Syphilis

Question 1

What is syphilis?
Causative organism
Transmission
Characteristics of the treponema species

Answer 1

It is caused by a spirochetes Treponema pallidum subspecies pallidum.

A common cause of painless genital ulcer disease in both males and females.

Infection is not strictly through sexual contact
The disease can also be transmitted by blood transfusion and during childbirth from infected pregnant women to their newborns.

There are other members of the genus Treponema that can cause non-venerable diseases in humans
Treponema pallidum subspecies pertenue (yaw), Treponema carateum (pinta), Treponema pallidum subspecies endemicum (bejel).

Treponema spp are non-culturable, motile and helical rods seen on dark field microscopy

Question 2

What are the three stages of the disease and what is the duration of incubation?

Answer 2

Primary, Secondary and Tertiary
The incubation period is 30days-90days

Question 3

Primary stage characteristics

Answer 3

This stage is highly infectious. It is characterized by the formation of a painless ulcer or chancre on the genitals.
It is often associated with regional lymphadenopathy.
The ulcer may be multiple especially in HIV-infected patients.
Healing may occur spontaneously after 1-2 months.

Question 4

Secondary
When does it occur?

Answer 4

A disseminated stage that develops after 4-10 weeks post appearance of the chancre.

The organism multiplies and spreads throughout the body.
There are generalized skin rashes, and mucocutaneous rashes involving the limbs, trunk, palms and soles .

Lymphadenopathy and condylomata lata appear on skin folds which are highly infectious.

Spread to the central nervous system may occur and early neurosyphilis develops.

This may be asymptomatic with high CSF protein, low glucose, high lymphocyte count and positive syphilis serology or symptomatic syphilitic meningitis, cranial neuritis, and meningovascular disease (damage to the blood vessels of the brain, meninges and spinal cord) other systemic symptoms are malaise, fever, sore throat and arthritis.

Question 5

Latent

Answer 5

It is clinically asymptomatic
Only detected by reactive serological test
It can be early or late(2years)
About 30% of untreated latent syphilis goes on to tertiary syphilis.

Question 6

Tertiary
How long post infection does it develop?

Answer 6

It develops an average of 5-20 years post-infection and is non-infectious. It is a rare disease. Cardiovascular (80-85%) and CNS (10-15%) are the major forms seen
Aortic regurgitation arising from endarteritis of the aorta may cause patients to present with angina, aneurysm, and left ventricular failure.

Question 7

Late syphilis

Answer 7

General paresis is characterized by hallucinations, confusions, fits, delusions and cognitive impairments
Tabes dorsalis: there is Argyii Robertson pupil sensory loss, ataxia and sphincter disturbance.

Question 8

Laboratory

Answer 8

Treponema detection by microscopy( Silver stain and Dark field microscopy, IF.
Serological tests(VDRL/RPR
Specific antibody test(TPHA, FTA-ABS e.t.c

Question 9

Treatment

Answer 9

IM Benzathine penicillin 2.4M unit QD is the drug of choice. Alternatively, procaine penicillin can be given.
In cases of penicillin allergy, doxycycline 100mg BD for 14 days, azithromycin 2g QD or erythromycin 500mg QD for 14 days.
The use of doxycycline is contraindicated in pregnancy.