoimmune disorder that causes patchy hair loss. It typically presents with smooth, round bald patches on the scalp, eyebrows, or beard.
2-Vitiligo is another autoimmune condition that causes loss of skin pigment, resulting in white patches on various body parts.
3-Secondary syphilis can manifest in various ways, including:
Non-scarring hair loss (alopecia) that can be patchy or diffuse, affecting the scalp, eyebrows, or other hairy areas.
Skin lesions that can be macular (flat), papular (raised), or pustular (filled with pus), often appearing in symmetrical patterns on the trunk, palms, and soles.
Constitutional symptoms like fever, malaise, headache, and fatigue.
