SYPHILIS. Syphilis is caused by a spirochete named TREPONEMA PALLIDUM. SYMPTOMS. PRIMARY SYPHILIS. *10-90days post infection. *Painless ,genital ulcer on cervix /penis called CHANCRE. *Inguinal lymphadenopathy. SECONDARY SYPHILIS. *Occurs within the first 2 years of infection. *Generalized polymorphic rash affecting the palms and soles. *Generalized lymphadenopathy. *Genital condyloma lata. *Anterior uveitis. TERTIARY SYPHILIS. *Presents in up to 40 %of people infected for at least 2 yrs ,but may take 40+yrs To develop. *Neurosyphilis Tabes dorsalis and dementia. *Cardiovascular syphilis.affects aortic root. *Gummata -inflammatory plaques or nodules.q DIAGNOSIS. VDRL / RPR test. Primary lesion smear may show spirochetes on dark field microscopy. TPHA test Treponema pallidum hemagglutinin assay. TREATMENT. EARLY LATENT PHASE. Benzathine penicillin G 2.4 million units IM ×1 dose. LATE LATENT PHASE. Benzathine penicillin G 2.4 million units IM×3 doses given at weekly intervals.. PRIMARY SYPHILIS. Benzathine penicillin G 2.4 million units IM × 1 dose. SECONDARY SYPHILIS. Benzathine penicillin G 2.4 million units IM×1 dose TERTIARY SYPHILIS. Benzathine penicillin G 2.4 million units IM ×3 doses given at weekly intervals. NEUROSYPHILIS. Aqueous crystalline penicillin G 3-4 million units // IV // 4 hours amounting to 24 million units/day for 10-14 days. Alternative regimen for penicillin sensitive patients and non-pregnant patients. Doxycycline 100 mg /orally / bd / 30 days. Or Tetracycline 500 mg /orally /4 times a day / 30 days. Alternative regimen for penicillin sensitive and pregnant patients. Erythromycin 500 mg /orally /4 times a day /30 days. CHANCRES usually begin as s SOLITARY , RAISED,FIRM,RED PAPULES which erode into the TYPICAL,PAINLESS,INDURATED,CLEAN BASED ULCER WITH SLIGHTLY ELEVATED EDGES. THE RASH IN SECONDARY SYPHILIS IS NON PRURITIC AND BILATERALLY SYMMETRICAL. NON TENDER LYMPHADENOPATHY. .



Very nice presentation. Helpful for many doctors. Thank you very much Dr. Suvarchala Pratap for sharing this. Just to add few points :- Causative agent : Name has changed, 1 ) Treponema pallidum sub sp pallidum - Responsible for Venereal Syphilis. Because other two genetically identical sub sp are there but produce different spectrum of the disease, For example, Treponema pallidum sub sp endemicum, produces Endemic Syphilis, spread by skin to skin contact predominantly amongst children and breastfed children may transmit Endemic Syphilis to his/her mother during breastfeeding, and mother develops Primary Syphilis at the niplle. Sexual and non sexual ( Finger prick of doctors and Nursing personnel from infected patients is possible , Primary Syphilis will occur in the tips of fingers, where needle stick injury has occurred ; Fresh blood from infected doner , (VDRL Test Negative by screening test) all recipient will suffer from Secondary Syphilis, bypassing Primary stage. In Primary Syphilis sensitivity of VDRL test is 70 % to 85 % indicates 15 % to 30 % voluntary doner with primary Syphilis will pass this VDRL (Nonspecific test/ STS Standard Test of Syphilis) , as False-Negative , though their fresh blood contains spirochetes of Syphilis. Fortunately, this bacteria can't tolatate cold, ie, they remain viable upto 48 - 72 hours at refrigerator, where blood pouch is being stored at 2-8 degree Celsius. This means from 4th day onwards stored blood transfusion is safe. In the clinical stages of syphilis : Latent syphilis lies between secondary and Tertiary Syphilis where it can't be detected. Primary Syphilis produces painless indurated rubbery feeling Chancre, known as "Hard Chancre " Whereas "Soft Chancre" is painful and produce by Haemophilus ducryei. RPR tests is much less cumbersome, and results are comparable to VDRL, are doing nowadays instead of VDRL , both are nonspecific. Acute and Chronic BFP (Biological False Positive ) are there. So, to interpret the results very cautiously and if positive, should be confirmed by TPHA or most specific test for Syphilis, FTA-Abs test. If a patient acquire Primary Venereal Syphilis and don't take Rx , He/she will have Secondary Syphilis and again he/she don't take Rx, he/she will proceed to Latent Syphilis. Remains in this stage for few years, 5 years approx in general, Or he/she will recover from Syphilis. Approx 2/3 rd of patients in Latent Syphilis will manifest in the form of Tertiary Syphilis along with it's complications.......

Excellent input Doctor.I was not aware of VDRL negativity in 30% of patients and live spirochetes in blood which perish in cold temperature. Once I had a primary infertility couple,bot VDRL positive and TPHA positive but has no lesions.Also says that there is no extramarital relationship.They didn't have any soft CHANCRE. How do you diagnose latent syphilis when you can't detect it.You can say that a patient is in the latent stage in a known case of syphilis who tests Negative .If a patient is not diagnosed in primary and secondary syphilis,then how can you identify latent phase.?

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@ @Dr. Suvarchala Pratap Mam, Clinically Primary Syphilis can be detected by "Hard Chancre ", at the site of entry of spirochetes , which is painless, relatively avascular , circumscribed, indurated, superficially ulcerated lesion. In some cases 'Hard Chancre' may not be visible particularly in uterine cervical region. In Secondary Syphilis , clinical findings may be i) Roseolar or papular skin rashes . ii) Mucous patches in oropharynx . iii) Condylomata at mucocutaneous junctions are the characteristic lesions usually found. After the secondary lesions disappear, there is a period of quiescence, which is called Latent Syphilis. Clinical diagnosis at this stage is not possible. The only way to diagnose a case of Latent Syphilis is made possible by Serological Tests. VDRL /RPR though nonspecific, it has got prognostic value. Whereas TPHA once positive, ( after treatment and cure of the patient) , it will remain positive lifelong. Once you had a primary infertility couple both VDRL positive and TPHA. .... Now coming to this case :- VDRL / RPR when become positive, lab reported quantitative value ie, Titre. For example :- Husband - VDRL Test Reactive ( 1:64 dil.) . Wife - VDRL Test Reactive (1:16 dil.) (dil. Stands for dilution ) . From this , Interpretation :- 1 ) Both are suffering from Syphilis. 2 ) Husband first acquired the disease (1:64) , and then transmit Syphilis to his wife (Titre 1: 16 ) . Reverse titres also possible and been observed by me, where wife transmit Syphilis to husband. When a person is already having active infection, it is believed that reinfection does not occur after exposure, which is called "PREMUNATION " or " INFECTION IMMUNITY" . Reading Syphilis in pregnancy which is vertically transmitted / transplacental transmission :- Woman with early Syphilis infects her foetus much more (75 - 95 % ) ,than woman with Syphilis of over 2 years' duration. Lastly, the classical Obstetric history of woman with untreated Syphilis is very much typical one of abortions -> Stillbirths -> Live births of infants with stigmata of Syphilis, and finally -> Healthy newborns. ( MAY BE USEFUL FOR UG STUDENTS ).

Please read ...... (75 - 95 %) , than woman with Syphilis of over 2 years ' duration (35%) .

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Dr. Suvarchala Pratap mam very nice presentation. Mam I think that now a days Syphilis is not come havoc in persons because everyone must taken penicillin in his whole life.

Easy and valuable demonstration of Syphilis with its treatment .Thanks ,Madam Ji . Etymology of Syphilis :- This word Syphilis first appeared in a poem by Fracstorius ( 1530 )as Syphilitic Shepherd .


Very nice presentation mam

Very nice information

Good info

Very nice information, very good presentation & pictures. Thanks for sharing.

Dr Suvarchala Prtap and Dr Puranjoy Saha thanx to sharing this important information

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