| ID | 215 |
|---|---|
| Name | SYPHILIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | Diagnosis: 1. In primary and secondary stage- T. pallidum may be demonstrated in chancre, papular rash, condylomata or mucous patches by dark ground microscopy. 2. Serological tests for syphilis becomes positive from about the 4th week of the disease and are always strongly positive in the secondary stage. The usual serological tests are- - Wassermann reaction (WR.) - Kahn and - V.D.R.L tests. 3. For conclusive results additional tests are-Fluorescent treponemal antibody (FTA-ABS). T. pallidum hemagglutination (TPHA) & treponemal immobilisation (TPI) tests. 4. The CSF should be examined to exclude neurological disease. 5. Chest radiographs should be taken to exclude calcification of the ascending aorta which indicates cardiovascular disease. D/D of primary syphilis chancre: 1. Herpes simplex, 2. Erosive balanitis, 3. Trauma, 4. Scabies and rarely 5. 2ndary syphilis. |
| Investigations | |
| Management | |
| Introduction | This is a venereal disease caused by ‘treponema pallidum1 leading to many structural or cutanious lesions, transmitted by direct sexual contact or in utero. Characteristics: Syphilis is a chronic, infectious disease, systemic from the beginning; characterised by florid features at sometimes & long periods of latency at other times. It responds well to penicillin & certain other antimicrobials such as tetracycline |
| History | |
| Etiology | |
| Clinical Features | Clinical features:1-2 1. Acquired syphilis: Primary stage- the primary lesion (chancre) develops at the site of infection after an incubation period of 9-90 days. A small pink macule appears on the genitalia which soon becomes papular and ulcerates. The regional lymphnodes are enlarged, discrete, rubbery and painless but non-tender. Secondary stage- the primary lesion tends to heal and 6 to 8 weeks after its appearance, evidence of generalised infection appears with malaise, headache and low irregular fever. Four cardinal signs must be remembered, though any of them may be absent, a. A rash is present in 75% of patients, b. Condylomata lata. c. Lymphadenopathy occuring in 50% of patients, d. Mucous patches occuring in 30% of patients. After several months the secondary changes gardually disappears to be followed by a latent period. Tertiary stage- this takes ten or more years to develop and mainly affects skin and subcutaneous tissues, mucous membrane & submucosa & the long bones. The characteristic pathological lesion is a granuloma called a gumma. Quarternary stage- neurosyphilis & cardiovascular syphilis take longer to develop- is the characteristic feature and may lead to the patients death. 2. Congenital syphilis: The foetus may contact syphilis from an infected mother with early acquired syphilis. There is no primary stage. 1. The disease may be so severe that the child is born dead, or skin eruption is present at birth. 2. The child may appear to be normal at birth but fails to thrive, and within a few months develop a rash and signs of slyphilitic disease of bone, liver, kidneys and other organs. 3. In a third group the disease remains latent for years until lesions of bones, joints, teeth, iritis, keratitis, nerve features, juvenile tabes or general paralysis appear or the disease may remain latent. |
| Preventions | |
| Treatment | Treatment:2’34,35 Primary syphilis- 1. Inj. Benzathine Penicilline 24 lac units i.m single dose. Or, 2. Procaine penicillin 600-1200mg i.m. once daily for 12 days. Or, 3. Oxytetracycline 500mg orally 6-hourly for 15 days. Or, 4. Doxycycline l00mg orally 8-hourly for 15 days. Secondary syphilis- 1. Inj. Benzathine Penicilline 24 lac units i.m weekly for two weeks. Or, 2. Procaine penicillin 600-1200mg i.m. once daily for 15 days. Tertiary A Latent syphttis- 1. Inj. Benzathine Penicilline 24 lac units i.m weekly for three weeks. Or, 2. Oxytetracycline 500mg orally 6-hourly for 15 days. Or, 3. Doxycycline lOOmg orally 8-hourly for 15 days. CNS syphilis- 1. Higher doses of short-acting penicillin (Inj. Crystalline penicillin) for better penetration. Followed by- 2. Inj. Benzathine Penicilline 24 lac units i.m weekly for three weeks. Or, 3. Procaine penicillin 900-1200mg i.m. once daily for 21 days. Or, 4. Oxytetracycline 500mg orally 6-hourly for 28 days. Or, 5. Doxycycline l00mg orally 8-hourly for 28 days. * In case of penicillin hypersensitive patients tetracyclines are preferable. |
| Complications | |
| Prognosis | |
| Types | |
| Classification | Classification of syphilis:2 A. Acquired Early-Primary Secondary Early latent Late-Late latent Tertiary (benign gummatous) Quarternary (cardiovascular, neurosyphilis) B. Congenital Early-Clinical & Latent Late-Clinical & latent, Stigmata (or scars) |
| Observation | |
| Pathology |
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