BACTERIAL INFECTION - SYPHILIS ( ETIOLOGY,TYPES IN DETAIL NOTES )

 SYPHILIS 

  • SYPHILIS is a world wide chronic infection produced by treponema pallidum 
  • History :christopher columbus and his crew returns from the new world possibly carrying syphilis
  • Global epidemiology:15-49 years old- 6 million new cases each year
  • Incidence decreased after penicillin
  • Male is to female ratio is 1 is to 1
  • Fetal ,neonatal deaths- 3,00,000 

ETIOLOGY:

  • Treponema pallidum :gram positive ,motile ,spirochete and is pathogenic to human 

ROUTE OF TRANSMISSION:

  • Sexual contact 
  • Vertical transmission 

(mother to foetus)

TYPES:

1)CONGENITAL 

2)ACQUIRED : PRIMARY,SECONDARY,TERTIARY 

1)CONGENITAL SYPHILIS :

  • Transmitted to offspring only infected mother and not inherited 
  • Totally preventable 
  • Recognised if treatment with antibiotic is begun in infected pregnant women before 4 months of pregnancy 




STIGMATA OF CONGENITAL SYPHILIS:

1)Head: Frontal bossing

2)Nose:Saddle nose

3)Eyes:Interstitial keratitis

4)Oropharynx;HUTCHINSON'S TRIAD 

  • HYPOPLASIA OF INCISOR -screw driver shaped incisor ,mulberry molar 
  • Eighth nerve deafness 
  • Interstitial keratitis
  • Short maxilla,protuberant mandible 
  • High palatal arch 
5)Ears;Sensorineural hearing loss 

6)Shoulder:HIGOUMENAKIS SIGN -Enlargement of the sternoclavicular portion of the clavicle 

,scaphoid scapula

7)Face: Rhagades

8)Cutaneous :Gummas 

9)Skeletal: Saber shins - Anterior bowing of the tibia 

clutton joint 

2)ACQUIRED:

PRIMARY STAGE:

  • 2 to 3 weeks after exposure
  • Char by chancre -1 to 2 cm with raised indurated margins at the site of inoculation 
  • 3 to 90 days after contact with infection 
  • Occur commonly : lips,tongue,palate,gingiva ,tonsil 
  • Heals without scar
  • Chancre may be solitary or multiple






SECONDARY STAGE/METASTATIC STAGE :

  • 2 to 3 months of exposure 
  • Usually occur 6 weeks after primary lesion
  • Alopecia -moth eaten appearance 
  • Characterised by diffuse painless maculopapular cutaneous rash surrounded by erythematous halo
  • Serological reaction is always positive 

Condyloma lata:

  • primary lesion resembling viral papilloma

lyes maligna :

  • Characterised by fever ,headache ,muscle pain 
  • Healing -3 to 12 weeks by hypo or hyper pigmentation 

TERTIARY SYPHILIS :

  • 2 TO 3 WEEKS AFTER EXPOSURE
  • Gumma occurs in skin ,mucous membrane ,granulomatous lesion 
  • Surface-nodular or ulcerated 

ORAL MANIFESTATION :

  • PALATE : ulcer perforate the nasal cavity 
  • Interstitial glossitis
  • luetic glossitis :males more affected than females ,diffuse atrophy of tongue papillae (precancerous) 
  • Syphilitic leukoplakia :white lesion on surface of tongue 

SYSTEMIC MANIFESTATION: 

  • Congenital heart failure
  • Aneurysm of ascending aorta 

DIAGNOSIS :

HISTOPATHOLOGY:

  • CHANCRE-Prominent mononuclear cell infiltrate ,dominated by plasma cell with scattered histiocyte 
  • Gummas -caseous necrosis ,chronic inflammatory cell infiltrate 
  • Ulcer border: dense granulomatous dermal infiltrate 
  • Perivascular inflammatory infiltrate together with few plasma cell

TEST:

  • Dark field microscopy 
  • Rapid plasma reagin
  • Venereal disease research and laboratory test 







TREATMENT ;

  • Three weekly doses of intramuscular benzathine penicillin (24,00,000 U)
  • Erythromycin ,tetracycline
  • Surgical correction of facial defects gives good esthetic results 






AIM OF THIS POST:

Today we discussed about syphilis its etiology,types in detail about congenital syphilis ,stigmata from head to toe and under acquired syphilis about primary,secondary and tertiary stage of syphilis its oral manifestation ,systemic manifestation ,different diagnosis histopathology ,test and finally about treatment options available .hope this post would have been informative if this post helped you learn then do let me know in the comment section below as this would motivate me to post more such content ,do stay connected through instagram as well to receive instant post notification.

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