SYPHILIS

 SYPHILIS

Syphilis is a bacterial infection that is curable if treated early. It is sexually transmitted infection (STI) that can cause serious health problems if left untreated. 

ETIOLOGY:

l. Treponema pallidum.

2. Infection acquired by sexual contact or transplacentally.

3. Chronic systemic infection with periods of latency.

CLINICAL FEATURES:

Primary syphilis

l. In primary syphilis, the typical lesion is chancre, which develops at the site of inoculation, usually penis in heterosexual males.

2. Single, rounded, reddish, indurated, painless lesion with a well-defined edge.

3. Heals without treatment in 2 to 6 weeks.

Secondary syphilis

l. This stage develops 6-8 weeks after primary infection.

2. Macular, papular, or pustular skin lesions.

3. Condyloma lata in genital and anal regions.

4. Mucous patches.

5. Alopecia, iritis, hearing loss, arthritis, nephritis, hepatitis, meningitis.

6. These are highly infectious.

Latent syphilis

Latency may remain indefinitely, be interrupted by a relapse of secondary syphilis or progress to tertiary stage.

Tertiary syphilis

l. Gumma: Involving the skin, mucous membranes and bones. It is the characteristic feature.

2. CVS: Aortitis, aortic aneurysms, aortic regurgitation, coronary ostial stenosis, gummatous myocarditis.

3. Neurosyphilis: Asymptomatic, meningeal, meningovascular or cerebrovascular syphilis, meningomyelitis, acute transverse myelitis, tabes dorsalis, general paresis and gummatous neurosyphilis.

Congenital syphilis

l. Preterm delivery, stillbirth, congenital

2. Infection or neonatal death.

3. Early: Snuffles, failure to thrive, condyloma lata, osteochondritis, periostitis.

4. Late: Interstitial keratitis with neovascularization, neurosyphilis, sensorineural deafness, gummas and bony involvement.

5. Stigmata: Rhagades, mulberry molars, peg-shaped Hutchinson teeth, frontal bossing, saddle nose and saber tibia.

6. Hutchinson’s triad: Hutchinson’s teeth, interstitial keratitis and eight nerve deafness.

DIAGNOSIS:

l. Dark field microscopy

2. VDRL test

3. Treponema pallidum haemagglutination assay (TPHA)

TREATMENT:

l. Parenteral penicillin is the drug of choice.

2. Primary, secondary and latent syphilis: Benzathine penicillin 24 lakh units IM stat.

3. Tertiary syphilis: Benzathine penicillin 24 lakh units IM once every week for three weeks.

4. Alternatives are doxycycline, erythromycin, azithromycin and ceftriaxone.