Syphilis

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Syphilis Clinical Aspects
of Late 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 clinical manifestations of
late syphilis.
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Objectives

• To review the clinical manifestations of late
  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 late syphilis
  cardiovascular, neurosyphilis, and gummas

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Natural History of Untreated Syphilis
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Syphlitic Aortic Aneurysm
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Aortic Aneurysm
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Syphilitic Aortitis
Tree-barking
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Ruptured Aortic Aneurysm
Tree-barking
Clot
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Stenosis of Coronary Arteries
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Neurosyphilis

• Asymptomatic
• no clinical manifestations
• defined by presence of CNS abnormalities
  including
• WBC gt 5/mm3, mostly lymphocytes
• elevated protein
• reactive CSF-VDRL (variable)
• may progress to overt neurosyphilis

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Neurosyphilis

• Meningeal neurosyphilis
• includes acute syphilitic meningitis
• headache, fever, CSF abnormalities
• Meningovascular neurosyphilis
• syphilitic stroke
• hemiparesis, hemiplegia, aphasia, seizure
• Parenchymatous neurosyphilis
• general paresis
• tabes dorsalis

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Parenchymatous neurosyphilis

• General paresis (dementia paralytica)
• T. pallidum directly invades cerebrum
• memory loss, personality changes, headache,
  delusions, seizure
• neurologic findings include
• Argyll Robertson pupils
• slurred speech
• expressionless face
• tremors

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Parenchymatous neurosyphilis

• Tabes dorsalis
• occurs after long latent period
  (20-25 yrs.)
• early features lightning pains, paresthesias,
  diminished DTRs, poor pupillary responses
• late features ataxia, bladder and rectal
  disturbances, Charcot joints, visceral crises
• cranial nerve involvement often overlooked
• tabetic facies due to ptosis and flabbiness of
  facial muscles

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Charcot Joint
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Gumma of Face
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Gummas of the Nose
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Gumma - Nose
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Gummas - Scalp
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Gmmas of Arm
u
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Gummas - Arm
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Ulcerating Gumma
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Conclusions

• Late complications of syphilis occurred in about
  1/3 of patients in the preantibiotic era
• Prompt penicillin therapy of early disease not
  only prevents infection in others, but also
  prevents late complications
• Neurosyphilis may present and progress rapidly in
  patients co-infected with HIV

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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