Syphilis is a bacterial infection caused by the Treponema pallidum spirochete, which has a wide range of clinical manifestations and has been dubbed the great mimicker and imitator. The origin of syphilis has been the subject of much debate and controversy. Numerous theories have been proposed to explain the origin of this disease, including the pre-Columbian and Columbian theories, which are currently the most widely accepted. The pre-Columbian theory suggests that syphilis existed in the America prior to Columbus’s arrival in the New World.
This theory is based on the discovery of skeletal markers that suggest the presence of syphilis in pre-Columbian populations. However, recent DNA and paleopathology findings have failed to provide conclusive evidence to support this theory. In contrast, the Columbian theory proposes that syphilis was brought to the New World from Europe by Columbus and his crew during their voyages in the 1490s. According to this theory, the disease spread from Italy, Naples, where it was first observed, to other parts of Europe after the city was captured by French troops. From there, it is believed to have been carried by European explorers and settlers to the Americas.
A significant amount of historical and clinical evidence supports the Columbian theory. For example, the first recorded outbreak of syphilis in Europe occurred in 1495, shortly after Columbus’s return from the New World. In addition, the clinical presentation of syphilis in the Americas was similar to that observed in Europe, suggesting that the disease was introduced to the New World from Europe. Despite the availability of effective treatments, syphilis remains a significant public health problem worldwide, particularly in low- and middle-income countries. The disease can progress through four stages and affect multiple organ systems, leading to serious complications if left untreated.
Epidemiology
Statistics from the Centers for Disease Control and Prevention indicate that 88,042 new cases of syphilis were recorded in 2016. In 2016, homosexual males accounted for most syphilis cases. The incidence of primary and secondary syphilis is highest in men between the ages of 20 and 29. The prevalence of active syphilis among sex workers globally in 2019 was 10.8%. Congenital syphilis rates decreased between 2008 and 2012, whereas adult incidence increased by 38%.
In 2016, there were 628 cases of congenital syphilis reported, with rates 8.0 times higher and 3.9 times higher, respectively, in Black and Hispanic infants compared to White infants. In the developing world, syphilis is pervasive and is particularly prevalent among the underprivileged and individuals with little access to medical care. Given that syphilis is more prevalent in those who have multiple partners, promiscuity plays a significant role in disease transmission. Since it strongly correlates with HIV infections, syphilis is a significant synergistic infection for HIV acquisition.
Anatomy
Pathophysiology
Treponema is a tiny organism that cannot be seen under a light microscope. Thus, its distinctive spiral movements can be recognized in darkfield microscopy. It does not last very long outside of the body. As a result of T. pallidum invasion, the characteristic primary syphilis presentation is a single, non-tender vaginal chancre. Patients may experience multiple non-genital chancres on their digits, tonsils, nipples, and oral mucosa.
Anybody area that comes into contact with the infected lesion might develop these lesions, accompanied by sensitive or non-tender lymphadenopathy. These original lesions will disappear even without therapy, leaving any scars. Primary syphilis can develop into secondary syphilis, with a wide range of clinical and histological symptoms if left untreated.
Condyloma lata, headache, hands and feet lesions, diffuse lymphadenopathy, macular rash, myalgia, pharyngitis, arthralgia, hepatosplenomegaly, alopecia, and malaise are some of the diverse clinical manifestations of secondary syphilis that result from hematogenous dissemination of the infection. Without medical intervention, both primary and secondary lesions disappear, and the patient enters either an early or a latent phase with no visible clinical symptoms.
Only serological tests can be used at this point to identify the infection. Some patients will move on to the tertiary stage, characterized by late benign syphilis, neurosyphilis, and cardiovascular syphilis. The incubation period ranges between 20 to 90 days. The organism penetrates the central nervous system early on, but symptoms do not appear until later.
Etiology
In 1905, Treponema pallidum was identified as the causative agent of syphilis. Treponema is a spirochetal order bacterium with a spiral form and a prosperous outer phospholipid membrane. It metabolizes slowly, taking an average of 30 hours to replicate.
The only treponemal organism that causes venereal disease is T. pallidum. Humans are the only hosts for organisms, and there is no animal reservoir. Syphilis is classified as a sexually transmitted disease since most cases are spread by anogenital, vaginal, or orogenital contact.
The virus is seldom transmitted by nonsexual contacts, such as skin contact or blood transfer—transplacental vertical transmission results in congenital syphilis.
Genetics
Prognostic Factors
The stage and level of organ involvement determine syphilis prognosis. If the organism is not treated, it will cause considerable morbidity and mortality. Patients typically acquire cardiovascular and CNS syphilis, which are deadly if left untreated.
Congenital syphilis is linked to spontaneous miscarriages, stillbirth, and neonatal fulminant pulmonary hemorrhage. Syphilis is almost always passed on to the fetus if not treated during pregnancy.
Clinical History
Clinical History
Primary syphilis typically manifests 10 to 90 days after exposure to Treponema pallidum. This initial stage of the disease is characterized by the development of a painless, solitary sore called a chancre, which appears at the site where the bacterium enters the body. The chancre is typically round and firm, with a raised border and a smooth, ulcerated surface. While the chancre may go unnoticed due to its painless nature, it serves as the primary means of transmission for the disease.
Without proper treatment, the chancre will resolve independently within 3-6 weeks. However, the bacterium will continue to multiply and spread throughout the body, leading to more severe stages of the disease. The secondary stage usually occurs 2 to 8 weeks after the chancre has disappeared and is characterized by various systemic symptoms that can affect any part of the body.
The symptoms of secondary syphilis are diverse. They include cutaneous manifestations such as condyloma lata, alopecia, mucous patches, and rashes on the palms or trunk. The rashes can be papular, pustular, or even scaly. The skin lesions of secondary syphilis are particularly concerning because they contain many spirochetes, the bacteria responsible for syphilis. As a result, these lesions are highly contagious and can be easily spread through sexual contact or even skin-to-skin contact.
Physical Examination
Physical Examination
The disease is characterized by the appearance of a painless, firm chancre at the site of infection. The chancre can occur in the genital area, anus, mouth, or lips. In men, the chancre is commonly found on the penis, while in women, it may be located on the cervix or labia. Homosexual men are at a higher risk of developing chancres in the anal canal or external genitalia.
The primary lesion is often accompanied by swelling of the lymph nodes in the groin area, which may be firm, mobile, and painless. In women, the lymph node swelling may be less noticeable. The regional lymphadenopathy can be unilateral or bilateral.
In about 15% of cases, patients with secondary syphilis develop painless circular silver-gray erosions with a red areola and superficial mucosal erosions. These erosions can occur on the palate, larynx, pharynx, glans penis, vulva, or anal canal and rectum. These erosions harbor bacteria and can transmit the infection.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Genital Herpes
Lymphoma
Behcet Syndrome
Erythema Multiforme
Viral Exanthema
Contact Dermatitis
Atopic Dermatitis
Mononucleosis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The treatment regimen varies depending on the stage of the disease. For primary and secondary syphilis, a single dose of intramuscular benzathine penicillin G 2.4 million units is the preferred treatment. Alternative therapies include oral doxycycline for two weeks, intravenous or intramuscular ceftriaxone for 10 to 14 days or oral tetracycline for two weeks. Azithromycin is no longer recommended due to the emergence of resistant strains.
After treatment, patients must be monitored after six months, a year, and after two years with clinical evaluation and serial nontreponemal testing, such as RPR and VDRL tests. High-risk individuals should be re-examined at three and nine months. Successful treatment is indicated by a fourfold decline in nontreponemal test titers, while a fourfold increase suggests reinfection or treatment failure.
One potential complication of treatment is the Jarisch Herxheimer reaction, a systemic inflammatory response that can occur when the bacteria die and release toxins. This reaction is common in patients with primary and secondary syphilis and those with high bacterial loads. Symptoms may include fever, chills, headache, myalgia, and exacerbation of skin lesions. Supportive care with NSAIDs and acetaminophen can help alleviate symptoms, but no proven method prevents the reaction.
US CDC recommends for bicillin a dose of 2.4 million units given IM once a week for 3 doses
US CDC recommends for permapen a dose of 3 million units given IM once a week for 2-3 doses
Indicated for Syphilis (early/late):
2.4 million units given IM per day as a single dose
In case of patients allergic to penicillin are administered tetracyclines
In the early stage of syphilis- 500 mg oral tablets every 6 hours to be taken for 15 days
For an extended duration, a dose of 500 mg orally every 6 hours for 30 days
Syphilis is a bacterial infection caused by the Treponema pallidum spirochete, which has a wide range of clinical manifestations and has been dubbed the great mimicker and imitator. The origin of syphilis has been the subject of much debate and controversy. Numerous theories have been proposed to explain the origin of this disease, including the pre-Columbian and Columbian theories, which are currently the most widely accepted. The pre-Columbian theory suggests that syphilis existed in the America prior to Columbus’s arrival in the New World.
This theory is based on the discovery of skeletal markers that suggest the presence of syphilis in pre-Columbian populations. However, recent DNA and paleopathology findings have failed to provide conclusive evidence to support this theory. In contrast, the Columbian theory proposes that syphilis was brought to the New World from Europe by Columbus and his crew during their voyages in the 1490s. According to this theory, the disease spread from Italy, Naples, where it was first observed, to other parts of Europe after the city was captured by French troops. From there, it is believed to have been carried by European explorers and settlers to the Americas.
A significant amount of historical and clinical evidence supports the Columbian theory. For example, the first recorded outbreak of syphilis in Europe occurred in 1495, shortly after Columbus’s return from the New World. In addition, the clinical presentation of syphilis in the Americas was similar to that observed in Europe, suggesting that the disease was introduced to the New World from Europe. Despite the availability of effective treatments, syphilis remains a significant public health problem worldwide, particularly in low- and middle-income countries. The disease can progress through four stages and affect multiple organ systems, leading to serious complications if left untreated.
Statistics from the Centers for Disease Control and Prevention indicate that 88,042 new cases of syphilis were recorded in 2016. In 2016, homosexual males accounted for most syphilis cases. The incidence of primary and secondary syphilis is highest in men between the ages of 20 and 29. The prevalence of active syphilis among sex workers globally in 2019 was 10.8%. Congenital syphilis rates decreased between 2008 and 2012, whereas adult incidence increased by 38%.
In 2016, there were 628 cases of congenital syphilis reported, with rates 8.0 times higher and 3.9 times higher, respectively, in Black and Hispanic infants compared to White infants. In the developing world, syphilis is pervasive and is particularly prevalent among the underprivileged and individuals with little access to medical care. Given that syphilis is more prevalent in those who have multiple partners, promiscuity plays a significant role in disease transmission. Since it strongly correlates with HIV infections, syphilis is a significant synergistic infection for HIV acquisition.
Treponema is a tiny organism that cannot be seen under a light microscope. Thus, its distinctive spiral movements can be recognized in darkfield microscopy. It does not last very long outside of the body. As a result of T. pallidum invasion, the characteristic primary syphilis presentation is a single, non-tender vaginal chancre. Patients may experience multiple non-genital chancres on their digits, tonsils, nipples, and oral mucosa.
Anybody area that comes into contact with the infected lesion might develop these lesions, accompanied by sensitive or non-tender lymphadenopathy. These original lesions will disappear even without therapy, leaving any scars. Primary syphilis can develop into secondary syphilis, with a wide range of clinical and histological symptoms if left untreated.
Condyloma lata, headache, hands and feet lesions, diffuse lymphadenopathy, macular rash, myalgia, pharyngitis, arthralgia, hepatosplenomegaly, alopecia, and malaise are some of the diverse clinical manifestations of secondary syphilis that result from hematogenous dissemination of the infection. Without medical intervention, both primary and secondary lesions disappear, and the patient enters either an early or a latent phase with no visible clinical symptoms.
Only serological tests can be used at this point to identify the infection. Some patients will move on to the tertiary stage, characterized by late benign syphilis, neurosyphilis, and cardiovascular syphilis. The incubation period ranges between 20 to 90 days. The organism penetrates the central nervous system early on, but symptoms do not appear until later.
In 1905, Treponema pallidum was identified as the causative agent of syphilis. Treponema is a spirochetal order bacterium with a spiral form and a prosperous outer phospholipid membrane. It metabolizes slowly, taking an average of 30 hours to replicate.
The only treponemal organism that causes venereal disease is T. pallidum. Humans are the only hosts for organisms, and there is no animal reservoir. Syphilis is classified as a sexually transmitted disease since most cases are spread by anogenital, vaginal, or orogenital contact.
The virus is seldom transmitted by nonsexual contacts, such as skin contact or blood transfer—transplacental vertical transmission results in congenital syphilis.
The stage and level of organ involvement determine syphilis prognosis. If the organism is not treated, it will cause considerable morbidity and mortality. Patients typically acquire cardiovascular and CNS syphilis, which are deadly if left untreated.
Congenital syphilis is linked to spontaneous miscarriages, stillbirth, and neonatal fulminant pulmonary hemorrhage. Syphilis is almost always passed on to the fetus if not treated during pregnancy.
Clinical History
Primary syphilis typically manifests 10 to 90 days after exposure to Treponema pallidum. This initial stage of the disease is characterized by the development of a painless, solitary sore called a chancre, which appears at the site where the bacterium enters the body. The chancre is typically round and firm, with a raised border and a smooth, ulcerated surface. While the chancre may go unnoticed due to its painless nature, it serves as the primary means of transmission for the disease.
Without proper treatment, the chancre will resolve independently within 3-6 weeks. However, the bacterium will continue to multiply and spread throughout the body, leading to more severe stages of the disease. The secondary stage usually occurs 2 to 8 weeks after the chancre has disappeared and is characterized by various systemic symptoms that can affect any part of the body.
The symptoms of secondary syphilis are diverse. They include cutaneous manifestations such as condyloma lata, alopecia, mucous patches, and rashes on the palms or trunk. The rashes can be papular, pustular, or even scaly. The skin lesions of secondary syphilis are particularly concerning because they contain many spirochetes, the bacteria responsible for syphilis. As a result, these lesions are highly contagious and can be easily spread through sexual contact or even skin-to-skin contact.
Physical Examination
The disease is characterized by the appearance of a painless, firm chancre at the site of infection. The chancre can occur in the genital area, anus, mouth, or lips. In men, the chancre is commonly found on the penis, while in women, it may be located on the cervix or labia. Homosexual men are at a higher risk of developing chancres in the anal canal or external genitalia.
The primary lesion is often accompanied by swelling of the lymph nodes in the groin area, which may be firm, mobile, and painless. In women, the lymph node swelling may be less noticeable. The regional lymphadenopathy can be unilateral or bilateral.
In about 15% of cases, patients with secondary syphilis develop painless circular silver-gray erosions with a red areola and superficial mucosal erosions. These erosions can occur on the palate, larynx, pharynx, glans penis, vulva, or anal canal and rectum. These erosions harbor bacteria and can transmit the infection.
Differential Diagnoses
Genital Herpes
Lymphoma
Behcet Syndrome
Erythema Multiforme
Viral Exanthema
Contact Dermatitis
Atopic Dermatitis
Mononucleosis
The treatment regimen varies depending on the stage of the disease. For primary and secondary syphilis, a single dose of intramuscular benzathine penicillin G 2.4 million units is the preferred treatment. Alternative therapies include oral doxycycline for two weeks, intravenous or intramuscular ceftriaxone for 10 to 14 days or oral tetracycline for two weeks. Azithromycin is no longer recommended due to the emergence of resistant strains.
After treatment, patients must be monitored after six months, a year, and after two years with clinical evaluation and serial nontreponemal testing, such as RPR and VDRL tests. High-risk individuals should be re-examined at three and nine months. Successful treatment is indicated by a fourfold decline in nontreponemal test titers, while a fourfold increase suggests reinfection or treatment failure.
One potential complication of treatment is the Jarisch Herxheimer reaction, a systemic inflammatory response that can occur when the bacteria die and release toxins. This reaction is common in patients with primary and secondary syphilis and those with high bacterial loads. Symptoms may include fever, chills, headache, myalgia, and exacerbation of skin lesions. Supportive care with NSAIDs and acetaminophen can help alleviate symptoms, but no proven method prevents the reaction.
US CDC recommends for bicillin a dose of 2.4 million units given IM once a week for 3 doses
US CDC recommends for permapen a dose of 3 million units given IM once a week for 2-3 doses
Indicated for Syphilis (early/late):
2.4 million units given IM per day as a single dose
In case of patients allergic to penicillin are administered tetracyclines
In the early stage of syphilis- 500 mg oral tablets every 6 hours to be taken for 15 days
For an extended duration, a dose of 500 mg orally every 6 hours for 30 days
Duration of ≥1 year: 100 mg Orally twice a day 4 weeks
https://www.ncbi.nlm.nih.gov/books/NBK534780/
medtigo
Syphilis
Updated :
September 5, 2023
Syphilis is a bacterial infection caused by the Treponema pallidum spirochete, which has a wide range of clinical manifestations and has been dubbed the great mimicker and imitator. The origin of syphilis has been the subject of much debate and controversy. Numerous theories have been proposed to explain the origin of this disease, including the pre-Columbian and Columbian theories, which are currently the most widely accepted. The pre-Columbian theory suggests that syphilis existed in the America prior to Columbus’s arrival in the New World.
This theory is based on the discovery of skeletal markers that suggest the presence of syphilis in pre-Columbian populations. However, recent DNA and paleopathology findings have failed to provide conclusive evidence to support this theory. In contrast, the Columbian theory proposes that syphilis was brought to the New World from Europe by Columbus and his crew during their voyages in the 1490s. According to this theory, the disease spread from Italy, Naples, where it was first observed, to other parts of Europe after the city was captured by French troops. From there, it is believed to have been carried by European explorers and settlers to the Americas.
A significant amount of historical and clinical evidence supports the Columbian theory. For example, the first recorded outbreak of syphilis in Europe occurred in 1495, shortly after Columbus’s return from the New World. In addition, the clinical presentation of syphilis in the Americas was similar to that observed in Europe, suggesting that the disease was introduced to the New World from Europe. Despite the availability of effective treatments, syphilis remains a significant public health problem worldwide, particularly in low- and middle-income countries. The disease can progress through four stages and affect multiple organ systems, leading to serious complications if left untreated.
Statistics from the Centers for Disease Control and Prevention indicate that 88,042 new cases of syphilis were recorded in 2016. In 2016, homosexual males accounted for most syphilis cases. The incidence of primary and secondary syphilis is highest in men between the ages of 20 and 29. The prevalence of active syphilis among sex workers globally in 2019 was 10.8%. Congenital syphilis rates decreased between 2008 and 2012, whereas adult incidence increased by 38%.
In 2016, there were 628 cases of congenital syphilis reported, with rates 8.0 times higher and 3.9 times higher, respectively, in Black and Hispanic infants compared to White infants. In the developing world, syphilis is pervasive and is particularly prevalent among the underprivileged and individuals with little access to medical care. Given that syphilis is more prevalent in those who have multiple partners, promiscuity plays a significant role in disease transmission. Since it strongly correlates with HIV infections, syphilis is a significant synergistic infection for HIV acquisition.
Treponema is a tiny organism that cannot be seen under a light microscope. Thus, its distinctive spiral movements can be recognized in darkfield microscopy. It does not last very long outside of the body. As a result of T. pallidum invasion, the characteristic primary syphilis presentation is a single, non-tender vaginal chancre. Patients may experience multiple non-genital chancres on their digits, tonsils, nipples, and oral mucosa.
Anybody area that comes into contact with the infected lesion might develop these lesions, accompanied by sensitive or non-tender lymphadenopathy. These original lesions will disappear even without therapy, leaving any scars. Primary syphilis can develop into secondary syphilis, with a wide range of clinical and histological symptoms if left untreated.
Condyloma lata, headache, hands and feet lesions, diffuse lymphadenopathy, macular rash, myalgia, pharyngitis, arthralgia, hepatosplenomegaly, alopecia, and malaise are some of the diverse clinical manifestations of secondary syphilis that result from hematogenous dissemination of the infection. Without medical intervention, both primary and secondary lesions disappear, and the patient enters either an early or a latent phase with no visible clinical symptoms.
Only serological tests can be used at this point to identify the infection. Some patients will move on to the tertiary stage, characterized by late benign syphilis, neurosyphilis, and cardiovascular syphilis. The incubation period ranges between 20 to 90 days. The organism penetrates the central nervous system early on, but symptoms do not appear until later.
In 1905, Treponema pallidum was identified as the causative agent of syphilis. Treponema is a spirochetal order bacterium with a spiral form and a prosperous outer phospholipid membrane. It metabolizes slowly, taking an average of 30 hours to replicate.
The only treponemal organism that causes venereal disease is T. pallidum. Humans are the only hosts for organisms, and there is no animal reservoir. Syphilis is classified as a sexually transmitted disease since most cases are spread by anogenital, vaginal, or orogenital contact.
The virus is seldom transmitted by nonsexual contacts, such as skin contact or blood transfer—transplacental vertical transmission results in congenital syphilis.
The stage and level of organ involvement determine syphilis prognosis. If the organism is not treated, it will cause considerable morbidity and mortality. Patients typically acquire cardiovascular and CNS syphilis, which are deadly if left untreated.
Congenital syphilis is linked to spontaneous miscarriages, stillbirth, and neonatal fulminant pulmonary hemorrhage. Syphilis is almost always passed on to the fetus if not treated during pregnancy.
Clinical History
Primary syphilis typically manifests 10 to 90 days after exposure to Treponema pallidum. This initial stage of the disease is characterized by the development of a painless, solitary sore called a chancre, which appears at the site where the bacterium enters the body. The chancre is typically round and firm, with a raised border and a smooth, ulcerated surface. While the chancre may go unnoticed due to its painless nature, it serves as the primary means of transmission for the disease.
Without proper treatment, the chancre will resolve independently within 3-6 weeks. However, the bacterium will continue to multiply and spread throughout the body, leading to more severe stages of the disease. The secondary stage usually occurs 2 to 8 weeks after the chancre has disappeared and is characterized by various systemic symptoms that can affect any part of the body.
The symptoms of secondary syphilis are diverse. They include cutaneous manifestations such as condyloma lata, alopecia, mucous patches, and rashes on the palms or trunk. The rashes can be papular, pustular, or even scaly. The skin lesions of secondary syphilis are particularly concerning because they contain many spirochetes, the bacteria responsible for syphilis. As a result, these lesions are highly contagious and can be easily spread through sexual contact or even skin-to-skin contact.
Physical Examination
The disease is characterized by the appearance of a painless, firm chancre at the site of infection. The chancre can occur in the genital area, anus, mouth, or lips. In men, the chancre is commonly found on the penis, while in women, it may be located on the cervix or labia. Homosexual men are at a higher risk of developing chancres in the anal canal or external genitalia.
The primary lesion is often accompanied by swelling of the lymph nodes in the groin area, which may be firm, mobile, and painless. In women, the lymph node swelling may be less noticeable. The regional lymphadenopathy can be unilateral or bilateral.
In about 15% of cases, patients with secondary syphilis develop painless circular silver-gray erosions with a red areola and superficial mucosal erosions. These erosions can occur on the palate, larynx, pharynx, glans penis, vulva, or anal canal and rectum. These erosions harbor bacteria and can transmit the infection.
Differential Diagnoses
Genital Herpes
Lymphoma
Behcet Syndrome
Erythema Multiforme
Viral Exanthema
Contact Dermatitis
Atopic Dermatitis
Mononucleosis
The treatment regimen varies depending on the stage of the disease. For primary and secondary syphilis, a single dose of intramuscular benzathine penicillin G 2.4 million units is the preferred treatment. Alternative therapies include oral doxycycline for two weeks, intravenous or intramuscular ceftriaxone for 10 to 14 days or oral tetracycline for two weeks. Azithromycin is no longer recommended due to the emergence of resistant strains.
After treatment, patients must be monitored after six months, a year, and after two years with clinical evaluation and serial nontreponemal testing, such as RPR and VDRL tests. High-risk individuals should be re-examined at three and nine months. Successful treatment is indicated by a fourfold decline in nontreponemal test titers, while a fourfold increase suggests reinfection or treatment failure.
One potential complication of treatment is the Jarisch Herxheimer reaction, a systemic inflammatory response that can occur when the bacteria die and release toxins. This reaction is common in patients with primary and secondary syphilis and those with high bacterial loads. Symptoms may include fever, chills, headache, myalgia, and exacerbation of skin lesions. Supportive care with NSAIDs and acetaminophen can help alleviate symptoms, but no proven method prevents the reaction.
https://www.ncbi.nlm.nih.gov/books/NBK534780/
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