Syphilis

Group 2:
 Concepcion, Abigail
 Cruz, Jhen Ruselle
 De Guzman, Marvinne Gabrielleen
 Elinzano, Diana Mae
 Enriquez, Sheina
 Tan, Catherine

Spirochaetales (order)
 Leptospiraceae (family)
o Leptospira (genus)
 Spirochaetaceae (family)
o Treponema (genus)
o Borrelia (genus)

Spirochetes
 Slender, flexuous, helically shaped, unicellular bacteria ranging from 0.1 to 0.5 μm wide and from
5 to 20 μm long, with one or more complete turns in the helix.
 They differ from other bacteria in that they have a flexible cell wall around which several fibrils
are wound.
o Periplasmic flagella, (also known as axial fibrils, axial filaments, endoflagella, and
periplasmic fibrils), are responsible for motility
 Highly Motile
 Corks screw- shaped bacteria

Treponema
 Thin, spiral organisms about 0.1 to 0.2 μm in thickness and 6 to 20 μm in length.
 The spirals are regular and angular, with 4 to 14 spirals per organism.
 They are highly and tightly coiled
 The organism is encased in a sheath that tends to hide its surface antigens from the host
immune’s system.
 The sheath is covered at the end of the microorganism.
 Three periplasmic flagella are inserted into each end of the cell.
 Corkscrew motility
 Gram negative
 Aerobic, microaerophilic or anaerobic
 Can be free living or parasitic
 They have a relatively slow generation time of 30-33 hours
 All are intrinsically susceptible to Penicillin
 The genus Treponema comprises four microorganisms that are pathogenic for humans
o T. pallidum subsp. pallidum, the causative agent of syphilis;
o T. pallidum subsp. pertenue, the causative agent of yaws;
o T. pallidum subsp. endemicum, the causative agent of endemic syphilis
o Treponema carateum, the causative agent of pinta.

Types of Syphilis
 Venereal Syphilis, sexually transmitted
 Non-venereal Syphilis (a.k.a Endemic), not sexually transmitted

Non-Venereal Syphilis
Yaws
 An infectious, relapsing non venereal skin disease cause by T. pallidum ssp. pertenue
  Highly endemic in the humid rural tropical areas with heavy rainfalls such as Africa and South
Africa
 Typically affects the poorest of the world and predominantly infects children
 75% of new cases occur in individuals less than 15 years of age

Pinta
 Caused by infection with T. carateum.
 Considered the most benign of the treponemal disease
 Most infections are acquired by young adults in Central and South America
 Inoculation is thought to occur via nonvenereal skin or mucous membrane contact.
 The skin appears to be the only organ affected in this disease

Endemic Syphilis
 a.k.a Bejel
 Caused by a nonvenereal skin infection with T. pallidum ssp. endemicum.
 Typically found in dry, hot climatic zones such as the Middle East and Sahara Desert.
 The main reservoir of infected individuals is children from 2 to 15 years of age.
 Not sexually transmitted, but rather through direct contact with infectious lesions on the skin or
mouth.

Venereal Syphilis
Syphilis
 Caused by a thin, tightly coiled spirochete, Treponema pallidum ssp. pallidum
 It has the ability to cross intact mucous membranes and the placenta, disseminate throughout
the body, and infect almost any organ system.
 Humans are the only known reservoir
 Transmission occurs by direct contact with active lesions, largely through sexual contact.
 Vertical transmission across the placenta is the second most common mode of infection
 Infection may also rarely be transmitted by nonsexual contact with an active lesion

Mode of Transmission
 Can spread primarily by sexual activity, including oral or anal sex.
o Occasionally, the disease can be passed to another person through prolonged kissing or close
bodily contact.
o The infected person is often unaware of the disease and unknowingly passes it on to his or
her sexual partner.

Clinical Manifestations
 Stages:
o Primary stage
 Painless sores appear at the site of infection. These are called chancres.
 The lesion, known as a chancre, is typically a single Erythematous lesion that is non-
tender but firm, with a clean surface and raised border.
 Develop between an average of 3 weeks after exposure
 After inoculation, the spirochetes multiply rapidly and disseminate to local lymph nodes
and other organs via the bloodstream.
 The primary lesion develops 10 to 90 days after infection and is a result of an
inflammatory response to the infection at the site of the inoculation.

o Secondary stage
 2 to12 weeks after development of the primary lesion.
 The spirochete disseminates via the lymphatic to the blood stream and other parts of the
body
 Involves the entire trunk of the body and the extremities including the palms of the
hands and soles of the feet
  Systemic symptoms of fever, weight loss and malaise, arthritis and neurologic
complications

o Latent infection
 During this phase, the syphilis bacteria are still alive in your body, but you have no signs
or symptoms of the infection.
 Early Latent and Late Latent
 Vertical transmission can occur to mother to infant
 Bacteria starts to damage the internal organs; brain, heart, sexual organs. Damage can go
unnoticed until the next stage
 Vertical transmission can occur to mother to infant resulting in congenital syphilis

o Tertiary or Late syphilis

 Develops 1 or more years after the initial infection
 Can manifest in almost any organ system
 The lesions typically involve the cardiovascular, CNS and musculoskeletal systems
 Gummas or large granulomas with extensive necrosis can develop in the bones, CNS,
spleen, and on the skin

Neurosyphilis
 Syphilis spread to the brains and nervous system
 Sign and symptoms of neurosyphilis include:
o Severe headache
o Difficulty coordinating muscle movements
o Paralysis
o Numbness; and
o Dementia (mental disorder)
Ocular Syphilis
 Syphilis spread in the eyes
 Symptoms of ocular syphilis:
o Changes in your vision and even blindness.

Diagnosis
1. Non – Treponemal Test
 Screening test
 Venereal Disease Research Laboratory (VDRL)
o Aggultination requires the use of microscope to visualize the agglutination.
 Rapid Plasma Reagin (RPR)
o More practical to be use in early stage of syphilis because the antibody against
treponema can be detected in blood.
o Rapid test because it uses charcoal to form a visible agglutination with our naked eye if
a sample is positive for treponema.
 Low specificity
Note:
 Neurosyphilis can be diagnose can detect using a CSF as a sample instead of a blood.
 RPR can only be used in blood sample thus it is not suitable to be used if the sample is CSF but
VDRL can be use even if the sample is CSF

2. Treponemal
 Confirmatory test
 Darkfield Microscopy
o May be used in the early stage of syphilis when a suspected syphilis sore or chancre is
present
 Fluorescent Treponemal Antibody absorption (FTA-ABS)
o Useful after the 3-4 weeks following the exposure
 o In addition to blood testing, it can be used to measure antibodies to T. pallidum in the
CSF to help diagnose neurosyphilis.
 Treponema pallidum Hemagglutination Assay (TPHA)
o Preferred than FTA-ABS because it is more specific
 False positive result can occur in the patients w/ SLE or Lyme disease, another spirochete
disease that caused by B. burgdorferi
 High specificity

Note:
Treponema cannot be cultivated in culture media
 The inability to grow of most pathogenic Treponema in in vitro, coupled with the transitory
nature of many of the lesions, makes diagnosis of Treponema infection impossible by routine
bacteriological methods

Treatment
 Antibiotics effectively treat syphilis during any stage.
 Antibiotic treatment cannot reverse the damage caused by complications of late-stage syphilis,
but it can prevent further complications.
 Follow-up blood tests, to make sure that treatment have been effective.
 Penicillin is the preferred drug for treating syphilis.
o Doxycycline
o Tetracycline
o Ceftriaxone
o Azithromyacin

Prevention
 Safe sex or Decrease direct contact when having sex
 Avoid having sex with multiple partners
 Use a dental dam (a square piece of latex) or condoms during oral sex
 Avoid sharing sex toys
 Get screened for sexually transmitted infections and talk to your partners about their results
 Syphilis can also be transmitted through shared needles. Avoid sharing needles if you’re going to
use drugs.

Additional Information (Facts & Updates)

 Immunity
o Can syphilis be cured? Yes
o Can I get syphilis again? Yes
 Although infection with T. pallidum results in the production of antibodies and a
cellular response, it is not sufficient to eradicate the organism and does not provide
long lasting immunity.
 Girolamo Fracastoro, who first used the term “syphilis” in 1530 in a Latin poem.
 Paul Ehrlich, discovered arsphenamine (Salvarsan), the first effective medicinal treatment
for syphilis
 The World Health Organization declared Cuba, the first country in the world to eliminate the
transmission HIV and Syphilis from mother to child.
 HIV-Syphilis linking
o Having a sore or break in the skin from an STD such as syphilis may allow HIV (Human
Immunodeficiency Virus) to more easily enter your body.
o You may also be more likely to get HIV because the same behaviors and circumstances
that put you at risk for getting other STDs can also put you at greater risk for getting HIV.