Late Latent Syphilis

by

Nagaraju B

SYPHILIS INTRODUCTIONA. ACQUIRED SYPHILIS

Primary syphilis Secondary syphilis Latent syphilis

Early latent Late latent

Tertiary syphilisB. CONGENITAL SYPHILISC. SYPHILIS RELATED DISEASE

Yaws [TP Pertenue], Pinta [TP endemecum], Bejel [TP carateum]

Yaws

PRIMARY SYPHILIS

10 days- 6 weeks, usually ~21 days. Develops at site of contact/inoculation.Classically: single, painless, clean-based, indurated

ulcer, with firm, raised bordersMostly ano-genital, but may occur at any site (tongue,

pharynx, lips, fingers, nipples, etc...)Non-tender regional adenopathyVery infectious

SECONDARY SYPHILIS 4 wks to 6 months after primary chancre rash on body including palms & soles. Fever, malaise, headache, sore throat, alopecia, wt loss Highly infectious

LATENT SYPHILISEARLY & LATE

Positive syphilis serology without clinical signs of syphilis

begins with the end of secondary syphilis and may last for a lifetime

Early(infectious) and late phase(Non-infectious)

Untreated syphilis 30% cure 30% latent 30% tertiary phase

TERTIARY SYPHILIS Years/ decades later Granulomatous lesion called

Gumma Skin, bones, liver Destructive lesions in CNS-stroke,

paresis, tabes, neuropsychiatric symptoms etc.)

CVS-Aortitis, aneurysm, valvularinsufficiency

Non infectious

INTERPRETATION OF SEROLOGICAL TESTS FOR SYPHILIS

Possible ExplanationTreponemalTests

(TP-PA/ FTA-ADS)

Non-Treponemal

tests (RPR/ VDRL)

Syphilis - recent or previousYaws or pinta++

No syphilis False positive –+Consistent with previously treated or untreated SyphilisYaws, Pinta, Bejel

+–

No syphilis Syphilis in incubation period ––

Etiology

Transmission

Pathology

Clinical Manifestations

Diagnosis

Treatment

Penidure:

MoA: Interferes with cell wall mucopeptide synthesis

during active multiplication resulting in bactericidal activity

against susceptible organisms

Dosing Forms

Warnings

Contraindications

Storage

Brands

Overdose

Drug Interactions

Side effects

ADRs

Patient Name -XXXX

IP/OP No -15197/14

DOA - 8/11/14

DOD - 10/11/14

Department - Med/IV

Age - 29years

Sex - Male

SUBJECTIVEChief complaint/ History of Presenting illness:

• c/o on and off fever, generalized weakness, pain in both groins,skin rash and weight loss for 6 months.

• c/o on and off mouth ulceration for 1-2 yrs.

• c/o recently started hair falling.

• c/o sore on his penis was almost completely healed withouttreatment.

Previous history:

Participated with unknown tourist foreigner without condom 6 weeks prior.

Last HIV antibody Test (2 month prior) was negative.

Diagnosed and treated VDRL+ 7 years ago.

Past MedicationHistory/Allergy:

Allergy to Tetracycline but not with Doxycycline.

Personal history:

Diet- Mixed

Appetite- Decreased

Sleep- Normal

B&B- Painful

Habits- h/o multiple sexual partnership when go on line duties.

Physical examination : A 29 year male patient moderately built, conscious, cooperative,

well-developed, well-nourished Vital signs:

BP - 120/80mmHg PR - 86bpm

RR - 18cpm Temp - 101.1°F.

Family history:

no f/h/o DVL issues

OBJECTIVE

P[-], I[-], C[-], C[-], L[-], E[-]

Systems:-

P/A-

RS

WNL

CVS

CNS

Provisional diagnosis :

? LGV/ GI/ STS

[ Referred to Venerologist for further evaluation and adv.]

Test Test Value Normal Value

08/11 09/11 10/11

Body Temp 101 99.0 99.1 37 °C (98.6 °F)

NACO 08/11 Non-Reactive

VDRL Kit type

(J& Mitra) Reactive

VDRL Kit type

(Span)

Urine complete Pus cells+

N.Gono NAAT

Chlamydia NAAT

Negative

FTA-ABS

TPHA

10/11 +ve

1:320

DFM of Penile

lesion

TP+

ASSESMENT

Based on the subjective & objective evidence the

patient was diagnosed to have Un-treated Syphilis

(late latent stage).

BRAND NAME GENEROIC

NAME

DOSE FREQ

UENC

Y

DATE DATE

END

Tab. Febrex 650 Paracetamol 650mg 1tid 8/11 10/11

Inj. Penidure 2.4

mU IM ATD

Benzathine

Pencillin G

2.4 mU - 10/11 -

Prescription on DAMA

Inj. Penidure 2.4 mU IM ATD Weekly for another 2 doses

Tab. Supradyn 1od

TREATMENT CHART

Suggestion to Physician-

Confirmatory tests for retroviral disease would have

been advised.

Differential diagnostic tests for LGV and GI might have

been advised when chancre and pain in both groin

reported.

PLAN

Advice to patient-

Safe sex practices.

Nil sexual contact until lesion or rash resolves.

Adhere to medication.

Bring partner to be screened and treated.

Repeat syphilis serology in 3 months to asses

response to treatment.

Once again after 1 or 2 months, just screen out for

retroviral disease profile.

Contact tracing of at risk partners.

THANK YOU…

‘’SYPHILIS IS ATREATABLE INFECTIONAND CURABLE WITH

ADEQUATE THERAPY IFPROVIDED BEFORE

ADVANCED DISEASEDEVELOPS”