SYPHILLIS

Complex chronic bacterial infection affecting a variety of organs and with multiple manifestations.

Cause

  • Treponema pallidum
  • Transmitted sexually and from mother to foetus, rarely
    through blood transfusion or non sexual contact

Clinical features

The disease has several stages

  • Primary syphilis: 10-90 days following inoculation, characterized by a painless genital ulcer with clean base and indurated margins, regional lymphadenopathy. It can heal spontaneously but the disease will progress to
    secondary lesions
  • Secondary syphilis: few weeks to months (max 6 months) from primary lesions, characterised by:
    • Generalised maculopapular rash
    • Mucous membranes lesions (patches and ulcers)
    • Weeping papules (condyloma alata) in moist skin areas
    • Generalized non tender lymphadenopathy
    • Fever, meningitis, hepatitis, osteitis, arthritis, iritis
  • Early latent syphilis (<1 year in duration): clinically quiescent but possible relapse of secondary syphilis
  • Late latent syphilis: clinically quiescent, not very infectious (but possible maternal foetal transmission)
  • Late (tertiary) syphilis: at any time after secondary syphilis (even many years):
    • Aortitis, aneurysms, aortic regurgitation
    • Central nervous system disorders (neurosyphilis): meningo vascular syphilis, hemiparesis, seizures, progressive degeneration with paraesthesias, shooting pains, dementia, psychosis

Investigations

  • Non-treponemal antibody tests (VDRL and RPR)
    • Positive 4-6 weeks after infection
    • Used as screening test
    • Possibility of false positive
    • Remains positive 6-12 months after treatment
  • Treponemal antibody tests (TPHA): very sensitive, used to confirm a positive non-treponemal test. Remains positive for long even after treatment so its positivity may not indicate active disease.

Management

TREATMENT

Primary, seconday and early latent syphilis

  • Benzathine penicillin 2.4 million IU IM stat, half in each buttock
  • or Doxycycline 100 mg every 12 hours for 14 days

Late latent or uncertain duration, or tertiary without neurosyphilis

  • Benzathine penicillin 2.4 million IU IM weekly for 3 weeks
  • Or Doxycycline 100 mg every 12 hours for 28 days

Neurosyphilis

  • Benzylpenicillin 4 million IU IV every 4 hours or
  • Ceftriaxone 2 g IV or IM daily for 10-14 days Followed by
  • Benzathine penicillin 2.4 million IU IM weekly for 3 weeks
  • Treat partner(s), abstain from sex during treatment and 10 days after.