early syphilis
DESCRIPTION
DERMATOLOGYTRANSCRIPT
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Early syphilis
Includes :-Primary , secondary and latent stage
KEERTHI NS
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Syphilis:-
A venereal disease caused by spirochaetes, treponema pallidium .
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Evidence and Information for Policy
HISTORICAL ASPECTSHISTORICAL ASPECTS
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The exact origin of syphilis is unknown.
2 PRIMARY HYPOTHESIS:
COLUMBIAN HYPOTHESIS
SYPHILIS WAS CARRIED TO EUROPE
BY RETURNING CREWMEN FROM
AMERICA BY CHRISTOPHER
COLUMBUS’S VOYAGES PRE-COLUMBIAN HYPOTHESISPROPOSES SYPHILIS
EXISTED IN EUROPE PREVIOUSLY’BUT WENT
UNRECOGNIZED
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• Italian physician and poet • 1530• Latin poem ‘syphilis sive
morbus gallicus’ describing the ravages of the disease in Italy.
• Coined the name from the legend of a shepherd called Syphilus who had purportedly gotten the illness as a punishment for defying the god APPOLO
Girolamo Fracastoro
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JHON HUNTER• The notorious self
experimentation of hunter by inoculating himself with gonococcal pus to see if gonorrhoea and syphilis were manifestation of same infection.
• Later he developed classical syphilitic heart disease due to which he died in 1739.
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PHILLIPPE RICORDHe classified syphIlis into primary ,secondary and tertiary stages.
He distinguished gonorhoea from syphilis after carrying out over 2500 inoculations in humans.
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Etiology
Treponema pallidum• A spirochete; corkscrew
shaped• Motile with characteristic
movements like angulation,bending,rotatory motion and back and forth squiggle
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Transmission
Acquired
Mainly sexual
Rarely via blood
Accidental
Congenital
Trans placentally
Mode of transmission
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syphilis
Early syphilis
Infections < 24 months; highly infectious
Late syphilis
Infection > 24months; not infectious
Classification of syphilis
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9-90 days
3-12 weeks EARLY SYPHILIS;Highly infectious
24 MONTHS
LATE SYPHILIS
Stages of syphilis
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Different manifestations occur depending on the
stage of the disease
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Signs&
symptoms
primary
secondary
latent
tertiary
Congenital* Early* late
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Clinical features:-
Primary syphilis
Morphology of lesion Location of lesion Lymphadenopathy
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Morphology
• In 50% of patients ,the typical lesion is called Hunterian chancre
• Features:-
Single,painlessRegular,indurated(button
like)Reddish
plaque;frequently ulcerates
Ulcer:-oozes clear serum on pressure
Heals spontaneously (4-6 weeks) or on treatment
Primary syphilis
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• In the rest 50%,the ulcers are atypical o Painfulo Multipleo Indurated
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Location of ulcers
Male genital areas:-
Coronal sulans
Glans
Prepuce
Shaft of penis
Perianal areas in homosexual males
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Females:-
Labia minora
Labia majora
Mons pubis
Sometimes in vagina or cervix
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Extra genital lesions:-• Lips• Nipples• Fingers
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Lymphadenopathy in PS
Inguinal:-• Multiple• Small• Firm
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Secondary syphilis
• Systemic disease with cutaneous as well as extracutaneous manifestations.
• It manifest itself 3- 12 weeks after the appearance of primary chancre.
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Cutaneous lesion in SS
• Skin lesions may be a few or numerous
• Lesions are symmetrical early , become asymetrical later
• Rashes; of any morphologyMacular Papular Papulo squamousNodular
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Types of rashes in SS
Roseolar syphilide
Papular syphilide
Psoriasiform lesion
Malignant syphilide
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Roseolar syphilide
Symmetrical erythematous macular rashes
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Papular syphilide
Most common rash of SS
Dull red papules, initially discrete
Later coalesce to form annular lesions
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Psoriasiform lesion
• When scaling is predominant
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Malignant syphilide
• Pustular• Necrotic • Rupioid lesions
in Immuno compromised patients.
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•Hyper pigmented, coppery red, scaly lesions
Palm and sole
lesions
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• In intertriginous area, the papules may erode superficially
Condyloma lata:
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Mucosal lesions
•Dull erythematous plaques with grayish slough
Mucosal
patches:
•Mucous patches with serpiginous erosions
Snail-track
ulcers:
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Lymphadenopathy in SS
• Generalised, symmetrical, and rubbery
AxillaryCervicalInguinal
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Systemic involvement in SS
• SS is a systemic disease with invovement of many organ
system:• Musculo-skeletal system:
• Periostitis , arthritis• Ocular:
• Iridocyclitis, uveitis, choroidretinitis• Renal:
• Nephrotic symdrome• CNS:
• CSF Abnormalities
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Latent syphilis• Patient has only serological
evidence of syphilis without any clinical evidence.
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• Depending on the number of of years passed :Early latent (<2 yrs)Late latent syphilis(>2yrs)
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TERTIARY SYPHILIS
• It manifest 3-10 years after the primary stage
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TERTIARY SYPHILIS• Mucocutaneous tertiary
– Gumma*(well defined punched out ulcer)
• Neurosyphilis– Asymptomaticparenchymatous
/meningeal
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• CVS syphilis– Aortitis– coronary stenosis– aneurysm
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CONGENITAL SYPHILIS
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CONGENITAL SYPHILIS
• T.Pallidum can be transmitted by an infected mother to foetus in utero
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EARLY CONGENITAL SYPHILIS
.Appear with in first 2 yearof life Signs First appear 3rd-8th week of lifeA form of rhinitis is the first specific finding. In severe infection there is classic picture of marasmic syphilis-wrinkled pot bellied old man.
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Cutaneous eruptions,hepatosplenomegaly,bone and joint involvement are common.C/F similar to acquired SS but visceral and bone involvement are more common.
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Cutaneous lesions:bullous,
fissuring of lips,nasolabial
folds
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Late congenital syphilis
• Hutchison’s triad– Hutchinson’s teeth– Interstitial keratitis– 8th nerve deafness.
• Other manifestations – Saddle nose– Frontal bossing– Cluttons joint(painless
swelling of joint
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DIAGNOSIS
Demonstration of T.pallidumDark ground microscopyDirect immunofluroscent
stainingRecent method-ELISA and
PCR have failed to improve diagnostic detection rates.
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Serological testing
• VDRL[Non treponemal/Reaginic test] is good screening test and + in case of most SS & also in tertiary syphilis.
• Confirmatory test (treponemal)-TPHA,TPI, FTA - ABS
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Csf examination and chest radiography:- in tertiary syphilis.
Skin biopsy may be used for histopathologic changes and organisms in tissue can be demonstrated by silver staining.
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Chancre – IP:9-90 days– Painless, single
– Margin: regular– inflammatory zone: absent– Button-like; induration– Lymphadenopathy :shotty;
may be b/l, nontender– nonsuppurative – VDRL: +/_ve– DG M/S:+VE
Chancroid– 3-5 days– Very painful,Ulcer
inflamed,multiple
– Irregular– present– Soft, covered by a
membrane– Lymphadenopathy:bubo;
u/l, tender– suppurative– _ve– _VE
Differential diagnosis
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TREATMENT
COUNSELING• Advice on safe sex:Use of
condoms.• Sex avoidance till healing
of lesions• Follow up testing for
HIV;hep B virus & VDRL at 3 months & further if necessary
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TREATMENTEarly syphilis
-Benzathine penicillin(2.4 mega dose)
Late syphilis– Three week i/m
injection of benzathine penicillin
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