Syphilis Summary

Pathogen

  • Treponema pallidum
  • Spirochete bacterium
  • Incubation: 9-90 days
  • Mean: 21 days

Stages

  • Primary: Chancre
  • Secondary: Rash, systemic
  • Latent: Asymptomatic
  • Tertiary: Severe complications

Diagnosis

  • Dark-field microscopy
  • Serological testing
  • GUM referral
  • Full STI screen

Treatment

  • Penicillin first-line
  • Duration by stage
  • GUM management
  • Partner notification

Congenital

  • Vertical transmission
  • Routine antenatal screening
  • Severe fetal complications
  • Treat during pregnancy

Neurosyphilis

  • Any stage possible
  • Meningeal involvement
  • Parenchymal damage
  • Permanent sequelae

Syphilis

An infectious disease caused by Treponema pallidum that can lead to severe cardiovascular, ocular and neurological complications if untreated

Transmission & Pathogenesis

Primary Transmission

  • Sexual transmission: Direct contact with infectious lesions
  • Sites: Genital, rectal, oral mucous membranes
  • Mechanism: Invasion through mucous membranes/abraded skin
  • Dissemination: Bloodstream and lymphatic spread
  • Incubation: 9-90 days (mean 21 days)

Other Transmission Routes

Vertical Transmission

Mother to child during pregnancy

Routine antenatal screening in UK

Needle Sharing

Injecting drug users

Blood-borne transmission

Blood Products

Rare transmission route

Mandatory screening in UK

Organ Transplant

Very rare occurrence

Comprehensive screening

Clinical Features by Stage

Early Syphilis (First 2 Years)

Primary Syphilis

  • Onset: 9-90 days post-exposure (mean 21 days)
  • Duration: 3-10 weeks (spontaneous resolution)
  • Key feature: Solitary painless, indurated ulcer (chancre)
  • Location: Site of infection (usually genital)
  • Associated: Local lymphadenopathy

Secondary Syphilis

  • Onset: 4-12 weeks after chancre
  • Duration: 3-12 weeks (may recur)
  • Systemic involvement with diverse manifestations:
  • Skin: Non-pruritic maculopapular rash
  • Mucosa: Condylomata lata, snail tract lesions
  • Hair: Patchy alopecia
  • Constitutional: Fever, headache, malaise
  • Lymphatic: Generalised lymphadenopathy
  • Early neurosyphilis signs may be present

Early Latent Syphilis

  • Confirmed infection without current symptoms
  • Within first 2 years of infection
  • Diagnosed by serological testing
  • Can progress to secondary stage

Late Syphilis (After 2 Years)

Late Latent Syphilis

  • Asymptomatic infection
  • More than 2 years duration
  • Diagnosed serologically
  • Lower transmission risk

Tertiary Syphilis

  • Onset: 15-40 years post-infection
  • Rare in modern era
  • Manifestations:
  • Cardiovascular disease
  • Neurosyphilis
  • Gummatous lesions

Clinical Features Detail

Primary Stage Features

  • Chancre: Painless, indurated ulcer
  • Location: Genital, anal, oral
  • Base: Clean, non-purulent
  • Edges: Raised, firm
  • Lymph nodes: Firm, non-tender, mobile
  • Highly infectious stage

Secondary Stage Features

  • Rash: Copper-colored, widespread
  • Palms/soles: Characteristic involvement
  • Mucous patches: Oral/genital lesions
  • Condylomata lata: Moist, wart-like
  • Alopecia: "Moth-eaten" appearance
  • Systemic: Fever, weight loss

Latent Stage Features

  • No symptoms
  • Early latent: <2 years duration
  • Late latent: >2 years duration
  • Diagnosis by serology only
  • Early latent more infectious
  • Can progress to tertiary

Management

Referral Protocol

  • Refer all suspected cases to GUM specialist
  • Laboratory investigations: Dark-field microscopy, serology
  • Full sexual health screen including HIV testing
  • Advise abstinence from sexual contact until:
  • Diagnosis excluded OR
  • Successful treatment confirmed
  • Avoid exposure of others to active lesions

Treatment Principles

Antibiotic Therapy

  • First-line: Penicillin-based regimens
  • Duration: Varies by disease stage
  • Alternatives: For penicillin allergy
  • Follow-up: Serial serological testing
  • Test of cure: Essential for monitoring

Public Health Measures

  • Partner notification: Essential
  • Contact tracing: Recent sexual partners
  • Health promotion: Safe sex education
  • STI screening: Comprehensive testing
  • Documentation: Detailed records

Complications

Prognosis: Syphilis can be cured with appropriate antibiotics before complications develop. Untreated, approximately one-third of cases progress to late stages with severe, sometimes irreversible complications.

Major Complications

Neurosyphilis

Can occur at any stage, affecting multiple neurological structures

  • Early neurosyphilis:
    • Meningitis
    • Cranial nerve defects
    • Cerebral infarction
    • Hearing loss
    • Ocular abnormalities
  • Late neurosyphilis:
    • General paresis
    • Tabes dorsalis
    • Progressive dementia
    • Spinal cord degeneration

Cardiovascular Syphilis

Chronic infection leading to vascular complications

  • Aortic aneurysm
  • Aortic regurgitation
  • Coronary ostial stenosis
  • Heart failure
  • Angina

Gummatous Syphilis

Granulomatous lesions with necrotic centers

  • Common sites:
    • Skin
    • Bones
    • Liver
    • Testes
  • Destructive lesions
  • Can affect any organ

Special Population Complications

Pregnancy & Congenital

  • Vertical transmission: High risk
  • Fetal complications: Hydrops, prematurity
  • Neonatal: Congenital syphilis
  • Pregnancy loss: Miscarriage, stillbirth
  • Routine screening: Essential in antenatal care

HIV Co-infection

  • Increased transmission: Both directions
  • Atypical presentation: More severe
  • Diagnostic challenges: Serological
  • Treatment response: May be altered
  • Accelerated progression to complications

Psychosocial Impact

  • Stigma and shame associated with STI diagnosis
  • Loss of self-worth and confidence
  • Relationship disruption and breakdown
  • Risk of domestic violence
  • Psychological distress requiring support

Prevention & Screening

Primary Prevention

  • Consistent condom use
  • Regular STI testing
  • Partner communication
  • Sexual health education
  • Needle exchange programs

Screening Programs

  • Antenatal: Universal in UK
  • High-risk groups: MSM, multiple partners
  • STI clinics: Routine testing
  • Blood donors: Mandatory screening
  • Pre-operative: Selected cases

Public Health

  • Contact tracing
  • Partner notification
  • Outbreak management
  • Surveillance systems
  • Health promotion