Syphilis Curriculum

By :
Bella Anggraeni Sari
Rani Oktaviani Utina
Muh. Taufik Syarifuddin
BAGIAN ILMU KESEHATAN KULIT KELAMIN
FAKULTAS KEDOKTERAN UNIVERSITAS MUSLIM
INDONESIA 2014

Syphilis Curriculum

Epidemiology

Syphilis Definition
Sexually acquired infection
Etiologic agent: Treponema pallidum
Disease progresses in stages
May become chronic without treatment

Syphilis Curriculum

Epidemiology

Transmission
Sexual contact
Congenital infection
Blood products

Syphilis Curriculum

Epidemiology
syphilis incident various country in all the world in

the year 1996 ranging from 0,04-0,52%.Low

Incident in cina, while highest Incident in USA. In
Indonesia incident 0,61%.
In decreasing order: 20 to 39 years, 15 to 19
years, 40 to 49 years.
Males outnumber females 2:1 to 4:1

Syphilis Curriculum

Syphilis Curriculum

Early Stage

T.Pallidum
skin or through membran
microlesi forming infiltrates in perivasculer
proliferate in T. Pallidum
hypertrophic in endothelium
obliteration
of the lumen
erosion

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Advance stage

Troponema apparently in a state of the dorman

antibodies in the serum of patients
trauma is one of the factor precipitation
S III shaped guma

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Pathogenesis

Treponema pallidum

Electron photomicrograph, 36,000 x.

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Venereal syphilis: Treponema pallidum subspecies

pallidum (T. pallidum).

Yaws: T. pallidum subspecies pertenue.
Endemic syphilis (bejel): T. pallidum subspecies
endemicum.
Pinta: T. carateum.
T. pallidum is a thin delicate spirochete with 6 to
14 spirals. Only natural host for T. pallidum is the
human.

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Clinical Manifestations

Primary Syphilis
Primary lesion or "chancre" develops at the site

of inoculation

Chancre:

Progresses from macule to papule to ulcer

Typically painless, indurated, and has a clean base
Highly infectious
Heals spontaneously within 1 to 6 weeks
25% present with multiple lesions

Regional lymphadenopathy: classically rubbery,

painless, bilateral

Serologic tests for syphilis may not be positive

during early primary syphilis

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Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Clinical Manifestations

Secondary
Syphilis
Secondary lesions occur 3 to 6 weeks after the

primary chancre appears; may persist for weeks

to months
Primary and secondary stages may overlap
Mucocutaneous lesions most common
Manifestations:
Rash (75%-100%)
Lymphadenopathy (50%-86%)
Malaise
Mucous patches (6%-30%)
Condylomata lata (10%-20%)
Alopecia (5%)

Serologic tests are usually highest in titer during

this stage

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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Clinical Manifestations

Secondary Syphilis:
Palmar/Plantar Rash

Source: Seattle STD/HIV Prevention

Training Center at the University of
Washington, UW HSCER Slide Bank

Source: CDC/NCHSTP/Division of STD

Prevention, STD Clinical Slides
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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Clinical Manifestations

Latent Syphilis
Host suppresses the infection enough so

that no lesions are clinically apparent

Only evidence is positive serologic test
for syphilis
May occur between primary and
secondary stages, between secondary
relapses, and after secondary stage
Categories:
Early latent: <1 year duration
Late latent: 1 year duration

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Clinical Manifestations

Tertiary (Late) Syphilis

Approximately 30% of untreated patients

progress to the tertiary stage within 1 to

20 years

Rare because of the widespread

availability and use of antibiotics

Manifestations
Gummatous lesions
Cardiovascular syphilis

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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis Curriculum

Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Neurosyphilis
Occurs when T. pallidum invades the CNS
May occur at any stage of syphilis
Can be asymptomatic
Early neurosyphilis occurs a few months to a few

years after infection

Clinical manifestations include acute syphilitic meningitis,

meningovascular syphilis, ocular involvement

Late neurosyphilis occurs decades after infection

and is rarely seen

Clinical manifestations include general paresis, tabes

dorsalis, ocular involvement

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Neurosyphilis - Spirochetes
in Neural Tissue

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Clinical Manifestations

Congenital Syphilis

Occurs when T. pallidum is transmitted from a pregnant

woman with syphilis to her fetus
May lead to stillbirth, neonatal death, and infant disorders
such as deafness, neurologic impairment, and bone
deformities
Transmission to the fetus in pregnancy can occur during
any stage of syphilis; risk is much higher during primary
and secondary syphilis
Fetal infection can occur during any trimester of pregnancy
Wide spectrum of severity exists; only severe cases are
clinically apparent at birth

Early lesions (most common): Infants <2 years old; usually

inflammatory
Late lesions: Children >2 years old; tend to be immunologic
and destructive
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Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides

Clinical Manifestations

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Syphilis has long been known as the "great

imitator," because the various cutaneous

manifestahons may simulate almost any
cutaneous or systemic disease. Pityriasis rosea
may be mistaken for secondary syphilis,
especxally since both begin on the trunk. The
herald patch, the oval patches with a fine scale at
the edge, patterned in the lines of skin cleavage,
the absence of lymphadenopathy, and infrequent
mucous membrane lesions help to distinguish
pityriasis rosea from secondary syphiIis.
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Differential diagnosis
S I

Genital herpes, traumatic ulcer, fixed drug

eruption,chancroid, lymphogranuloma
venereum
S II
Adverse cutaneous drug eruption (e.g.,
captopril), pityriasis rosea, viral exanthem,
infectious mononucleosis, tinea corporis, tinea
versicolor, scabies, condylomata acuminata,
acute guttate psoriasis, lichen planus.
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S III

Cutaneous tuberculosis, cutaneous atypical

mycobacterial infection, lymphoma, invasive
fungal infections

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Diagnosis

Laboratory Diagnosis
Identification of Treponema pallidum in

lesions

Darkfield microscopy
Direct fluorescent antibody - T. pallidum (DFA-

TP)

Serologic tests
Nontreponemal tests
Treponemal tests
Histopatoloy

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Primary syphilis

1.Penisilin G benzatin 4,8 million unit I.M once a week

2.Penisilin G prokain in akua 0,6 million unit /day for 10 days
3.PAM 1,2 million unit/time, 2 time a week
Latent syphilis

1.Penisilin G benzatin 7,2 million unit total dose

2.Penisilin G prokain in akua 0,6 million unit /day
3.PAM 1,2 million unit/time, 2 time a week
Sifilis III

1.Penisilin G benzatin 9,6 million unit total dose

2.Penisilin G prokain in akua 0,6 million unit /day
3.PAM 1,2 million unit/time, 2 time a week
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Prevention

Patient Counseling and

Education
Nature of the disease
Transmission
Treatment and follow up
Risk reduction

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