Syphilis

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It has multiple stages and can cause a wide range of clinical symptoms if not treated. Here’s an overview of key points about syphilis:

Etiology

• Caused by Treponema pallidum, a spirochete bacterium.
• Transmitted primarily through sexual contact (vaginal, anal, or oral sex).
• Can also be transmitted from mother to fetus (congenital syphilis).

Stages of Syphilis

1. Primary Syphilis

   • Characterized by a painless ulcer (chancre) at the site of infection, usually genital, anal, or oral.
   • The chancre appears about 3 weeks after exposure.
   • The ulcer heals spontaneously within 3–6 weeks even without treatment.

2. Secondary Syphilis

   • Develops weeks to a few months after the chancre heals.
   • Symptoms include a highly variable rash (often on palms and soles), mucous patches, condyloma lata, generalized lymphadenopathy, fever, malaise, and sore throat.
   • Symptoms resolve spontaneously but infection persists.

3. Latent Syphilis

   • Asymptomatic phase.
   • Early latent: within first year after infection.
   • Late latent: more than one year after infection.
   • Without treatment, can last for years.

4. Tertiary Syphilis

   • Occurs years to decades after initial infection in untreated individuals.
   • Can involve serious complications such as:
     • Gummas: granulomatous lesions that can affect skin, bones, or organs.
     • Cardiovascular syphilis: aortitis, aneurysms.
     • Neurosyphilis: can cause meningitis, tabes dorsalis, general paresis.

Congenital Syphilis

• Transmitted from an infected mother to the fetus.
• Can cause miscarriage, stillbirth, or severe congenital abnormalities.
• Early signs include rash, hepatosplenomegaly, jaundice, anemia.
• Late consequences include dental abnormalities, deafness, bone deformities.

Diagnosis

• Nontreponemal tests (screening):
  • VDRL (Venereal Disease Research Laboratory)
  • RPR (Rapid Plasma Reagin)
• Treponemal tests (confirmatory):
  • FTA-ABS (Fluorescent treponemal antibody absorption)
  • TPPA (T. pallidum particle agglutination)
• Darkfield microscopy can detect the organism from chancre lesions.
• CSF analysis for neurosyphilis (positive VDRL in CSF, elevated protein, lymphocytic pleocytosis).

Treatment

• Early syphilis:
  • Benzathine penicillin G 2.4 million units IM single dose.
• Late latent or tertiary (without neurosyphilis):
  • Benzathine penicillin G 2.4 million units IM weekly for 3 weeks.
• Neurosyphilis:
  • Aqueous crystalline penicillin G 18–24 million units/day IV for 10–14 days.
• For penicillin-allergic patients, alternatives may be used, but penicillin desensitization is preferred especially in pregnancy.

Prevention

• Safe sex practices (condom use).
• Screening high-risk populations.
• Treatment of infected individuals and their partners.
• Prenatal screening to prevent congenital syphilis.

If you need detailed information on a specific aspect of syphilis (e.g., clinical presentation, diagnosis, treatment protocols, epidemiology), please let me know!