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Sexually Transmitted Infections

(STIs)

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Objective

To define syphilis

To describe the different stages of syphilis and their


morphologic features.

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Syphilis: Definition

Chronic systemic infection caused by Treponema


pallidum subspecies pallidum, is usually sexually
transmitted & is characterized by episodes of active
disease interrupted by periods of latency.

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Different stages of syphilis
1). Primary stage:

first stage of syphilis that occurs after 2-6 weeks of


exposure.
Characterized by chancre and regional
lymphadenopathy.
Chancre heals after 10-40 days even without treatment
leaving thin scar.

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Morphology : Primary syphilis

Gross:
Usually solitary, firm, painless,
superficially ulcerated lesion
(Hunterian chancre)
Covered with thick, glairy
exudate.
Swollen, rubbery &
nontenderous inguinal lymph
nodes.

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Microscopy:
Perivascular infiltration of
plasma cells, lymphocytes &
macrophages.
Capillary endothelium
proliferation & obliteration
of small blood vessels.

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2) Secondary Stage:
Appears 1-3 months after primary lesion heals, in
75% of untreated cases.
Secondary lesions are widely spread in skin and
mucocutaneous tissues.
Usually heal spontaneously.

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Morphology: secondary syphilis
Gross:
Roseolar or papular skin rashes.
Mucous patches
Condylomata lata at
mucocutaneous junction.

Microscopy:
Almost same features as chancre,
with less intense inflammation

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3). Latent Stage:
Infection dormant for variable period (2 years)

No any clinical manifestations

Seropositive

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4). Tertiary Stage:

Usually develops >5 years after the infection, in one-


third of cases.

3 main manifestations:
- neurosyphilis: meningovascular syphilis, paresis &
tabes dorsalis)
- cardiovascular syphilis: aortitis, aortic aneurysm &
aortic valve insuffiency.
- benign tertiary syphilis: presence of gumma

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Gummas: white-gray
granulomatous lesions with
central necrosis.
Present in any organ
(mostly in skin, bones &
liver)
Spirochetes are very few or
may be absent.

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THANK YOU
Any questions, queries and
suggestions are highly welcomed.

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