Dr. med. Dirk Manski

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Syphilis: Etiology, Pathology, Signs and Symptoms

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


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

Epidemiology of Syphilis

Europe and USA:

Declining frequency, the incidence of syphilis dropped in the last decades from 20/100000 to 3–5/100000 for primary and secondary syphilis. Since 2000 rising incidence, especially in risk groups for syphilis: young sexually active people with multiple partners, lack of condom use, homosexuals, men are more often affected than women, low social status.

Developing world:

High prevalence and mortality and perinatal deaths due to untreated syphilis.

Etiology of Syphilis


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, https://phil.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


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


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. Often, a painless inguinal lymphadenopathy can be observed.

Symptoms of Secondary Syphilis

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

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 after untreatet early latent syphilis (0–2 years) or late latent syphilis (2–10 years) with onset in different organ systems:

Symptoms of Congenital Syphilis

The maternal 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 , poor feeding, rhinitis, hepatospenomegaly, pseudoparalysis and various lesions of the skin. However, the children may be asymptomatic and diagnosed only by screening.

Late congenital syphilis (age over 2 years) manifests with a saddle nose, skin lesions and rarely with the Hutchinson triad (deafness, Hutchinson teeth (notched incisor teeths), and keratitis).

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


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.
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)