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SYPHILIS
Presentation by: Loreen Lacsina
HCR 240 - Human Pathophysiology
What is syphilis?
Introduction & Etiology
- Syphilis is a systemic, bacterial infection
- Most commonly transmitted sexually
- Symptoms progress in stages
- Worsens and may cause death if untreated
- May be asymptomatic
(Tudor et al., 2019)
Etiology
- Syphilis is caused by a spirochete bacteria called Treponema pallidum
- Spiral-shaped
- Slow-metabolizing
- 30 hours to multiply
- Resevoir: Humans
Etiology
(Tudor et al., 2019)
Treponema pallidum
Prevalence in the U.S.
- 176,713 cases (all syphilis) in 2021
- 28.6% increase rate since 2020
- Slow increase rate for all syphilis cases during the first year of the COVID-19 pandemic
Prevalence
(CDC, 2023)
Pathophysiology
- Root cause of inflammatory response and clinical manifestations: T. pallidum
- Enters body through mucosal and/or cutaneous surface breaks (open sores)
- Invades the lymphatic system and blood
- If untreated, system damage occurs
- Stages progress from
1. primary
2. secondary
3. latent (early & late)
4. tertiary
(CDC, 2023 & Peeling et al., 2019)
Clinical presentation
Clinical Presentation
(CDC, 2023; Hussain & Vaidya, 2019; Peeling et al., 2017; Tudor et al., 2019)
Primary Stage
- 10-90 days after exposure
- Single chancre at site of inoculation
- Painless, round, firm
- Heals on its own
Primary Stage
Secondary Stage
- 2-8 weeks after chancre disappears
- Skin rashes on one or more areas of the body
- Palms and bottom of feet
- Condylomata lata
- Syphilitic alopecia
Secondary Stage
Latent Stage
- Hidden
- No signs or symptoms
- Early latent: infection within a year
- Late latent: infection after a year
- Can last for years
Latent Stage
Tertiary Stage
- 10-30 years after initial infection
- Rare
- Can be fatal
- Affects multiple organs (symptoms vary)
Tertiary Stage
System Damage
- Neurosyphilis: nervous system damage
- Ocular syphilis: visual system damage
- Otosyphilis: auditory & vestibular system damage
System Damage
Congenital Syphilis
- Transplacental transmission
- Hepatomegaly, jaundice, enlarged lymph nodes, rash
Congenital Syphilis
Transmission
Transmission & Risk Factors
- Sexual:
- Most common
- Vaginal, anal, or oral
- Unprotected direct contact
- Kissing
- Non-sexual:
- Sharing personal items
- Blood transfer
- Transplacental:
- Mother to fetus:
- Congenital syphilis
(Hussain & Vaidya, 2019 & Tudor et al., 2019)
Risk Factors
Risk Factors
- Unprotected sex
- Sex with multiple partners
- Transactional sex
- IV drug use
- HIV-infected
- No prenatal care
(CDC, 2023)
Assessment & Testing
- Medical History: assess symptoms, sexual history, potential exposure
- Physical Exam: assess visible signs
- sores, swollen lymph nodes
- Testing: blood or spinal fluid
- Nontreponemal
- Venereal Disease Research Laboratory (VDRL) - blood or spinal fluid
- Rapid Plasma Reagin (RPR) - blood
- antibodies linked to syphilis
- Treponemal (confirmatory)
- antibodies specific to syphilis
Assesment & Testing
(MedlinePlus, 2022)
Syphilis Treatment
Treatment
- Single intramuscular (IM) injection of Benzathine penicillin G can cure early stages (primary, secondary, & early latent)
- Three doses of Benzathine penicillin G IM injections on a weekly basis for later stages (late latent & latent)
- Aqueous (IV) / procaine penicillin G (IM) for 7-14 days for infants with congenital syphilis
- Used for neurosyphilis, ocular, and otosyphilis
- Doxycycline (oral) 2x/day for 2 weeks, if allergic to penicillin
(CDC, 2019; Hussain & Vaidya, 2019; Tudor et al., 2019)
Management
&
Prevention
- Clinical evaluation and serial screening 6, 12, & 24 months after treatment
- Avoid sex during and immediately after treatment, until sores are healed
- Safe sex or abstinence to prevent reinfection
Syphilis Management & Further Prevention
- Regular STD testing if sexually active
(Peeling et al., 2017 & Tudor et al., 2019)
References
- Centers for Disease Control and Prevention [CDC]. (2019). Syphilis - STD information from CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/std/syphilis/default.htm
References
- Centers for Disease Control and Prevention [CDC]. (2023). Sexually transmitted disease surveillance, 2021. Centers for Disease Control and Prevention. www.cdc.gov/std/statistics/2021/default.htm#:~:text=Reported%20cases%20of%20syphilis%20(all.
- Hussain, S. A., & Vaidya, R. (2019, February 10). Congenital Syphilis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537087/
References
- MedlinePlus. (2022). Syphilis Tests: MedlinePlus Lab Test Information. Medlineplus.gov. https://medlineplus.gov/lab-tests/syphilis-tests
References continued
- Peeling, R. W., Mabey, D., Kamb, M. L., Chen, X.-S., Radolf, J. D., & Benzaken, A. S. (2017). Syphilis. Nature Reviews Disease Primers, 3(1). https://doi.org/10.1038/nrdp.2017.73
- Tudor, M. E., Al Aboud, A. M., Leslie, S. W., & Gossman, W. G. (2019). Syphilis. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534780/
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