SYPHILIS

DR.S.PARVEEN
ASSOCIATE PROFESSOR
PRRMCP
 SYPHILIS
• INTRODUCTION
• Syphilis is a systemic bacterial infection caused by
the spirochete Treponema pallidum.
• Most often, it spreads through sexual contact. The
disease starts as a sore that's often painless and
typically appears on the genitals, rectum or mouth.
• Syphilis spreads from person to person through
direct contact with these sores.
• It also can be passed to a baby during pregnancy and
childbirth and sometimes through breastfeeding.
• syphilis bacteria can stay in the body for many
years without causing symptoms.
• But the infection can become active again.
Without treatment, syphilis can damage the
heart, brain or other organs. It can become
life-threatening.
• All pregnant people should get tested for
syphilis at their first prenatal checkup
 Causes
• The cause of syphilis is a bacterium called Treponema
pallidum.
• The bacteria enter the body through minor cuts or scrapes
in the skin or in the moist inner lining of some body parts.
• Syphilis is contagious during its primary and secondary
stages. Sometimes it's also contagious in the early latent
period,
• syphilis can spread by kissing or touching an active sore on
the lips, tongue, mouth, breasts or genitals.
• It also can be passed to babies during pregnancy and
childbirth and sometimes through breastfeeding.
• Syphilis can't be spread through casual contact with objects
that an infected person has touched.
 STAGES OF SYPHILIS
• Syphilis develops in stages. The symptoms vary with
each stage.
• Primary syphilis- Incubation period is 14 – 28 days
• The first symptom of syphilis is a small sore called a
chancre (SHANG-kur).
• The sore is often painless. It appears at the spot
where the bacteria entered in to the body.
• Most people with syphilis develop only one chancre.
Some people get more than one.
• Regional lymph nodes are moderately enlarged
• The chancre often forms about three weeks
after come in contact with syphilis bacteria.
The chancre is usually painless.
• It also may be hidden within the vagina or
rectum.
• The chancre heals on its own within 3 to 6
weeks.
 Secondary syphilis -Starts from 6-8 weeks after chancre (skin
lesions) appearance
• The first chancre heals or a few weeks, after it heals.
A rash caused by syphilis:
• Often is not itchy, look like rough, red or reddish-brown rashes.
• That includes the chest, stomach area, pelvis and back. In some times, it
also could appear on the limbs, the palms of the hands and the soles of the
feet.
• Along with the rash, symptoms such as:
• Wart like sores in the mouth or genital area.
• Hair loss.
• Muscle aches.
• Fever.
• Sore throat.
• Tiredness, also called fatigue.
• Weight loss.
• Latent syphilis( existing but not noticeable)
• It appears after 1 or 2 years of infection.
• If not treated for syphilis, the disease moves from the secondary
stage to the latent stage. This also is called the hidden stage
because no symptoms are seen.
 Early latent syphilis:-
•Incubation period:- less than 1yr from onset of infection.

•Site of infection:- multisystem involvement such as liver and kidney.

 Late latent syphilis:-
•Incubation period :- > 1year after infection.

•Site of infection:- In untreated individuals.

• Tertiary syphilis
• After the latent stage, up to 30% to 40% of people with
syphilis who don't get treatment have complications known
as tertiary syphilis. Another name for it is late syphilis.
• The disease may damage the:
• Brain.
• Nerves.
• Eyes.
• Heart.
• Blood vessels.
• Liver.
• Bones and joints.
• Congenital syphilis
• Pregnant women have syphilis can pass the disease to their
babies. Unborn babies can become infected through the organ
that provides nutrients and oxygen in the womb, the placenta
get Infected to develop baby during birth.
• Newborns with congenital syphilis might have no symptoms.
• Without fast treatment, some babies might get:
• Sores and rashes on the skin.
• Fever.
• jaundice.
• Anemia.
• Swollen spleen and liver.
• Sneezing
• Later symptoms may include deafness, teeth problems and
saddle nose.
 Transmission
• Nearly all cases are acquired by sexual contact.
• 50-60% individuals acquire syphilis after a single
sexual contact with an infected person.
Less common modes of transmission:
• Non-sexual transmission.
• Infection in uterus.
• Blood transfusion.
• Organ transplantation
• Placenta
• Risk factors
• The risk of syphilis is higher if
• Have unprotected sex.
• Have sex with more than one partner.
• Live with HIV, the virus that causes AIDS if
untreated.
 Diagnosis
• Blood.
• CRP- CRP levels of 0.8-1.0 mg/dL (or 8-10 mg/L) or
lower .
• Dark field microscopy. Syphilis bacteria are visible
through a microscope in fluid taken from a skin sore or
lymph node.
• CSF -Fluid in the brain and spinal cord: lumbar
puncture-
• A needle is used to take a sample of cerebrospinal fluid
from between two of the bones in the back. )
• Positive VDRL (Venereal Disease Research
Laboratory).
 Treatment
• Beta-lactam antibiotic.
• PENICILLIN-G is also called benzyl penicillin.
• It binds penicillin-binding proteins (PBPs)
to weaken or cause lysis of the cell wall.
Penicillin G is bactericidal with a time-
dependent action.
• Penicillin G, administered parenterally.is
the preferred drug for treating patients in
all stages of syphilis.
• Treatment for late latent syphilis (>1
years’ duration) and tertiary syphilis
• Sodium or potassium penicillin G (crystalline penicillin), which is
water soluble and can be administered intravenously or
intramuscularly. It may also be mixed with fluids for IV administration.

• •Penicillin G benzathine, which is insoluble and available as a

suspension. It is slowly absorbed from an injection site to produce
low but prolonged (several days of) penicillin concentrations. All
benzathine penicillin G forms are combined with procaine penicillin G
in commercial formulation (1:1 ratio).

• •Penicillin G procaine is a poorly soluble suspension for intramuscular

or subcutaneous administration. It is absorbed slowly, producing
concentrations for 12-24 hours after injections.

• •Penicillin V, oral penicillin, is not highly absorbed and has a narrow

spectrum in comparison with other penicillin derivatives.
• Penicillin G is poorly absorbed following oral administration. The sodium
and potassium salts are rapidly absorbed following i.m. injection.
• The benzathine and procaine salts are relatively insoluble and are slowly
absorbed and hydrolyzed to penicillin G.
• The benzathine and procaine forms have a more prolonged action. Easily
penetrate csf fluid.

• Side effects : Allergic reactions like skin rash, itching or hives, swelling of
the face, lips, or tongue.
• bloody or watery diarrhea.
• fever.
• redness, blistering, peeling or loosening of the skin, including inside the
mouth
 MANAGEMENT OF SYPHILIS
Stage / type Alternate
of syphilis Recommende regimens
d regimens
Primary, Benzathine Doxycycline
secondary, or penicillin G 2.4 100 mg PO bid
latent syphilis million units IM for 2 weeks
of less than in a single OR
one year dose. Tetracycline
duration (early 500 mg PO qid
latent syphilis) for 2 weeks
Latent syphilis Benzathine Doxycycline
of more than penicillin G 2.4 100 mg PO bid
one year million units IM for 4 weeks
duration (late once a week OR
latent syphilis) for 3 Tetracycline
or syphilis of successive 500 mg PO qid
unknown weeks (7.2 for 4 weeks.
 Aqueous crystalline penicillin G
18-24 million units IV (3-4 million
units every 4 hours or by continuous
infusion) for
Neuro 10-14 days.
syphilis

Aqueous crystalline
penicillin G 50,000 units/kg IV every
Congenital 12 hours during first 7 days of life
syphilis and every 8 hours thereafter for a
total of 10 days
OR
Procaine penicillin G 50,000 units/kg
Pregnancy IM daily for 10 days.
Parenteral Penicillin G is the only
therapy with documented efficacy
for syphilis during pregnancy.
Pregnant women with syphilis at any
stage who report penicillin allergy
should be desensitized and treated
with penicillin
THANK YOU