Syphilis

Syphilis Basics - The Great Mimic

• Agent: Treponema pallidum, a thin, motile spirochete.
• Visualized: Dark-field microscopy, silver stains (e.g., Warthin-Starry). Cannot be cultured in vitro.
• Transmission: Sexual contact, transplacental (congenital syphilis).
• "The Great Mimic": Diverse clinical manifestations across stages.

⭐ T. pallidum possesses endoflagella (axial filaments) located in the periplasmic space, causing its characteristic corkscrew motility and facilitating tissue invasion.

Clinical Stages - Spirochete's Journey

• Incubation: 9-90 days (average 21 days).
• Spirochete dissemination occurs early.

• Primary (1°):
  • Chancre: Painless, indurated ulcer at entry site.
  • Regional lymphadenopathy: Rubbery, non-tender.
  • Heals spontaneously: 3-6 weeks.
• Secondary (2°):
  • 2-8 weeks post-chancre (can overlap).
  • Systemic: Fever, malaise, generalized lymphadenopathy.
  • Rash: Maculopapular, non-pruritic; palms & soles characteristic.
  • Condylomata lata: Moist, flat papules in intertriginous areas.
  • Mucous patches; Moth-eaten alopecia.

  ⭐ Highly infectious stage; spirochetemia.

• Latent:
  • Asymptomatic, seropositive.
  • Early latent: <1 year duration (potentially infectious).
  • Late latent: ≥1 year or unknown (less infectious).
• Tertiary (3°):
  • Develops 1-30 years after infection. Non-infectious.
  • Gummatous syphilis: Gummas (destructive granulomas) in skin, bone, viscera.
  • Cardiovascular syphilis: Aortitis, aortic aneurysm.
  • Neurosyphilis: Tabes dorsalis, GPI. (Can occur at any stage).

Neuro & Cardio Syphilis - Late-Stage Havoc

• Neurosyphilis: Manifests years after infection.
  • Meningovascular: Stroke-like symptoms, cranial nerve palsies.
  • Parenchymatous:
    • Tabes Dorsalis: Sensory ataxia, Argyll Robertson pupil (ARP), lancinating pains, Charcot joints. 📌 ARP: Accommodates but does not React.
    • General Paresis of Insane (GPI): Dementia, personality changes, delusions.
  • CSF: VDRL reactive, ↑protein, pleocytosis.
• Cardiovascular Syphilis:
  • Aortitis (esp. ascending aorta), aortic aneurysm, aortic regurgitation.
  • "Tree bark" intimal appearance.

  ⭐ Tabes dorsalis features loss of proprioception and vibratory sense. oka

Congenital Syphilis - Inherited Woes

• Transmission: Transplacental, typically after 4th month.
• Early (≤2 years): Snuffles (rhinitis), maculopapular rash (palms/soles), hepatosplenomegaly, osteochondritis (pseudoparalysis of Parrot), anemia, thrombocytopenia.
  • 
• Late (>2 years): Hutchinson's triad (interstitial keratitis, Hutchinson's teeth, 8th nerve deafness), saber shins, Clutton's joints, mulberry molars, saddle nose, frontal bossing.

  ⭐ Hutchinson's teeth: Centrally notched, widely spaced, peg-shaped upper incisors.

Diagnosis Decoded - Finding Treponema

• Direct: Dark Field Microscopy (DFM) identifies motile spirochetes from primary/secondary lesions (chancre, condyloma lata).
• Serology (Antibody Detection):
  • Non-Treponemal Tests (NTT):
    • VDRL, RPR (Rapid Plasma Reagin).
    • Screening; monitor treatment response (titers ↓ with therapy).
    • 📌 False Positives (VDRL): Viral, Drugs, Rheumatic fever, Lupus, Leprosy, Pregnancy.
  • Treponemal Tests (TT):
    • FTA-ABS, TP-PA, TPHA, specific EIAs/CIAs.
    • Confirmatory; detect specific anti-treponemal antibodies. Usually lifelong positive.

⭐ VDRL is the standard serological test for CSF examination to diagnose neurosyphilis.

Treatment & Prevention - Penicillin Power

• DOC: Penicillin G.
  • Early Syphilis: Benzathine Penicillin G (BPG) 2.4 MU IM, single dose.
  • Late Syphilis (non-neuro): BPG 2.4 MU IM weekly x 3.
  • Neuro/Ocular: Aqueous Penicillin G 18-24 MU/day IV, 10-14 days.
• Allergy: Doxycycline (avoid in neuro/pregnancy).
• JHR: Acute febrile reaction post-treatment.
• Follow-up: VDRL/RPR titres.
• Prevention: Partner tracing, safe sex.

⭐ Penicillin G: sole Rx for neurosyphilis & syphilis in pregnancy.

High‑Yield Points - ⚡ Biggest Takeaways

• Treponema pallidum causes syphilis; primary: painless chancre (use dark-field microscopy).
• Secondary: maculopapular rash (palms/soles), condylomata lata, lymphadenopathy.
• Tertiary: gummas, cardiovascular syphilis (aortitis), neurosyphilis (tabes dorsalis, Argyll Robertson pupil).
• Congenital: early (snuffles); late (Hutchinson's triad: teeth, keratitis, deafness).
• Serology: VDRL/RPR (non-treponemal for screening/monitoring); FTA-ABS/TPHA (treponemal for confirmation).
• Treatment: Benzathine Penicillin G. Beware Jarisch-Herxheimer reaction (post-treatment fever).