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What is the etiologic agent of syphilis?

Treponema pallidum, a spirochete


How does congenital syphilis happen.

T. pallidum can cross the placenta!


What is the hallmark feature of primary syphilis?

A painless ulcer called a chancre. Develops at the site of entry of the treponeme.


What is secondary syphilis?

A systemic infxn characterized by fever, swollen lymph nodes, mucus membrane lesions, and sometimes a rash that includes the soles and palms and/or wart resembling lesions.


How do we tx syphilis?

Penicillin G


How do we find T. pallidum microscopically?

Dark field micro. Can't find on light micro bc too thin.


What is primary responsible for the pathology associated with syphilis?

Host immune response.


Describe the diseases of syphilis.

Primary: 2-3 wk incubation. Symptoms resolve in 3-6 wks.

2ndary: Manifest 1-2 mo post-infxn. Symp. resolve in 1 mo w/o tx.

Early latent: 1-2 yr period post resolution of 2ndary.

Late latent: begins 1-2 yrs post infxn. May progress to tertiary if not tx, may resolve on its own.

Tertiary: Almost any organ system can be affected (Heart, CNS, skin, bone)

Congenital syphilis: may/may not present at birth. Stigmata may develop >2yrs after birth.


Describe the signs/symptoms of primary syphilis.

painless chancre
non-tender lymphadenopathy


Describe the signs/symptoms of secondary syphilis.

Disseminated infxn. Many organ systems infected.
*Hyperpigmented maculopapular rash extends over entire body w/ time to include palms and soles.* Also seen in RMSF, meningococcemia, hand-foot-mouth dz.
Mucus membrane "snail track" lesions in mouth and genital mucosa.
Condylomata lata- wart-like lesions in moist skin folds of anus/perineum.
Pt is sick: fever, headache, diffuse lymphadenopathy (non-tender).


Describe the signs/symptoms and clinical course of early latent syphilis.

No symptoms.
Positive serology.
May relapse to secondary.
Preg. women may pass infxn in utero.


What about clinical course differentiates early from late latent syphilis?

Can't relapse to secondary.
Not contagious, even to fetus.


Describe the signs/symptoms and clinical course of tertiary syphilis.

Progressive, inflammatory dz that may take yrs to develop.
Tertiary syphilis is an endarteritis (aorta, aortic valve regurg.)
Pt not infectious
Gummas: charac. skin and bone lesions
CNS: Acute meningitis (asymptomatic)
Meningovascular syphilis
Paresis- many spirochetes, changes in personality, insanity, paranoia.
Tabes dorsalis- demyelination of posterior columns and dorsal roots. Pt shuffles when walks. Lightening pains.


Describe the signs/symptoms and clinical course of congenital syphilis.

Still birth or spontaneous abortion common
May/may not be symptoms at birth
Disseminated infxn transmitted across placenta
Early symptoms may include: serous runny nose, bullous rash, snail track lesions on mucosa, condylomata lata at birth, enlarged liver/spleen.
Late congenital syphilis: stigmata develop over years. Generally starting around age 2. Bone abnormalities: saber shins, frontal bossing.
Vision defects (gun barrel sight.
Hutchinson's triad: *cone teeth*, keratitis, deafness


How do we diagnose syphilis?

These are NONTREPONENAL serological screenings
::Rapid plasma reagin (RPR) test
Carbon particles coated with cardiolipin; mix w/ dilutions of pt serum; observe agglutination.
::Venereal disease research lab test

Test is cheap and fast.

Have high sensitivity, can have false positives.


Describe the treponemal diagnostic tests.

Fluorescent Treponemal Antigen-Absorbed (FTA-ABS) test
T. pallidum commercially prepared and fixed on microscope slide.
Pt serum first absorbed w/ nonpathologic treponemes to remove cross-reactive abs against normal flora.
Mixed absorbed serum w/ antigen fixed to slide.
Add fluoro dye.
Observe for fluorescent staining spirochetes. If they fluoro, means pt has abs to pathogen and they are infected.
Cons: titers remain high for years after cure.
Test is cumbersome and expensive.
Test IS definitive.


Ok, this has nothing to do with syphilis, but what is the causative agent of chancroids and what differentiates these lesions from charcres of syphilis?

Hemophilus ducreyi.
Lesions are bigger and PAINFUL. Chancres are not painful.