Syphilis Clinical Aspects of Primary Syphilis

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Syphilis Clinical Aspects of Primary
Syphilis

• Thad Zajdowicz, MD, MPH
• Medical Director, STD/HIV Program
• Chicago Dept of Public Health

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Why a lecture on syphilis? Although
syphilis is an eminently treatable disease, its
continuing occurrence illustrates that our
control efforts still need to be improved. The
disease remains elusive clinically even today,
and unless thought of and sought for can silently
cause disease as it has for centuries. Further,
control of syphilis is vital because of its
interactions with HIV. This lecture will focus
on primary syphilis.
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Objectives

• To review the pathogenesis of primary syphilis
• To demonstrate the clinical features of primary
  syphilis
• To illustrate clinical variants of primary
  syphilis

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Clinical Stages

• Syphilis is conventionally divided into several
  stages
• Primary
• Secondary
• Latent
• Late, or tertiary
• This lecture will focus on primary syphilis

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Treponema pallidum
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Pathogenesis

• Infectious dose unknown in humans
• In rabbits, experimental infection induced with
  as few as 4 spirochetes
• Estimated average inoculum 500-1000 in humans
• Inoculation may occur at any body site
• Eternal genitalia most frequent
• Mouth, anus, cervix quite common
• Other sites also well described

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Pathogenesis

• T. pallidum divides every 30-33 hrs
• Incubation period
• Primary syphilis median 21 days, range 3-90
  days
• The most prominent histopathological findings are
  arteritis and periarteritis in affected tissues

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Primary syphilis - chancre
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Chancre characteristics

• Indolent, punched out appearance
• Indurated
• Painless
• Raised border
• Red, smooth base
• Scant serous secretions

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Chancre characteristics

• Chancre usually solitary, but multiple lesions
  can occur
• May occur at any site in the genital tract
• coronal sulcus, glans, frenum, prepuce, shaft of
  penis, anorectal area, fourchette, vulva, cervix
• May occur in the oropharyngeal area
• lip, tongue, tonsil
• And may occur wherever treponemes are inoculated

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Penile Chancre
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Penile Chancre
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Penile Chancre
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Rolled Edges
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Crusted Chancre
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Chancres 18th Century
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Multiple Chancres
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Primary Chancre - Labial
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Kissing Chancres
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Kissing Chancres
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Perianal Chancre
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Chancre of the Tongue
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Oral Chancre - Lip
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Chancre of Hard Palate
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Chancre of the Lip
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Facial Chancre
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Facial Chancre
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Digital Chancre
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Conclusions

• The typical primary syphilitic chancre is
  solitary, indurated, and painless, but many
  clinical variants occur
• Most chancres are genital, oral, or perianal, but
  may occur anywhere T. pallidum is inoculated
• The primary histopathology seen in syphilis is
  arteritis and periarteritis

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Sources of Information
The following sites are useful if more
information on syphilis is sought www.cdc.gov C
enters for Disease Control www.who.int World
Health Organization www.ashastd.org American
Social Hygiene Assoc www.vnh.org Virtual Naval
Hospital