SYPHILIS Three stages in syphilis •Primary syphilis -Three week incubation period between exposure and appearance of lesion (chancre) -Chancre may be internal or external, is painless, and goes away in 2-6 weeks without treatment -Fluid from chancre is infectious (contains bacteria) -Can diagnose by using special microscopic technique to look at the bacteria (blood test not useful) -Bacteria transferred to another person by direct sexual contact (contact with fluid from lesion) -Person may be asymptomatic for 2-24 weeks before next stage •Secondary syphilis -Skin rash typical of secondary syphilis -Rash is systemic, may occur on thighs or trunk, with many lesions -Secondary syphilis is contagious, but treatable -Rash goes away in 2-6 weeks regardless of treatment -Blood test for anti-bacterial antibodies useful in diagnosis during secondary stage Tertiary Syphilis -Bacteria no longer detectable in tertiary syphilis -Immune response made to bacteria causes damage to small blood vessels in various organs (brain, heart, kidney, liver, eyes, skin, bone) -Symptoms depend on organ damaged -Not treatable, not contagious, damage not reversible -Blood test for antibacterial antibodies useful in diagnosis •Tertiary syphilis may occur approximately three to 15 years after the initial infection, and may be divided into three different forms: •gummatous syphilis (15%), •Late neurosyphilis (6.
5%), and •cardiovascular syphilis (10%).
Without treatment, a third of infected people develop tertiary disease.
•Gummatous syphilis or late benign syphilis usually occurs one to 46 years after the initial infection, with an average of 15 years.
This stage is characterized by the formation of chronic gumma.
• which are soft, tumor-like balls of inflammation which may vary considerably in size.
They typically affect the skin, bone, and liver, but can occur anywhere.
•Neurosyphilis refers to an infection involving the CNS.
It may occur early, being either asymptomatic or in the form of syphilitic meningitis, or late as meningovascular syphilis, general paresis or tabesdorsalis which is associated with poor balance and lightning pains in the lower extremities.
Late neurosyphilis typically occurs four to 25 years after the initial infection.
•Meningovascularsyphilis typically presents with apathy and seizure, and general paresis with dementia and tabesdorsalis.
Also, there may be Argyll Robertson pupils, which are bilateral small pupils that constrict when the person focuses on near objects, but do not constrict when exposed to bright light.
•Cardiovascular syphilis usually occurs 10-30 years after the initial infection.
The most common complication is syphilitic aortitis which may result in aneurysm formation.
•Congenital syphilis -100% preventable if mother diagnosed and treated before 16th week of pregnancy -Bacteria can cross placenta to infect fetus before birth -Baby is born with stage 2 syphilis -25% of infected fetuses die before birth, 25% die after birth, 25% born with stage 2 syphilis, and 25% not infected -Case frequency of congenital syphilis closely follows frequency in pregnant women Symptoms include •inflammation of the cornea known as interstitial keratitis •deafness from auditory nerve disease •frontal bossing (prominence of the brow ridge) •saddle nose (collapse of the bony part of nose) •hard palate defect •swollen knees •saber shins •short maxillae •protruding mandible