SYPHILIS – 

INTRODUCTION

• Syphilis is a chronic sexually transmitted disease caused by
  Treponema pallidum.
• It is a spirochete bacterium (thin, spiral-shaped).
• Disease progresses in stages and can affect multiple organs.
• Common in developing countries, but re-emerging globally.

MODE OF TRANSMISSION

1. Sexual Transmission (Most common)

• Through vaginal, anal, or oral sex
• Entry via broken skin or mucous membranes

2. Non-Sexual Transmission

• Blood transfusion (rare)
• Accidental inoculation
• Mother → fetus (Congenital syphilis)

PATHOGENESIS

• Incubation period: 10–90 days (average 21 days)
• Infection spreads via bloodstream
• Disease progresses in 3 stages:
1. Primary
2. Secondary
3. Tertiary

STAGES OF SYPHILIS

1. Primary Syphilis

• Chancre (classic lesion):
• Painless, firm, round ulcer
• Usually single
• Site: Genitals, mouth, lips
• Associated with regional lymphadenopathy
• Heals in 3–6 weeks (even without treatment)

2. Secondary Syphilis

• Occurs 2–3 months after primary stage
• Highly infectious

Features:

• Generalized rash (palms & soles)
• Non-itching (non-pruritic)
• Mucous patches (silver-grey lesions)
• Lymphadenopathy
• Condyloma lata (moist lesions)

3. Tertiary Syphilis

• Occurs after years (2–3+ years)
• Less infectious but severe damage

Complications:

• Cardiovascular syphilis
• Aortic aneurysm
• Neurosyphilis
• Dementia, paralysis
• Gummas
• Soft necrotic lesions in organs (liver, bone, brain)

CLINICAL FEATURES

Primary Stage

• Painless chancre
• Lymph node enlargement

Secondary Stage

• Rash (palms, soles, trunk)
• Mucous patches
• Fever, malaise

Late Stage

• Organ damage:
• Brain → dementia
• Eyes → blindness
• Heart → aneurysm

CLINICAL MANIFESTATIONS

• Rash
• Fever
• Swollen lymph nodes
• Sore throat
• Headache
• Weight loss
• Muscle aches

DIAGNOSIS

1. Dark-field Microscopy

• Detects motile spirochetes from lesions

2. Serological Tests

Non-treponemal tests

• VDRL (screening)
• RPR

Treponemal tests

• TPHA / TPPA
• FTA-ABS

MANAGEMENT

1. Drug of Choice

• Penicillin (first-line)

2. Treatment Regimens

Early Syphilis

• Benzathine penicillin G
  → 2.4 million units IM (single dose)

Late Syphilis

• Benzathine penicillin G
  → 2.4 million units IM weekly × 3 doses

OR

• Procaine penicillin
  → Daily IM for 17–21 days

3. Alternative Drugs (Penicillin Allergy)

• Doxycycline
• Tetracycline
• Azithromycin
• Erythromycin (least effective)

⚠️ Avoid ceftriaxone in severe penicillin allergy (cross-reactivity risk)

4. Important Treatment Points

• IM route preferred → better bioavailability
• Treat sexual partners
• Screen for other STDs
• Follow-up with serological tests

PREVENTION

• Use of condoms
• Sexual health education
• Awareness in high-risk groups
• Screening:
• Pregnant women
• Avoid sexual contact:
• Until treatment complete
• Until lesions heal
• Partner testing & treatment

COMPLICATIONS

• Neurosyphilis → dementia, paralysis
• Cardiovascular → aortic aneurysm
• Blindness
• Organ damage (liver, bone, brain)

ULTRA-FAST REVISION

• Organism: Treponema pallidum
• Primary lesion: Chancre (painless)
• Most infectious stage: Secondary
• Best test: Dark-field microscopy
• Screening test: VDRL
• Drug of choice: Penicillin
• Early treatment: Single IM dose
• Late treatment: Weekly × 3 doses