Syphilis: Difference between revisions

<section begin="dermatology" />Syphilis is an STD which is sometimes called lues. It’s caused by infection of the spirochete Treponema pallidum. It’s a very rare disease nowadays. Mostly only the primary stage is seen nowadays.

 

=== Risk factors ===

 

* Men who have sex with men

* Promiscuity

* Unprotected sex

 

Incubation period can last from 10 – 90 days (average 21). Syphilis has 4 characteristic stages

 

* Primary syphilis

** Characterised by a special lesion called a chancre

** Chancres occur at the site where the bacterium enters the body

** It’s a painless, firm ulcer with indurated borders and a smooth base

** Chancres resolve spontaneously without scarring after 3 – 6 weeks

* Secondary syphilis

** Known as the “great imitator” as its skin symptoms resemble those of many other skin diseases

** Begins 8 – 12 weeks after primary infection

** Lasts 2 – 6 weeks

** Condyloma lata

*** Broad-based, wart-like papular erosions

*** In anogenital region, intertriginous folds, oral mucosa

** Disseminated, polymorphic, symmetric rash

** Mucous patches (White patches on mucous membranes)

** Patchy alopecia

** Necklace of Venus = hypopigmentation around the neck

* Latent syphilis

** The patient is seropositive but there are no symptoms

** Can last months, years or the rest of the patient’s life

** There are four outcomes:

*** The disease resolves and the patient becomes healthy

*** The disease reactivates as secondary syphilis

*** The disease progresses into tertiary syphilis

*** The patient dies before any of these outcomes occur

* Tertiary syphilis

** Occur in approx. 30% of untreated patients in the latent stage

** Gummas (Destructive and ulcerative granulomatous lesions with necrotic centre)

*** Can occur anywhere on or in the body, even on organs and bones

** Nodules

** Psoriasiform granulomatous lesions

** Cardiovascular syphilis

*** Aortitis with resulting aneurysm of the aorta

*** Dilated aortic root

** Neurosyphilis

*** Meningitis

*** Stroke

*** Tabes dorsalis (broad-based sensory ataxia)

*** Dysesthesia

*** General paresis

*** Widespread cerebellar atrophy

*** Dementia

*** Argyll Robertson pupil (Bilateral miosis, pupils don’t react to light)

 

=== Diagnosis and evaluation ===

 

Direct visualization of treponema is also possible, and may be useful in the primary stage, when the serological tests below can be negative. The bacteria are visible by darkfield microscopy.

 

 

* For prevention, primary, secondary, and early latent syphilis: 2,4 million units of benzathine penicillin G intramuscularly – single dose (one 1,2 mill IU vial in each gluteus)

* For tertiary (except neurosyphilis) and late latent syphilis: 2,4 million units of benzathine penicillin G IM – once weekly for three weeks

* For neurosyphilis: IV penicillin G for 10 to 14 days

 

Jarisch-Herxheimer reaction may occur after treatment is initiated. It's a systemic reaction to bacterial endotoxins. It is usually self-limiting.<section end="dermatology" />