Obs. and Gynae. Forum

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SYPHILIS
This is a Sexually transmitted infection caused by the bacterium Treponema pallidum.

AETIOLOGY
Transmission is by s*xual contact, blood-borne, or vertical (conge***al syphilis).

ASSOCIATIONS/RISK FACTORS
Unprotected s*x, multiple s*xual partners, HIV.

EPIDEMIOLOGY
Uncommon but increasing: 2680 cases in the UK in 2007.

HISTORY
Primary syphilis
Painless but infectious lesions on skin (chancres) develop after an incubation period of 10–90
days, disappear spontaneously after 1 week.
Secondary syphilis
1 to 10 weeks after appearance of the chancre, development of macular-papular skin rash,
sore throat, fever, headache, arthralgia.
Tertiary syphilis
1 to 20 years after initial infection, can develop into neurosyphilis (paresis, dementia,
psychosis, epilepsy, tabes doralis), cardiovascular syphilis (aortitis, aortic regurgitation, heart
failure, angina), gummatous syphilis (granulomatous lesions in skin, bone).

EXAMINATION
Primary: Painless ge***al chancre (papule, often ulcerated) with regional lymphadenopathy.
Secondary/tertiary: Examine skin, mucosal membranes, lymph nodes, neurological and
cardiovascular systems.

PATHOLOGY/PATHOGENESIS
Treponema pallidum is a spirochaete that survives only briefly
outside the body. Requires direct contact with an infected part of the body for transmission.
Invades abraded skin or mucous membranes and disseminates rapidly via blood or lymphaticsystem.

INVESTIGATIONS
Blood: RPR and VDRL, can give false positive results (e.g. with EBV, TB, lymphoma, malaria),
therefore combine with TPHA and FTA-ABS which are more specific based on monoclonal
antibodies and immunofluoresence.
Microbiology: Microscopy offluid from primary/secondary lesions(with dark-field illumination).

MANAGEMENT
Antibiotics: Penicillin G (first choice) or oral tetracycline or doxycycline (contraindicated in
pregnancy).
Follow-up: Clinically and serologically at 1, 2, 3, 6 and 12 months and then 6-monthly until
seronegative.
Other: Contact tracing, requires full STI screen
COMPLICATIONS
Cardiovascular disease, CNS disease, Jarisch–Herxheimer reaction (febrile
reaction to treatment with fever, chills, myalgia), conge***al syphilis, " susceptibility to HIV.