Syphilis

Background

• Syphilis is caused by the spirochete Treponema pallidum.
• Usually sexually transmitted
• Causes a wide range of systemic manifestations that are characterized by episodes of active disease interrupted by periods of latency
• Approximately 30% of asymptomatic contacts examined within 30 days of exposure have infection

Pathogenesis

• Spirochetes penetrate intact mucous membranes or microscopic dermal abrasions.
• Transmission through sexual contact with infectious lesions, infection in utero, blood transfusion, and organ transplantation
• Blood from a patient with incubating or early syphilis is infectious.
• Characterized by multiple stages separated by periods of latency: primary, secondary, latent and tertiary

Clinical Features

[[File:Chancres on the penile shaft due to a primary syphilitic infection caused by Treponema pallidum 6803 lores.jpg|thumbnail|Chancres on the penile shaft due to a primary syphilitic infection]

Primary Syphilis

• Primary lesion appears after an incubation of 2-6 weeks
  • Single painless papule that becomes eroded and indurated, cartilaginous consistency on palpation
  • Minority of patients can have multiple lesions or atypical appearance
  • Occurs at point of contact: penis, rectum, mouth, external genitalia, cervix, or labia
  • Heals in 4-6 weeks
• Regional lymphadenopathy that is painless and firm

Differential Diagnosis

• Ulcerative STDs
• Proctitis

Management

• Benzathine penicillin G 2.4 million units IM x 1 (for primary or secondary infection)

See Also

• Ulcerative STDs

Source

• Emedicine