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| <section begin="dermatology" />* Sometimes called ''lues'' | | <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. |
| * Treponema pallidum
| | |
| * Risk factors
| | === Risk factors === |
| ** Men who have sex with men
| | |
| ** Promiscuity
| | * Men who have sex with men |
| ** Unprotected sex
| | * Promiscuity |
| * Incubation period 10 – 90 days (average 21)
| | * Unprotected sex |
| * Has 4 characteristic stages
| | |
| ** Primary syphilis
| | === Clinical features === |
| *** Characterised by a special lesion called a ''chancre''
| | Incubation period can last from 10 – 90 days (average 21). Syphilis has 4 characteristic stages |
| *** Chancres occur at the site where the bacterium enters the body
| | |
| *** It’s a painless, firm ulcer with indurated borders and a smooth base
| | * Primary syphilis |
| *** Chancres resolve spontaneously without scarring after 3 – 6 weeks
| | ** Characterised by a special lesion called a chancre |
| ** Secondary syphilis
| | ** Chancres occur at the site where the bacterium enters the body |
| *** Known as the “great imitator” as its skin symptoms resemble those of many other skin diseases
| | ** It’s a painless, firm ulcer with indurated borders and a smooth base |
| *** Both systemic and mucocutaneous lesions
| | ** Chancres resolve spontaneously without scarring after 3 – 6 weeks |
| *** Begins 8 – 12 weeks after primary infection
| | * Secondary syphilis |
| *** Lasts 2 – 6 weeks
| | ** Known as the “great imitator” as its skin symptoms resemble those of many other skin diseases |
| *** Disseminated, symmetric rash
| | ** Begins 8 – 12 weeks after primary infection |
| **** Polymorphic, i.e. can take on many appearances
| | ** Lasts 2 – 6 weeks |
| **** Typically nonpruritic macular or papular rash
| | ** Condyloma lata |
| **** Reddish-brown
| | *** Broad-based, wart-like papular erosions |
| **** Roseola syphilitica = macules on trunk and flexor aspects of the extremities
| | *** In anogenital region, intertriginous folds, oral mucosa |
| **** Corona veneris
| | ** Disseminated, polymorphic, symmetric rash |
| ***** Maculopapular lesions
| | ** Mucous patches (White patches on mucous membranes) |
| ***** On forehead or back of neck
| | ** Patchy alopecia |
| **** Clavus syphiliticus = maculopapular lesions on palms and soles
| | ** Necklace of Venus = hypopigmentation around the neck |
| *** Mucous patches
| | * Latent syphilis |
| **** White patches on mucous membranes
| | ** The patient is seropositive but there are no symptoms |
| *** Condyloma lata
| | ** Can last months, years or the rest of the patient’s life |
| **** Broad-based, wart-like papular erosions
| | ** There are four outcomes: |
| **** In anogenital region, intertriginous folds, oral mucosa
| | *** The disease resolves and the patient becomes healthy |
| *** Patchy alopecia | | *** The disease reactivates as secondary syphilis |
| *** Leucoderma syphiliticum | | *** The disease progresses into tertiary syphilis |
| **** Hypopigmentation | | *** The patient dies before any of these outcomes occur |
| **** Necklace of Venus = hypopigmentation around the neck
| | * Tertiary syphilis |
| **** Differential diagnosis: pityriasis versicolor
| | ** Occur in approx. 30% of untreated patients in the latent stage |
| *** Non-cutaneous and non-mucosal symptoms
| | ** Gummas (Destructive and ulcerative granulomatous lesions with necrotic centre) |
| **** Pharyngitis
| | *** Can occur anywhere on or in the body, even on organs and bones |
| **** Iritis
| | ** Nodules |
| **** Hepatitis
| | ** Psoriasiform granulomatous lesions |
| **** Generalized nontender lymphadenopathy
| | ** Cardiovascular syphilis |
| **** Meningitis
| | *** Aortitis with resulting aneurysm of the aorta |
| ** Latent syphilis
| | *** Dilated aortic root |
| *** The patient is seropositive but there are no symptoms
| | ** Neurosyphilis |
| *** Can last months, years or the rest of the patient’s life
| | *** Meningitis |
| *** There are four outcomes
| | *** Stroke |
| **** The disease resolves and the patient becomes healthy
| | *** Tabes dorsalis (broad-based sensory ataxia) |
| **** The disease reactivates as secondary syphilis
| | *** Dysesthesia |
| **** The disease progresses into tertiary syphilis
| | *** General paresis |
| **** The patient dies before any of these outcomes occur
| | *** Widespread cerebellar atrophy |
| ** Tertiary syphilis
| | *** Dementia |
| *** Occur in approx. 30% of untreated patients in the latent stage
| | *** Argyll Robertson pupil (Bilateral miosis, pupils don’t react to light) |
| *** Late benign syphilis
| | |
| **** Gummas
| | === Diagnosis and evaluation === |
| ***** Destructive and ulcerative granulomatous lesions with necrotic centre
| | A specimen is taken from a lesion. Nontreponemal tests like RPR and VDRL are used for screening. These are sensitive but not specific tests. Treponemal tests are used for confirming the diagnosis. These are highly specific. |
| ***** Can occur anywhere on or in the body, even on organs and bones
| | |
| **** Nodules
| | 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. |
| **** Psoriasiform granulomatous lesions
| | |
| *** Cardiovascular syphilis
| | === Treatment === |
| **** Aortitis with resulting aneurysm of the aorta
| | |
| **** Dilated aortic root
| | * 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) |
| *** Neurosyphilis
| | * For tertiary (except neurosyphilis) and late latent syphilis: 2,4 million units of benzathine penicillin G IM – once weekly for three weeks |
| **** Early neurosyphilis
| | * For neurosyphilis: IV penicillin G for 10 to 14 days |
| ***** Meningitis
| | |
| ***** Stroke
| | 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" /> |
| **** Late neurosyphilis
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| ***** Tabes dorsalis
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| ****** Demyelination of the dorsal column and dorsal root ganglia
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| ****** Causes a broad-based ataxia
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| ***** Dysesthesia
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| ***** General paresis
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| ***** Widespread cerebellar atrophy
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| ***** Dementia
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| ***** Argyll Robertson pupil (Bilateral miosis, pupils don’t react to light)
| |
| ** Diagnosis
| |
| *** Direct visualization of treponema
| |
| **** In the primary stage, when the serological tests below can be negative
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| **** Darkfield microscopy
| |
| **** Specimen from a lesion
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| *** Nontreponemal tests – for screening
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| **** RPR
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| **** VDRL
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| **** Sensitive, not specific
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| *** Treponemal test – for confirming the diagnosis
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| **** TPPA
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| **** FTA-ABS
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| **** Specific, not sensitive
| |
| ** Treatment
| |
| *** 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)
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| *** For tertiary (except neurosyphilis) and late latent syphilis
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| **** 2,4 million units of benzathine penicillin G IM – once weekly for three weeks
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| *** For neurosyphilis
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| **** IV penicillin G for 10 to 14 days
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| *** Jarisch-Herxheimer reaction may occur
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| **** Systemic reaction to bacterial endotoxins
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| **** Is usually self-limiting
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| *** In case of penicillin allergy
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| **** Doxycycline
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| **** Desensitization to penicillin, then use penicillin as normal<section end="dermatology" />
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| [[Category:Dermatology]] | | [[Category:Dermatology]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |