Syphilis

Complex chronic bacterial infection affecting a variety of organs and with multiple manifestations.

Cause

Treponema pallidum
Transmitted sexually and from mother to foetus, rarely through blood transfusion or non sexual contact

Clinical features

The disease has several stages

Primary syphilis: 10-90 days following inoculation, characterized by a painless genital ulcer with clean base and indurated margins, regional lymphadenopathy. It can heal spontaneously but the disease will progress to secondary lesions
Secondary syphilis: few weeks to months (max 6 months) from primary lesions, characterised by:
- Generalised maculopapular rash
- Mucous membranes lesions (patches and ulcers)
- Weeping papules (condyloma alata) in moist skin areas
- Generalized non tender lymphadenopathy
- Fever, meningitis, hepatitis, osteitis, arthritis, iritis
Early latent syphilis (<1 year in duration): clinically quiescent but possible relapse of secondary syphilis
Late latent syphilis: clinically quiescent, not very infectious (but possible maternal foetal transmission)
Late (tertiary) syphilis: at any time after secondary syphilis (even many years):
- Infiltrative tumour of skin, bones, liver
- Aortitis, aneurysms, aortic regurgitation
- Central nervous system disorders (neurosyphilis): meningo vascular syphilis, hemiparesis, seizures, progressive degeneration with paraesthesias, shooting pains, dementia, psychosis

Investigations

Non-treponemal antibody tests (VDRL and RPR)
- Positive 4-6 weeks after infection
- Used as screening test
- Possibility of false positive
- Remains positive 6-12 months after treatment
Treponemal antibody tests (TPHA): very sensitive, used to confirm a positive non-treponemal test. Remains positive for long even after treatment so its positivity may not indicate active disease.

ManagementTreatment

Primary, secondary and early latent syphilis

Late latent or uncertain duration, or tertiary without neurosyphilis

Neurosyphilis

Followed by