Syphilis_Expanded_Consultant_Presentation (1).pptx

SYPHILIS SIGNS + SYMPTOMS

1. Syphilis Comprehensive Consultant-Level Overview Mode of Transmission, Pathophysiology, Diagnosis & Management

2. Etiology • Caused by Treponema pallidum • Spirochete bacterium • Humans are the only reservoir

3. Transmission • Sexual contact (most common) • Vertical transmission (Transplacental) • Blood transfusion (rare now) • Direct contact with infectious lesions • Not spread by toilet seats, clothing, utensils

4. Stages of Syphilis • Primary Syphilis • Secondary Syphilis • Latent Syphilis (Early & Late) • Tertiary Syphilis • Neurosyphilis (can occur at any stage) • Congenital Syphilis

5. Primary Syphilis • Painless chancre at site of entry • Non-tender regional lymphadenopathy • Chancre heals spontaneously in 3-6 weeks

6. Secondary Syphilis • Generalized maculopapular rash including palms & soles • Condyloma lata • Mucous patches • Fever, malaise, lymphadenopathy • Patchy alopecia

7. Latent Syphilis • Asymptomatic stage • Early <1 year, Late >1 year • Positive serology only • Still transmissible in early latent

8. Tertiary Syphilis • Gummas (granulomatous lesions) • Cardiovascular syphilis (aortitis, aneurysm) • Tabes dorsalis • General paresis

9. Neurosyphilis • Early: Meningitis, cranial nerve palsies • Late: Tabes dorsalis, dementia • Positive CSF-VDRL

10. Congenital Syphilis • Stillbirth or neonatal death • Snuffles (profuse nasal discharge) • Hutchinson teeth, saddle nose, frontal bossing

11. Pathophysiology • Treponema pallidum enters via mucous membrane • Spreads via lymphatics & blood • Obliterative endarteritis → tissue ischemia • Immune response causes tissue damage

12. Biochemical Notes • Spirochete not culturable on routine media • Dark-field microscopy from chancre • Serology detects antibodies • CSF protein ↑, lymphocytes ↑ in neurosyphilis

13. Diagnosis Screening: VDRL, RPR Confirmatory: FTA-ABS, TP-PA Direct: Dark-field microscopy, PCR Neurosyphilis: CSF VDRL

14. Treatment First-line: Benzathine Penicillin G • Primary/Secondary: 2.4 million units IM single dose • Early latent: Single dose • Late latent/Tertiary: 2.4 MU weekly x3 weeks Neurosyphilis: IV Penicillin G 10-14 days Penicillin allergy: Doxycycline (except pregnancy)

15. Jarisch–Herxheimer Reaction • Acute febrile reaction within 24 hours of therapy • Caused by endotoxin-like release • Treatment: Antipyretics, supportive care

16. Complications • Cardiovascular: Aortic aneurysm, aortic regurgitation • CNS: Stroke, dementia, tabes dorsalis • Ocular: Uveitis, optic neuritis

17. Consultant Pearls • Always screen pregnant women • HIV co-testing mandatory • Treat partners • Follow serology titers at 3, 6, and 12 months

18. Public Health & Prevention • Safe sex practices, condoms • Screening high-risk groups • Prenatal screening • Partner notification & treatment

19. Treatment Guidelines (CDC/WHO Style) Primary & Secondary Syphilis: • Benzathine Penicillin G 2.4 MU IM once Early Latent: • Benzathine Penicillin G 2.4 MU IM once Late Latent/Tertiary: • Benzathine Penicillin G 2.4 MU weekly x3 Neurosyphilis: • Aqueous Penicillin G IV 10-14 days Pregnancy: • Penicillin only (desensitize if allergic)

20. Syphilis Diagnosis Flowchart Clinical suspicion Chancre / Rash / Neuro signs Screening Tests VDRL / RPR Confirmatory Tests FTA‑ABS / TP‑PA Stage assessment & CSF testing if neuro signs

21. OSCE / Viva Points • Describe painless chancre • Rash including palms/soles • Ask sexual & antenatal history • Always check HIV status • Management: Penicillin regimen • Partner notification • Follow-up titers schedule

22. Congenital Syphilis Key Points Early: • Snuffles • Maculopapular rash • Hepatosplenomegaly Late: • Hutchinson teeth • Saddle nose • Deafness • Clutton joints

23. Clinical Images (Reference) (Add images clinically or dark-field image) • Chancre • Rash palms & soles • Condyloma lata • Snuffles in neonate • Aortic aneurysm radiograph