Syphilis is a chronic sexually transmitted infection

Syphilis is a chronic sexually transmitted infection

  Syphilis

 

ETIOLOGY

 

Syphilis is a chronic sexually transmitted infection.

Treponema pallidum is the causative agent and is corkscrew shaped, microaerophilic, nonculturable, 10 to 14 um length, 0.15 um diameter, and very fragile.

Episodes of active clinical disease interrupted by periods of latency are characteristic of syphilis.

Transmission.

Direct contact with infectious lesion is required for infection. Organism does not survive outside the body.

Incubation period is 9 to 90 days (2 to 6 weeks average).

Primary stage characteristics.

Painless, indurated chancre (genital, anal, oral)

Firm, nontender, regional adenopathy

Lasts 1 to 5 weeks

Heals spontaneously if untreated

Secondary syphilis characteristics.

Systemic infection: all major organ systems

Headache, fever, malaise: may precede rash

Generalized rash: macular (10%), papular (34%), pustular (6%), or maculopapular (51%); may be confused with other dermatoses

Generalized lymphadenopathy (86%)

Mucous patches (10%)

Condylomata lata (10%)

Persisting or unhealing chancre (15%)

Alopecia; liver or kidney involvement

Lasts 2 to 6 weeks; resolves spontaneously

  1. Recurrent secondary symptoms possible within 1 year for 25% of cases

Latent syphilis characteristics.

Clinical manifestations will be absent.

Positive serologic tests for syphilis are the mainstay of diagnosis.

Less than 1 year duration: early latent

More than 1 year duration: late latent

Two thirds of patients with untreated syphilis remain in the latent phase for life.

Tertiary syphilis: If untreated, 33% of patients will progress to the tertiary stage.

Late benign (gumma) (15%): Complete resolution is possible with treatment; bone, skin, cartilage, and internal organs are involved.

Cardiovascular (10%): Ascending aorta is involved and results include the following:

Aortitis

Aortic insufficiency

Aneurysm

Neurosyphilis (symptomatic) occurs in 8% of patients.

Congenital syphilis.

Caused by transplacental transmission

Can occur at any time during gestation

Can occur at any stage of syphilis

Early active: 75% to 90% transmission

Late latent: 30% transmission

Can result in the following:

Spontaneous abortion (second trimester)

Stillbirth

Infant with active or latent syphilis

 

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