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.
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
- 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:
Neurosyphilis (symptomatic) occurs in 8% of patients.
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)
Infant with active or latent syphilis