SYPHILIS

B Y : A L I H A S S A N

? - ?

Syphilis….is a contagious bacterial infection that

is transmitted through contact with an

chancre on an infected person, usually

during intimate sexual contact

History

1493 1526

?

Origins

- origin of syphilis has not been agreed on by researchers

1.Christopher Columbus and his crew or other explorers brought it back with them from the

“new world”.

2. Syphilis was always present in the “old world” but it wasn’t yet identified as a separate disease

from leprosy.

3.Syphilis developed from the related diseases bejel and yaws.

1495

1500

Christopher Columbus and his

crew returns from the “new world”

possibly carrying syphilisFernandez de Oviedo was the first person

to mention the “American origin”

of syphilis

# of cases in Europe reach

epidemic proportions

http://www.latinamericanstudies.org/columbus/older-columbus.gif

Christopher Columbus

The first reference to the “French sickness” is made

during Charles VIII’s Italian campaign

1514

1530

The disease recieves the name syphilis

from a poem entitled “Syphilis Sive

Morbus Gallicus” by Jerome Francastor

A complete description of the “French sickness” was

given by Juan de Virgo

History

1996

the rising occurrence of syphilis around

the world causes hope of eradicating the disease

to lessen after being raised by the success of penicillin

1964-1965

so few cases that the medical and

scientific community is prepared to

consider it erradicated

2001

of cases on the rise in western countries

http://nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-bio.html

1928

Sir Alexander Fleming discovers

penicillin while working on the

influenza virus.

1905

Treponema Pallidum, the bacteria that

causes syphilis is discovered on March 3

in Berlin by Chauvinand Hoffmann

Sir Alexander Fleming

DISEASE - CAUSE/GENERAL INFO

classified as an STI (sexually

transmitted infection)

caused by the bacterium Treponema

Pallidum

spiral shaped

enters through open cuts or sores in the

mucous membrane

contracted through contact with a

chancre during sexual contact or

passed from mother to baby called

congenital syphilis

progresses through 4 stages; primary,

secondary, latent and tertiary stages

stages get progressively worse if left

untreated

highly contagious

potentially fatal

http://www.uveitis.org/images/syphil1.jpg

Treponema Pallidum

Disease - Symptomsnot all people show visible signs of the

disease at the beginning

Primary Stage

a small painless ulcer like sore called a chancre appears at the site of initial infection

chancre usually appears 2-3 weeks after the initial infection

a rash near the chancre may also appear

the chancre may go unnoticed because of the location in the mouth, anus, vagina or throat

usually disappears in 4-6 weeks without treatment

the bacteria is still multiplying in the body

contagious

chancre

http://www.co.multnomah.or.us/man2manpdx/image

s/primary_oral_syphilis.jpg

http://www.homeomiracles.com/Index/Male/Male_article/STD/Sexually%20transmitted%20Diseases.html

Secondary Stage

begins a few weeks to months after the chancre heals

• rash with flat and raised patches

- frequently on palms, soles, can be anywhere on body

• lesions in the mouth, vagina, penis, mucus patches; condyloma lata

• fever

• swollen glands

• loss of appetite

• fatigue

• aches and pains in bones or joints

• patchy hair loss

• chancre still present in some cases

bacteria has spread to the blood

most contagious stage

resolves in 2-6 weeks without

treatment

Disease - Symptoms

http://www.ratsteachmicro.com/Assets/Syphilis/syphilis/poem.jpg

http://www.worldsbest-sexual-health-site.com/images/Hand.jpg

http://www.scielo.br/img/revistas/abd/v80n1/ia09f07.jpg

Disease - Symptoms

Latent Stage

characterized by the lack of symptoms

no symptoms may appear for months or years

syphilis is still alive in the body

bacteria starts to damage the internal organs; brain, heart, sexual organs

damage can go unnoticed until the next stage

Congenital Syphilis

• during the secondary stage the infection can be transferred to the baby

• if the mother is not treated during pregnancy it can cause deformations, or possibly death

• tested after birth; if the baby has syphilis it is treated right away

http://services.epnet.com/GetImage.aspx/getImage.aspx?ImageIID=6227

http://www.neonatology.org/classics/hess1922/figures/fig168.gif

Disease - Symptoms

Tertiary Stage

• occurs many years later, 5 to 50 years after secondary stage symptoms disappear

• characterized by paralysis, gradual blindness, deterioration of the brain, loss of co-ordination, shooting pains, and death

• gummatous syphilis - destructive lesions of bones, skin or liver

• cardiovascular syphilis - severe damage to heart and blood vessels, inflammation of the aorta, heart disease

• neurosyphilis - nervous system disorders; brain, eye, spinal cord, auditory system; deafness

• brain - can cause paralysis, blindness, dementia or insanity

http://www.ynhh.org/cardiac/heart/exterior_heart_anatomy.jpg

http://www.ipmc.cnrs.fr/~duprat/neurophysiology/images/brain2.jpg

NEUROSYPHILIS

Divided into 5 groups, which may overlap:

Asymptomatic neurosyphilisSyphilitic meningitis Meningovascular syphilisGeneral paresisTabes dorsalis

SYPHILITIC MENENGITIS‘OAseptic meningitis’ at any One year after primary stage. CSF shows: Lymphocytic pleocytosisElevated protein and usually normal glucose concentrations

VDRL test is usually reactive. It can mimic tuberculous or fungal meningitis or aseptic

meningitis of various causes. Often involves the base of the brain and may result in

unilateral or bilateral cranial nerve palsies. Without treatment, syphilitic meningitis usually

resolves, like the other manifestations of early syphilis

CARDIOVASCULAR SYPHILIS

Ma5-10 years after initial infection.

Primarily aortic insufficiency and aortic aneurysm of the

ascending aorta. Other large arteries may sometimes be

involved, and rarely the coronary ostia may be involved.

Caused by obliterative endarteritis of the vasa vasorum

with resultant damage to the intima & media of the great

vessels, causing dilatation of the ascending aorta and

eventually results in stretching of the ring of the aortic

valve, producing aortic insufficiency. The valve cusps

remain normal.

Asymptomatic aortitis is best diagnosed by visualizing

linear calcifications in the wall of the ascending aorta.

More common in men than in women and possibly in

blacks than in whites.

hard to diagnose because the symptoms

are similar to other diseases such as

the flu

different tests used for the different stages

primary stage - physical examination,

description of symptoms taken, fluid

from chancre taken and examined

secondary stage - blood tests

tertiary stage - spinal tap may be required

in case of neurosyphilis

Diagnosis

http://www.raisingkids.co.uk/images/editorial/preg_test02.jpg

http://www.healthsystem.virginia.edu/internet/cstap/images/IMG_1457.jpg

TESTS FOR SYPHILIS

Dark field Microscopy

VDRL, RPR

FTA-ABS, MHA-TP

Direct Fluorescent Antibody (DFA)

TREPONEMAL TESTS

FTA-ABS

Used as a confirmatory tests.

Sensitivity and specificity high. 85% of patients with primary syphilis are reactive 99% with secondary syphilis > 95% with late syphilis (It may be the only test with a positive result for

patients with cardiovascular or neurologic syphilis).

Remains reactive for life in most, despite adequate therapy. Only 15-25 % of those treated for primary syphilis may turn negative by 2-3 yrs.

False positive in other treponemal diseases (pinta, yaws..) and other spirochete diseases (Lyme, leptospirosis…)

MHA-TP test (micro haemagglutination assay for T. pallidum; agglutination of RBCs to which T. pallidum antigens have been fixed is the basis).

Treatment

antibiotics; usually penicillin was used but nowadays

Flouroquinolones like levofloxacin are used

doxycycline may also be used

administered either intramuscularly or intravenously daily

then asked to attend injections for two years monthly

And then every three months for examination and blood test to ensure and check the success of the treatment

http://www.volstate.edu/HSCenterofEmphasis/images/image2.jpg

http://www.brooksidepress.org/Products/Injections/320SubQ.JPG

• regular check-ups are needed after the treatment to make sure the infection is gone

• treatment can be done at any stage but any damage done is irreversible

PREVENTION

Abstinance is the most effective way to prevent the contraction of the disease

practice safe sexbe tested regularly for syphilis if married or sexually active • best way to detect syphilis early

get treated if you have it, to prevent the spread

avoid direct contact with blood, sores or bodily fluidlearn about safe sex and injection practices

get tested for syphilis if you are pregnant so you can be treated; won’t pass it on to your baby

If you have it….• Get yourself treated and avoid sexual contact• may need to be tested.

http://www.avert.org/photo_library/images/normal_photo_no_240.gif

FUTURE OUTLOOK

raise awareness of the effects of the disease

inform people of safe sex practices in order to prevent the

spread

hope to be able to eradicate syphilis using the above tactics

http://www.cdc.gov/std/syphilis/syphilis2.jpg

http://www.thedaily.washington.edu/image/preview/158?x=225

REFERENCE PAGE

Archaeological Institute of America Tours.Origins of Syphilis on the World Wide

Web: < http://www.archaeology.org/9701/newsbriefs/syphilis.html >

Canadian Association for Adolescent Health. Syphilis on the World Wide Web:

< http://www.youngandhealthy.ca/caah/Informations/STI/t428c431s509x413/Syphilis.aspx >

Endersbe, Julie K Sexually Transmitted Diseases. Manakato, Minnesota: Capstone Press.

Health Canada. on the World Wide Web:

< http://www.hc-sc.gc.ca/iyh-vsv/alt_formats/cmcd-dcmc/pdf/syphilis_e.pdf >

Medline Plus. Medical Encyclopedia: Syphilis.on the World Wide Web:

< http://nim.nih.gov/medlineplus/ency/article/001327.html >

Nobel Foundation. Sir Alexander Fleming. on the World Wide Web:

< http://nobelprize.org/cgi-bin/print?from=/nobel_prizes/medicine/laureates/1945/fleming-bio.html >

Quetel, Claude.. History of Syphilis. Cambridge: Policy Press.

Secrets of the Dead.. The Syphilis Enigmings on the World Wide Web:

< http://www.pbs.org/wnet/secrets/case_syphilis/p_index.html >

Syphilis. In Diseases (Vol 8, pp.32-34). United States (CT): Scientific Publishing, Inc.

Syphilis. In Health Matters (Vol 3 pp 126-127). Danbury, CT: Grolier Educational.

Reference Page

Syphilis.. In Encyclopedia pf Family Health (Vol 15 pp2153-2155). Tarrytown, NY: Marshall Cavendish, Crop.

The Flying Walrus.. Health. on the World Wide Web: <

http://www.yorku.ca/walrus/06-12/health02.html>

The Society of Obstetricians and Gynaecologists of Canada. . Sex Facts in Canada on the World Wide Web: <

www.sexualityandu.ca/media-room/pdf/Sex-Stats-Fact-Sheet_e.pdf >

Pharmacology by k.d tripathi

Pathalogy by Dr. Vithal kulkarni

Biochemistry by Eugene C. Toy M.D