Syphilis: Etiology, Pathology, Signs and Symptoms (1/2)

Syphilis (1/2): Etiology, Signs and Symptoms
Syphilis (2/2): Diagnosis and Treatment

Review-Literature: (CDC Guidelines, 2006) (Golden et al, 2003) (Parkes et al, 2004) (RKI-Ratgeber, 2010)(Schneede et al, 2003) (Zeltser and Kurban, 2004).

Definition

Syphilis is a chronic infectious disease with three stages caused by Treponema pallidum.

Epidemiology of Syphilis

Declining frequency, the incidence of syphilis dropped in the last decades from 20/100000 to 3/100000 for primary and secondary syphilis. Risk groups for syphilis are young sexually active people with multiple partners, lack of circumcision, lack of condom use, homosexuals, men are more often affected than women, low social status.

Etiology of Syphilis

Pathogen:

Syphilis is caused by Treponema pallidum, a bacterial spirochete. So far, Treponoma pallidum cannot be cultured.

Morphology of Treponoma pallidum:

15 μm long, spiral bacteria, visible in the dark field microscopy with screwlike motions [fig. Treponema pallidum].

treponema pallidum (pathogen of syphilis) in dark field and elektron microscopy

Treponema pallidum seen in dark field microscopy (left) and electron microscopy (right). Figures from W. F. Schwartz (left) and Dr. D. Cox, Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov/

Transmission of syphilis:

Syphilis is transmitted through direct mucous membrane contact. An infection occurs in 30% of sexual intercourses with infected partners. A transmission is even with less intensive contact possible. Rare transmission: intrauterine, perinatally or through blood transfusion.

Pathology, Signs and Symptoms of Syphilis

Pathology

The infection of endothelial cells leads to endarteritis obliterans and periarteritis with plasmacytic infiltration. Due to cellular immune mechanisms, granulomas develop in the further course of disease.

Symptoms of Primary Syphilis

Chancre:

The primary lesion (genital or oral ulcus) occurs with an incubation period of 10-90 days. The ulcus (also called chancre) is a firm painless ulceration, 5–15 mm and sharply demarcated [fig. chancre in primary syphilis]. Often, a painless inguinal lymphadenopathy can be observed.

fig. Chancre (genital ulcer) in primary syphilis: firm painless ulceration, which is sharply demarcated. Figure from Dr. Gavin Hart and Dr. N. J. Fiumara. Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov.

Symptoms of Secondary Syphilis

Symptoms of secondary syphilis develop 6 weeks to several months after untreated primary syphilis.

General symptoms: Fever, arthralgia.
Dermatologic symptoms: skin rash (maculopapular, papulo, pustulo or squamous types of rash). Many dermatologic diseases can be imitated.
Condyloma lata: painless warts or moist erosions in the genital and perianal region [fig. Condyloma lata in secondary syphilis]. The lesions contain Treponema pallidum and are highly infectious.

fig. Multiple condylomata lata in secondary syphilis; painless warts and moist erosions in the genital and perianal region. Figure from Brian Hill, New Zealand. Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov.

Latent Syphilis

Serologic evidence for syphilis without any signs of infection is called latent syphilis. If the initial infection of syphilis is suspected to be within the last two years, early latent syphilis is probable. If the initial infection is suspected to have occurred more than two years ago, late latent syphilis is diagnosed.

Symptoms of Tertiary Syphilis

Tertiary syphilis develops within years (usually 1–10 years) after untreated primary syphilis with onset in different organ systems:

Skin: brown nodules of the skin
Aortic aneurysm: due to endarteritis of the vasa vasorum.
Gumma: granulomas in bone, skin and mucous membranes. Cutaneous gumma may ulcerate.
Neurosyphilis: asymptomatic or symptomatic meningitis, hemiplegia, epilepsy, progressive paralysis (cerebral atrophy, dementia, psychosis), tabes dorsalis (gait ataxia, bladder dysfunction).
Eyes: uveitis, retinitis and neuritis of the optic nerve.

Symptoms of Congenital Syphilis

Depending on the stage of syphilis at the beginning of the pregnancy or the time of infection, there is a risk for the fetus for an infection with syphilis. The infection increases the risk of a stillbirth, a miscarriage or the birth of the child with congenital syphilis. The probability of a "vertical transmission" amounts to 80–90% in primary syphilis, 40% in early latent syphilis and 10% in late latent syphilis. In infants (0–2 years), early congenital syphilis manifests with syphilitic rhinitis, interstitial hepatitis, pseudoparalysis and various lesions of the skin. In childhood (>2 years), late congenital syphilis manifests with a saddle nose, skin lesions and rarely with the Hutchinson's triad, deafness, Hutchinson's teeth (centrally notched incisors), and interstitial keratitis.

NGU Urethritis

Index

Syphilis: Treatment

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

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References

Center for Disease Control and Prevention.:: Sexually transmitted diseases treatment guidelines 2006.
in: MMWR
2006; 55 (No. RR-11): 1–93.
Golden u.a. 2003 GOLDEN, M. R. ; MARRA, C. M. ; HOLMES, K. K.:: Update on syphilis: resurgence of an old problem.
In: Jama
290 (2003), Nr. 11, S. 1510–4
Parkes u.a. 2004 PARKES, R. ; RENTON, A. ; MEHEUS, A. ; LAUKAMM-JOSTEN, U.:: Review of current evidence and comparison of guidelines for effective syphilis treatment in Europe.
In: Int J STD AIDS
15 (2004), Nr. 2, S. 73–88
RKI-Ratgeber:: Infektionskrankheiten – Merkblätter für Ärzte: Syphilis.
Downloaded from www.rki.de, 10.5.2010.
Zeltser und Kurban 2004 ZELTSER, R. ; KURBAN, A. K.:: Syphilis.
In: Clin Dermatol
22 (2004), Nr. 6, S. 461–8

Deutsche Version: Erreger und Symptome der Syphilis (Lues)

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